Abstract:Objective To analyze the relationships of metal artifact on plain CT scan and parameters of CT perfusion with collateral circulation in elderly patients with acute ischemic stroke(AIS)in late-time window and their prognostic value.Methods A total of 120 elderly AIS patients admitted to our department from January 2022 to November 2024 were retrospectively enrolled,and according to the score of modified Rankin scale(mRS)at 6 months of follow-up,they were divided into a good prognosis group(mRS score:0-2,n=42)and a poor prognosis group(mRS score:3-6,n=78).All patients underwent CT plaining scanning and CT perfusion imaging.Pearson correlation analysis was used to analyze the correlation of metal artifact on CT plain scan and CT perfusion parameters with collateral circulation as well as prognosis.Logistic regression analysis was adopted to screen the related factors affecting the prognosis,and then a prognostic prediction model was constructed based on the obtained factors.ROC curve analysis was applied to evaluate the predictive value of metal artifact and CT perfusion parameters for the prognosis of the elderly AIS patients.Results There was a statistical difference in the grade distribution of collateral circulation between the elderly AIS patients with positive and negative metal artifact on CT plain scan(P<0.01).Pearson correlation analysis showed that the metal artifact on CT scan was negatively correlated with the grade of collateral circulation(r=-0.456,P<0.05),and positively correlated with the mRS scores at 3 and 6 months of follow-up(r=0.356,r=0.421,P<0.05);the cerebral blood flow(CBF)and cerebral blood volume(CBV)were positively correlated with the grade of collateral circulation,and negatively correlated with the mRS score at 3 and 6 months of follow-up(P<0.05);the mean transit time(MTT)and time to peak(TTP)were negatively correlated with collateral circulation grade(P<0.05),and positively correlated with mRS scores at 3 and 6 months of follow-up(P<0.05).Multivariate logistic regression analysis revealed that metal artifact on CT plain scan,CBF,CBV,MTT and TTP were independent influencing factors for poor prognosis in the elderly AIS patients(P<0.05,P<0.01).ROC curve analysis suggested that the AUC value of the combined detection of metal artifact on CT plain scan and CT perfusion parameters was 0.894,which was significantly higher than that of metal artifact,CBV,CBF,MTT,TTP and other single indicator(P<0.01).Conclusion The metal artifact on CT plain scan and CT perfusion parameters are related to the collateral circulation in elderly AIS patients in late-time window,and the combined detection of these indicators can more accurately predict the prognosis.

Abstract:Objective To analyze the longitudinal change in the ratio of N-terminal pro-brain natriuretic peptide(NT-proBNP)to brain natriuretic peptide(BNP)in patients with acute heart failure and its correlation with the risk of cardiovascular events.Methods A total of 210 patients with acute heart failure were consecutively enrolled in Department of Geriatrics of the Fifth Affiliated Hospital of Xinjiang Medical University from May 2022 to May 2024.According to the occurrence of adverse cardiovascular events during a follow-up of 6 months,they were divided into a good prognosis group(179 patients)and a poor prognosis group(31 patients).The serum NT-proBNP and BNP levels were measured in all the patients.Taking the median ratio(1.01)of NT-proBNP/BNP ratio at 5 d to it at 30 min after admission as cutoff value,the patients were divided into high ratio group and low ratio group.Multivariate logistic regression model was used to analyze the correlation between the ratio and poor prognosis.Kaplan-Meier curve was plotted to analyze the risk incidence,and multivariate Cox regression model was employed to evaluate the prognostic value.Results The poor prognosis group exhibited significantly higher NT-proBNP/BNP ratios within 30 min of admission,at 5 d after admission,and at discharge when compared with the good prognosis group(P<0.01).Multivariate logistic regression analysis showed that the ratios at abovementioned three time points were risk factors for adverse cardiovascular events in patients with acute heart failure(P<0.01).The incidence rate of adverse cardiovascular events was 20.95%(22 cases)and 8.57%(9 cases)in the high ratio group and the low ratio group,respectively,with that of the former group statistically higher than that of the latter group(P<0.01).Cox regression analysis revealed that a high NT-proBNP/BNP ratio was independently associated with an increased risk of poor prognosis in patients with acute heart failure(HR=2.762,95%CI:1.258-6.065,P<0.05).Conclusion For patients with acute heart failure,persistent high NT-proBNP/BNP ratio during hospitalization is related to the risk of adverse cardiovascular events,and the high ratio at 5 d after admission is of great significance for evaluating poor prognosis.

Abstract:Objective To explore the safety and long-term efficacy of pacing-induced cardiomyopathy(PICM)patients with left bundle branch area pacing(LBBAP).Methods A retrospective study was conducted on 13 PICM patients undergoing routine pacemaker upgrade to cardiac resynchronization therapy(CRT)in Department of Cardiovascular Medicine of Northern Jiangsu People's Hospital from January 2018 to January 2024.According to different CRT procedures,the patients were divided into LBBAP group(n=5)and biventricular pacing group(BiVP,n=8).All of them were followed up for at least 1 year in outpatient clinic.The changes in QRS duration(QRSd),left atrial dimension(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),N-terminal pro-B-type natriuretic peptide(NT-proBNP),New York Heart Association(NYHA)cardiac function class,and pacing threshold were compared before and in 12 month after surgery and between the two groups.The CRT response rate,and incidences of postoperative complications and adverse events during follow-up were recorded.Results Compared with the levels before the upgrade,both group obtained significantly reduced QRSd,LAD,LVEDD and LVESD and NT-proBNP level,and improved LVEF and NYHA cardiac function class in 12 months after the upgrade(P<0.05,P<0.01).But there were no statistical differences in QRSd,LAD,LVEDD,LVESD,LVEF,NT-proBNP,and NYHA cardiac function class between the LBBAP group and the BiVP group(P>0.05).In 12 months after surgery,the CRT response rate was 80%(4/5)in the LBBAP group and 62.5%(5/8)in the BiVP group,but no significant difference was found between them(P>0.05).Conclusion LBBAP upgrading therapy results in stable long-term thresholds in PICM patients,and achieves good electro-mechanical synchronization.It shows no significant differences from BiVP in improving cardiac function and clinical efficacy,which can be used as an alternative choice for these patients.

Abstract:Objective To explore the correlation of IL-18 and IL-34 with occurrence of vascular cognitive impairment(VCI)in elderly patients with acute anterior circulation cerebral infarction.Methods A total of 140 elderly eligible patients admitted to our department from March 2022 to June 2024 were recruited.According to the results of mini-mental state examination(MMSE)combined with diagnosis and treatment guidelines for VCI status after 6 months of follow-up,the patients were classified into a cognitive impairment(CI)group(95 cases)and non-CI group(45 cases).The levels of IL-18 and IL-34 were compared between both groups.ROC curve was plotted to determine the predictive efficiency of IL-18 and IL-34 for VCI in elderly patients with acute anterior circulation cerebral infarction,and the areas under the curve(AUC)were calculated.Results The CI group exhibited significantly advanced age,higher fasting blood glucose,SBP and DBP,national institutes of health stroke scale(NIHSS)score,IL-18 and IL-34 levels,but lower MMSE score when compared with the non-CI group(P<0.01).Fasting blood glucose,SBP,NIHSS score,IL-18 and IL-34 were the influencing factors for VCI(P<0.05,P<0.01).Pearson correlation analysis revealed that IL-18 and IL-34 levels were negatively correlated with MMSE score in the elderly patients(r=-0.242,P=0.004;r=-0.355,P=0.001).The AUC values of IL-18,IL-34 and their combination in predicting VCI in elderly patients were 0.699,0.747 and 0.777,respectively.Conclusion The IL-18 and IL-34 levels are associated with VCI occurrence in elderly patients with acute anterior circulation cerebral infarction.Early detection of IL-18 and IL-34 is helpful to predict the occurrence of VCI.

Abstract:Objective To evaluate the predictive value of neutrophil-to-lymphocyte ratio(NLR)for major adverse cardiovascular events(MACE)in elderly patients with hypertension and obstructive sleep apnea(OSA).Methods A retrospective analysis was conducted on 881 patients with hypertension and OSA treated at First Medical Center of Chinese PLA General Hospital from January 2017 to August 2022.The patients were divided into a young and middle-aged group(621 cases)and an elderly group(260 cases).The young and middle-aged group was further subdivided into MACE1 group(55 cases)and control group 1(566 cases),while the elderly group was divided into MACE2 group(28 cases)and control group 2(232 cases).Clinical data were collected,and all of them were followed up for a median period of 50 months.Results Compared with the young and middle-aged group,the elderly group had significantly higher NLR level[2.08(1.51,2.77)vs 1.83(1.45,2.34),P<0.01].The MACE1 group showed significantly higher apnea hypopnea index(AHI)and NLR levels than the control group 1(P<0.05,P<0.01),and the MACE2 group exhibited same trends than the control group 2(P<0.01).NLR was an independent predictor of MACE in elderly patients with hypertension and OSA(HR=1.46,95%CI:1.18-1.79,P<0.01).ROC curve analysis revealed that the AUC value of NLR in predicting MACE in elderly patients with hypertension and OSA was 0.766,with an optimal cut-off value of 2.34.Kaplan-Meier curve analysis demonstrated that the patients with higher NLR level had poorer prognosis compared with those with lower level(Plog rank<0.01).However,ROC curve analysis indicated that the AUC value of NLR in MACE prediction for the young and middle-aged patients was 0.671,and the optimal cut-off value was 2.04.Conclusion NLR can be used as an independent predictor of MACE in elderly patients with hypertension and OSA,demonstrating good predictive performance.But its predictive value is limited for young and middle-aged patients.

Abstract:Objective To investigate the effects of aerobic exercise(AE)combined with safflower yellow(SY)on cardiovascular remodeling,ion channels in cardiomyocytes,and the transforming growth factor β(TGF-β)/Smad signaling pathway in hypertensive rats.Methods Eight normotensive rats were selected as the control group.Thirty-two spontaneously hypertensive rats(SHRs)were randomly divided into a hypertensive group,an AE group(AE training),a safflower yellow group(gavage administration of 50 mg/kg SY),and combined intervention group(aerobic exercise training+SY),with 8 rats in each group.A non-invasive rat tail artery blood pressure monitor was used to measure systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP).The total heart weight and left ventricular weight were measured to calculate heart weight index(HWI)and left ventricular weight index(LVWI).Patch-clamp technique was employed to detect the density of L-type calcium channel current(ICa-L)and transient outward potassium current(Ito).HE staining and Masson staining were performed to observe the pathological changes in myocardial tissue.Western blot analysis was applied to detect the expression of key proteins in the TGF-β/Smad signaling pathway.Results Compared with the control group,the SBP,DBP,MAP,HWI,LVWI,amplitude of ICa-L density,and expression levels of TGF-β1,p-Smad2,and p-Smad3 were significantly increased,while the Ito expression was significantly decreased in the hypertensive group,AE group,SY group,and combined intervention group;the Smad7 expression was obviously decreased in the other three groups except the combined intervention group(P<0.05).The AE group,SY group,and combined intervention group exhibited significantly reduced SBP,DBP and MAP,HWI,LVWI,amplitude of ICa-L density,and expression of TGF-β1,p-Smad2,and p-Smad3,whereas elevated Ito density and Smad7 expression when compared with the hypertensive group(P<0.05).Combined intervention of AE and SY resulted in more significant decreases in SBP[135.82±5.47 mm Hg(1 mm Hg=0.133 kPa)vs 152.45±6.23 mm Hg and 148.72±5.89 mm Hg,P<0.05],DBP(88.45±3.78 mm Hg vs 98.34±4.56 mm Hg and 96.67±4.32 mm Hg,P<0.05)and MAP(104.91±4.63 mm Hg vs 116.71±5.42 mm Hg and 114.36±5.18 mm Hg,P<0.05),HWI,LVWI,amplitude of ICa-L density,and the expression levels of TGF-β1,p-Smad2,and p-Smad3,as well as more remarkable increases in Ito density and Smad7 expression in comparison with the AE group and the SY group(P<0.05).Conclusion Combination of AE and SY can reduce blood pressure,alleviate cardiac remodeling,regulate the function of myocardial cell ion channels,and inhibit the overactivation of the TGF-β/Smad signaling pathway.

Abstract:Objective To explore the effect of microRNA-6321(miR-6321)on myocardial ischemia-reperfusion injury(MIRI)in rats and further analyze the relationship between its mechanism of action and the methylation of N6-methyladenosine.Methods Twelve male Sprague-Dawley(SD)rats were randomly selected from 36 rats and divided into a pre-experimental sham operation group and a pre-experimental model group,with 6 rats in each group,to verify the MIRI model.In the pre-experimental sham operation group,the thread was inserted below the left anterior descending branch without ligation.In the pre-experimental model group,the ligation thread was removed in 30 min after ligation followed by reperfusion for 2 h.Subsequently,the remaining 24 rats were randomly divided into Sham operation group,model group(MIRI group),adeno-associated virus negative control group(AAV-NC group)and miR-6321 overexpression intervention group(AAV-miR-6321 group),with 6 rats in each group.The AAV-NC group and the AAV-miR-6321 group received a single injection of AAV-NC and AAV-miR-6321,respectively via the tail vein 2 weeks before modeling.The MIRI model in rats was established by ligation of the left anterior descending coronary artery.HE staining was used to observe the severity of myocardial tissue injury.Western blotting was employed to detect the expression of methyltransferase-like protein 3(METTL3),alkylation repair homolog 5(ALKBH5)and YTH domain family protein 1(YTHDF1)in myocardial tissue.Results Compared with the pre-experimental sham operation group,the expression level of ALKBH5 was significantly decreased,while those of METTL3 and YTHDF1 were obviously up-regulated in the pre-experimental model group(P<0.05).When compared with the sham operation group,the MIRI group exhibited more severe myocardial injury,decreased expression of miR-6321,elevated expression of METTL3 and YTHDF1(0.96±0.06 vs 0.52±0.08,1.04±0.04 vs 0.47±0.04,P<0.05),and reduced expression of ALKBH5(0.36±0.14 vs 0.89±0.09,P<0.05).AAV-miR-6321 injection resulted in significantly alleviated myocardial injury,enhanced expression of miR-6321,declined expression of METTL3 and YTHDF1(0.58±0.05 vs 0.96±0.06,0.55±0.04 vs 1.04±0.04,P<0.05),and increased expression of ALKBH5(0.76±0.14 vs 0.36±0.14,P<0.05)when compared with the MIRI group.Conclusion MiR-6321 can regulate N6-methyladenosine methylation modification to alleviate MIRI in rats.

Abstract:Objective To investigate the correlation between the ratio of triglycerides to high-density lipoprotein cholesterol(TG/HDL-C)and the overall burden of cerebral small vessel diseases(CSVD)on cranial magnetic resonance imaging.Methods Clinical data 98 CSVD patients admitted to our hospital from January 2019 to January 2020 were collected and retrospectively analyzed.Based on the total CSVD burden score,they were divided into a mild-to-moderate group(score:0-2,n=60)and a severe group(score:3-4,n=38).The correlation between the TG/HDL-C ratio and CSVD burden score was evaluated using binary logistic regression analysis.Results The severe group exhibited significantly advanced age,larger ratios of alcohol consumption and hypertension,higher TG/HDL-C ratio and TC level,and markedly lower HDL-C level when compared with the mild-to-moderate group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that age,hypertension,and TG/HDL-C ratio were independent risk factors for increased CSVD burden(P<0.05,P<0.01),while HDL-C was a protective factor(OR=0.013,95%CI:0.001-0.154,P<0.01).Conclusion Older age,higher TG/HDL-C ratio,and presence of hypertension indicate a heavier burden of CSVD.While,higher HDL-C level is beneficial for cerebral blood vessels.

Abstract:Objective To analyze the predictive value of combination of serum fibroblast growth factor-23(FGF-23),heart-type fatty acid-binding protein(HFABP),and serum creatinine(Scr)for the occurrence of secondary acute kidney injury(AKI)in elderly patients with acute cerebral infarction(ACI).Methods A retrospective study was conducted on 90 elderly ACI patients admitted in our hospital from January 2023 to July 2024.According to the occurrence of secondary AKI,they were divided into a secondary AKI group(14 cases)and a non-secondary group(76 cases).The clinical data and serum FGF-23,HFABP and Scr levels were compared between the two groups.ROC curve was plotted to analyze the value of serum FGF-23,HFABP and Scr combined together in predicting secondary AKI in the elderly ACI patients.Results The secondary AKI group exhibited significantly advanced age,larger ratios of transfusion history and using β-blockers,higher glycated hemoglobin A1c(HbA1c)level,and lower estimated glomerular filtration rate than the non-secondary group(P<0.05,P<0.01).Statistical differences were observed in fluid input and output between the two groups(P<0.05).The serum levels of FGF-23,HFABP,and Scr were obviously higher in the secondary group than the non-secondary group(P<0.01).The blood transfusion history,negative balance of input and output volume,HbA1c,FGF23,HFABP,and Scr were risk factors for secondary AKI in elderly ACI patients(P<0.05,P<0.01).ROC curve analysis revealed that the AUC values of serum FGF-23,HFABP and Scr were 0.826,0.795 and 0.840,respectively,which were lower than the value of combined the three indicators(0.872,P<0.05).Conclusion Serum FGF-23,HFABP and Scr levels are obviously higher in the elderly ACI patients with secondary AKI,and their combination shows effectively predictive value for secondary AKI.

Abstract:Objective To explore the relationship between the levels of serum nesfatin-1(NSF-1),chitinase protein 40(YKL-40),and lipoprotein-associated phospholipase A2(Lp-PLA2)and left ventricular remodeling as well as clinical outcomes in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 123 STEMI patients undergoing PCI in our hospital from September 2024 to January 2025 were prospectively enrolled.They were divided into a good prognosis group(78 cases,including recovery and improvement)and a poor prognosis group(45 cases,including deterioration and death)based on the clinical outcomes of 6-month follow-up.The left ventricular remodeling indicators and the levels of serum NSF-1,YKL-40,and Lp-PLA2 were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between the serum levels of above biomarkers and left ventricular remodeling indicators in STEMI patients after PCI.Multivariate logistic regression analysis was used to identify the risk factors affecting the prognosis of STEMI patients after PCI.ROC curve analysis was used to evaluate the predictive value of above serum biomarker levels for prognosis.Results The left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and serum levels of YKL-40 and Lp-PLA2 were significantly higher,while left ventricular ejection fraction(LVEF)and NSF-1 level were obviously lower in the poor prognosis group than the good prognosis group(P<0.01).Pearson correlation analysis showed that in the STEMI patients after PCI,the serum NSF-1 level was negatively correlated with LVEDV and LVESV and positively with LVEF(P<0.01);the serum YKL-40 and Lp-PLA2 levels were positively correlated with LVEDV and LVESV and negatively correlated with LVEF(P<0.01).Multivariate logistic regression analysis showed that NSF-1 was a protective factor for the prognosis of STEMI patients after PCI,while YKL-40 and Lp-PLA2 were independent risk factors(P<0.05,P<0.01).ROC curve analysis revealed that the AUC value of the combined prediction of serum NSF-1,YKL-40,and Lp-PLA2 for the prognosis of STEMI patients after PCI was significantly higher than that of single predictions(0.917 vs 0.864,0.807,0.778,P<0.01).Conclusion The serum levels of NSF-1,YKL-40 and Lp-PLA2 are related to left ventricular remodeling and clinical outcomes in STEMI patients after PCI.Their combination shows better prediction for poor prognosis.

Abstract:Objective To explore the correlation of nosocomial infection after percutaneous coronary intervention(PCI)with gene polymorphisms of serum TNF-α and IL-6 in patients with acute myocardial infarction(AMI).Methods Clinical data of 210 AMI patients undergoing PCI in our hospital from December 2021 to December 2024 were collected and retrospectively analyzed.Based on postoperative infection status,the patients were divided into an infection group(n=39)and a non-infection group(n=171).According to the severity of the infection,the infection group was further assigned into a severe subgroup(11 cases)and a mild subgroup(28 cases).The risk factors of postoperative nosocomial infection were analyzed.The polymorphisms of serum TNF-α and IL-6 genes were compared between the infection group and non-infection group,and the relationship with infection occurrence was analyzed.The evaluation value of gene polymorphisms of TNF-α and IL-6 for the severity of infection was analyzed in AMI patients after PCI.Results The infection group exhibited significantly larger proportions of surgical time≥1 h,diabetes mellitus,chronic bronchitis and invasive procedures,higher levels of TNF-α and IL-6,and smaller proportion of prophylactic use of antibiotics than the non-infection group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that surgical time≥1 h(OR=2.063,95%CI:1.301～3.269,P<0.01),diabetes mellitus(OR=1.432,95%CI:1.138～1.801,P<0.01),chronic bronchitis(OR=2.472,95%CI:1.183～5.165,P<0.05)and invasive procedures(OR=2.261,95%CI:1.043～4.905,P<0.05)were risk factors of nosocomial infection after PCI in AMI patients,and prophylactic use of antibiotics was a protective factor(OR=0.311,95%CI:0.159～0.610,P<0.01).The polymorphisms of serum TNF-α and IL-6 genes were in line with Hardy-Weinberg equilibrium in both groups(P>0.05).The detection rates of GA and AA at rs1799724 locus of TNF-α and CG and GG at rs2249825 locus of IL-6 were notably higher in the infection group than the non-infection group(P<0.05).The gene polymorphism at rs1799724 locus of TNF-α was an influencing factor of nosocomial infection in AMI patients after PCI(P<0.01).The detection rates of GA and AA at rs1799724 locus of TNF-α and CG and GG at rs2249825 locus of IL-6 were higher in the severe subgroup than the mild subgroup(P<0.05,P<0.01).The area under the ROC curve of TNF-α gene polymorphisms at rs1799724 locus in assessing severity of infection was greater than that of IL-6 gene polymorphisms at rs2249825 locus(P<0.01).Conclusion Surgical time≥1 h,diabetes mellitus,chronic bronchitis and invasive procedures are risk factors of nosocomial infection in AMI patients after PCI.The polymorphisms of TNF-α gene at rs1799724 locus are associated with nosocomial infection in the patients.

Abstract:Objective To explore the impact of IL-17/IL-23 on ventricular remodeling and prognosis in elderly coronary heart disease(CHD)patients with heart failure(HF).Methods A total of 120 elderly patients with concomitant CHD and HF undergoing PCI in Nanyang First People's Hospital from May 2021 to May 2024 were recruited and served as the study group.They were further divided into a poor prognosis group(21 cases)and a good prognosis group(99 cases)based on their survival status during the 12-month follow-up.Another 100 elderly healthy individuals who taking physical exams in the same hospital during the same period were enrolled and taken as a control group.Ventricular remodeling indicators,including left ventricular posterior wall thickness(LVPWT),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF),were measured.Pearson correlation analysis was used to determine the correlation between serum IL-17 and IL-23 levels and ventricular remodeling indicators.Logistic regression analysis was conducted to identify factors influencing the prognosis of the elderly CHD patients with HF.ROC curve analysis was performed to evaluate the predictive value of serum IL-17 and IL-23 expression for the prognosis of the elderly patients.Results Significantly higher IL-17 levels,elevated LVPWT and LVEDD values,and lower LVEF value were observed in the study group than the control group(P<0.01).Pearson correlation analysis showed that IL-17 was positively correlated with LVPWT and LVEDD values(r=0.415,r=0.380,P<0.01),and both the two indicators were negatively correlated with LVEF(r=-0.392,P<0.01).The poor prognosis group had significantly lower LVEF and higher IL-17 and IL-23 levels than the good prognosis group(P<0.01).Elevated serum IL-17 and IL-23 levels were risk factors for poor prognosis in the elderly CHD patients with HF(P<0.05).ROC curve analysis showed that the AUC value of combined IL-17 and IL-23 was significantly higher than the AUC value of the indicator alone in predicting the prognosis of the elderly patients(0.961 vs 0.813,0.887,P<0.01).Conclusion The serum expression of IL-17 and IL-23 in the IL-17/IL-23 axis is associated with ventricular remodeling and prognosis in the elderly CHD patients with HF after PCI,and the two indicators have certain predictive value for the prognosis of these patients.

Abstract:Objective To explore the relationship between short-term blood pressure variability(BPV)and 3-year all-cause mortality in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 130 elderly STEMI patients undergoing primary PCI in our department from June 2020 to June 2022 were recruited,and based on their survival status during 3 years of follow-up,they were divided into a death group(30 cases)and a survival group(100 cases).The relationship between 24-hour BPV[systolic BPV(SBPV),diastolic BPV(DBPV),daytime systolic standard deviation(dSSD),daytime diastolic standard deviation,nocturnal systolic standard deviation(nSSD),and nocturnal diastolic standard deviation(nDSD)]and all-cause mortality in elderly STEMI patients in 3 years after PCI was analyzed.Results Significantly older age,higher Gensini score,and larger proportions of Killip gradeⅢ-Ⅳ,and number of lesioned vessels≥2 were observed in the death group than the survival group(P<0.01).The death group also exhibited obviously higher SBPV,DBPV,dSSD,nSSD,and nDSD values at 24 h after PCI than the survival group(P<0.05,P<0.01).Multifactorial logistic regression analysis showed that SBPV and DBPV were risk factors for all-cause mortality in 3 years after PCI in elderly STEMI patients(OR=4.533,95%CI:1.576-13.037,P<0.01,OR=3.181,95%CI:1.164-8.694,P<0.05).ROC curve analysis showed that the AUC value of SBPV,DBPV,and their combination for predicting all-cause mortality in 3 years after direct PCI was 0.835,0.793,and 0.912.The combination of SBPV and DBPV showed higher predictive value than that of individual detection for all-cause mortality in elderly STEMI patients in 3 years after primary PCI.Conclusion Short-term BPV after primary PCI in elderly STEMI patients is associated with 3-year postoperative all-cause mortality,and SBPV and DBPV have predictive value for 3-year postoperative all-cause mortality.

Abstract:Objective To investigate the differences and correlation in carotid plaque characteristics among patients with carotid atherosclerosis across different severities of coronary atherosclerosis with high-resolution magnetic resonance imaging(HRMRI)and coronary computed tomography angiography(CCTA).Methods A retrospective analysis was conducted on the clinical and imaging data of 123 patients with carotid atherosclerosis who were admitted to Xuanwu Hospital of Capital Medical University and Shandong Provincial Hospital between January 2018 and December 2024.All patients underwent CCTA and carotid HRMRI.According to the coronary artery disease-reporting and data system(CAD-RADS)criteria based on CCTA,they were divided into a mild CAD group(CAD-RADS 1～2,n=39)and a moderate to severe CAD group(CAD-RADS 3～5,n=84).The detection rates of intraplaque hemorrhage(IPH),lipid-rich necrotic core(LRNC),thin/ruptured fibrous cap(TRFC),and plaque calcification were compared between the two groups.The correlation between carotid plaque characteristics and the severity of coronary artery atherosclerosis was also analyzed.Results Compared with the mild CAD group,the moderate to severe group had significantly higher detection rates of IPH,LRNC,TRFC,and plaque calcification than the mild disease group(P<0.05,P<0.01).Moreover,IPH(r=0.42,P<0.01),LRNC(r=0.31,P<0.01),TRFC(r=0.23,P=0.01),and plaque calcification(r=0.29,P<0.01)were correlated with CAD-RADS classification.Conclusion The characteristics of carotid plaques in patients with carotid atherosclerosis are significantly correlated with the severity of coronary artery atherosclerosis,providing an imaging basis for the risk assessment of CAD.

Abstract:Objective To explore the association between sensitivity to thyroid hormones and lipid metabolism indicators in elderly male population with diabetes.Methods A total of 230 elderly male patients with diabetes who were admitted to Chinese PLA General Hospital from January 2008 to December 2013 were enrolled.Based on the tertiles of the ratio(NHHR)of non-high-density lipoprotein cholesterol(non-HDL-C)to high-density lipoprotein cholesterol(HDL-C),they were divided into lower(NHHR≤2.17,76 cases),middle(2.18～3.17,76 cases)and upper(NHHR>3.17,78 cases)tertile groups.Blood lipid indicators and thyroid function indicators,such as free thyroxine(FT4),free triiodothyronine(FT3),and thyroid-stimulating hormone(TSH)were detected.NHHR,FT3/FT4 ratio,thyrotropin thyroxine resistance index(TT4RI),thyroid-stimulating hormone index,thyroid feedback quantile-based index by FT4(TFQIFT4),and thyroid feedback quantile-based index by FT3(TFQIFT3)were calculated.Linear regression model was used to explore the correlation of thyroid hormone sensitivity indices and blood lipid indices.Results Statistical differences were observed among the three groups in terms of hyperuricemia ratio,incidence of chronic kidney disease,TFQIFT3 and levels of non-HDL-C,HDL-C,triglycerides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)(P<0.05,P<0.01).FT3 level was positively correlated with HDL-C(β=0.162,P<0.05),and TSH was positively correlated with NHHR(β=0.123,P<0.01).After adjusting multiple factors,TFQIFT3 was positively correlated with LDL-C and non-HDL-C(β=0.268,P<0.05;β=0.269,P<0.05).Nonlinear test indicated that after adjusting multiple factors,there was no nonlinear correlation between TFQIFT3 and non-HDL-C as well as NHHR(Pnonlinear>0.05).Conclusion In male elderly patients with diabetes,reduced central sensitivity to FT3 is correlated with increased non-HDL-C level,which may increase the risk of blood lipid disorders and cardiovascular disease.

Abstract:Objective To explore the features of energy metabolism in cerebrospinal fluid(CSF)in patients with subarachnoid hemorrhage(SAH)and their correlation with occurrence of delayed cerebral ischemia(DCI).Methods A total of 150 patients with aneurysmal SAH(aSAH)admitted to our department from January 2021 to May 2024 were enrolled.The CSF fluid lactate and glucose levels were monitored through external ventricular drain(EVD).Based on the occurrence of symptomatic DCI or not,they were divided a symptomatic DCI group(45 patients)and an asymptomatic DCI group(105 patients).According to clinical outcomes in 3 months later,they were also classified into a good prognosis group(56 cases)and a poor prognosis group(94 cases).Clinical data,such as gender,serum lactate and glucose levels were collected.Multivariate logistic regression analysis was employed to identify influencing factors for symptomatic DCI and poor prognosis in aSAH patients.Results The symptomatic DCD group exhibited significantly larger proportions of hypertension,World Federation of Neurosurgical Societies(WFNS)grades Ⅳ-Ⅴ and elevated CSF lactate and glucose levels,and higher serum glucose level than the asymptomatic DCD group(P<0.01).Multivariate logistic regression analysis revealed that WFNS grade,elevated CSF lactate,and increased CSF glucose were independent risk factors for symptomatic DCI in the aSAH patients(P<0.05,P<0.01).Larger proportion of WFNS grades Ⅳ-Ⅴ,elevated CSF lactate level,symptomatic DCI and increased serum glucose level were observed in the poor prognosis group than the good prognosis group(P<0.05,P<0.01).The symptomatic DCI was an independent risk factor for poor prognosis in aSAH patients(OR=11.080,95%CI:3.559-34.498,P<0.01).Conclusion WFNS grade and elevated CSF lactate/glucose levels are independent risk factors for subsequent symptomatic DCI in aSAH patients,and symptomatic DCI is an independent risk factor for poor prognosis.Monitoring CSF lactate/glucose levels may serve as a bedside test to improve the prediction for post-aSAH subacute and late-stage neurological deterioration,and to guide the adjustments for treatment plans.

Abstract:Objective To investigate the correlation between coronary arterial calcification(CAC)and bone metabolism indicators in elderly patients with atrial fibrillation(AF).Methods A retrospective study was conducted on 300 elderly AF patients admitted in Department of Cardiovascular Medicine of Qinghai Provincial People's Hospital between January 2022 and January 2025.Based on the CT coronary calcium score(TCS),they were divided into a CAC group(98 cases,TCS>0)and a non-CAC group(202 cases,TCS=0).The CAC group was further subdivided into a trace calcification subgroup(30 cases,TCS:1-10),a mild calcification subgroup(40 cases,TCS:11-100),a moderate calcification subgroup(21 cases,TCS:101-400),and an extensive calcification subgroup(7 cases,TCS:>400).Differences in bone metabolism indicators,including osteocalcin,osteopontin(OPN),alkaline phosphatase(ALP),and 25-hydroxyvitamin D[25-(OH)D],were compared and analyzed among the groups.The predictive efficacy of bone metabolism indicators for CAC in elderly AF patients was evaluated.Results Serum osteocalcin and 25-(OH)D levels in each subgroup of the CAC group were significantly lower than those in the non-CAC group,and the levels were decreased with increasing calcification severity.In contrast,serum OPN and ALP levels were significantly higher in the CAC group and increased with calcification severity(P<0.05).Pearson correlation analysis showed that serum osteocalcin and 25-(OH)D levels were negatively correlated with TCS(r=-0.560,r=-0.640,P<0.01),while serum OPN and ALP levels were positively correlated with TCS(r=0.560,r=0.700,P<0.01).Multivariate logistic regression analysis indicated that age,hypertension,diabetes,coronary heart disease,and levels of OPN,ALP,osteocalcin,and 25-(OH)D were independent influencing factors for CAC in elderly AF patients(P<0.05,P<0.01).ROC curve analysis revealed that the combined prediction of CAC using serum osteocalcin,OPN,ALP,and 25-(OH)D had a significantly higher AUC value than the individual indicator(0.891 vs 0.754,0.768,0.758,0.743;Z=2.224,Z=2.215,Z=2.220,Z=2.232,P<0.05).Conclusion CAC in elderly AF patients is closely associated with bone metabolism indicators.The combined detection of serum osteocalcin,25-(OH)D,OPN,and ALP levels has good predictive efficacy for CAC.

Abstract:Objective To investigate the predictive value of serum human cartilage glycoprotein 39(YKL-40)and caspase cleaved cytokeratin-18(CCCK-18)for postoperative cerebral vasospasm(CVS)in patients after subarachnoid hemorrhage(SAH)surgery.Methods A prospective study was conducted on 122 SAH patients who underwent surgical treatment in our department from October 2021 to October 2024.According to the occurrence of CVS at 4 d after surgery,they were divided into a CVS group(39 cases)and a non-CVS group(83 cases).According to the severity of CVS,the patients from the CVS group were further assigned into mild(8 cases),moderate(17 cases)and severe(14 cases)subgroups.Serum YKL-40 and CCCK-18 levels were measured.ROC curve was plotted to assess the predictive value of serum YKL-40 and CCCK-18 levels for CVS.Logistic regression was used to identify the influencing factors of CVS occurrence.Results Statistical differences were observed in Fisher and Hunt-Hess grades at admission between CVS group and non-CVS group(P<0.01).The serum YKL-40 and CCCK-18 levels were significantly higher in the CVS group than the non-CVS group(P<0.05),in the moderate and severe subgroups than the mild subgroup,and in the severe subgroup than the moderate subgroup(P<0.05).Serum YKL-40 and CCCK-18 level,and the Fisher and Hunt-Hess grades at admission were risk factors for CVS(P<0.05).The area under curve value of YKL-40 and CCCK-18 in predicting CVS was 0.883 and 0.874,respectively,while the value of their combination was 0.971,notably higher than single indicator.Conclusion Serum YKL-40 and CCCK-18 are highly expressed in CVS patients after SAH surgery.Their combination has high predictive value in predicting CVS occurrence.

Abstract:Objective To analyze the pathogenic characteristics,drug resistance and gene polymorphisms of Toll-like receptor 3(TLR3)and nicotine cholinergic receptor 3(CHRNA3)in elderly patients with cerebral infarction complicated with pulmonary infection.Methods A total of 185 elderly patients with cerebral infarction complicated with pulmonary infection(infection-positive group)admitted to our second section from June 2019 to December 2023 were enrolled in this study.The pathogenic characteristics were analyzed,and the drug resistance of the main pathogens was analyzed.Another 198 elderly patients with cerebral infarction but without pulmonary infection(infection-negative group)were also recruited.The general clinical data,TLR3 rs5743303 locus and CHRNA3-1923 locus were statistically analyzed and compared between the two groups.Results There were 198 strains of pathogenic bacteria detected in the infection-positive group,including 112 strains of Gram-negative bacteria,66 strains of Gram-positive bacteria and 20 strains of fungi,and among the pathogens,Klebsiella pneumoniae accounted for 20.7%,Pseudomonas aeruginosa for 12.6%,Staphylococcus epidermidis for 15.7%and Staphylococcus aureus for 11.6%.The isolated Klebsiella pneumoniae showed resistance to ampicillin,levofloxacin and ciprofloxacin,Pseudomonas aeruginosa to ampicillin,ceftazidime,levofloxacin,ciprofloxacin,tobramycin and sulfamethoxazole/trimethoprim,Staphylococcus epidermidis to penicillin,erythromycin,levofloxacin and oxacillin,and Staphylococcus aureus to penicillin,oxacillin,erythromycin,levofloxacin and moxifloxacin,and all above resistance rates were higher than 70%.The infection-positive group exhibited significantly larger proportions of diabetes and disorder of consciousness(P<0.01),and higher ratios of those carrying AA genotype and allele A of TLR3 rs5743303 locus,and those carrying CC genotype and allele C of CHRNA3-1923 locus when compared with the infection-negative group(P<0.05,P<0.01).Conclusion Main pathogenic bacteria show quite different drug resistances in elderly cerebral infarction patients with concomitant pulmonary infection.Complication of diabetes mellitus and disorder of consciousness can promote the occurrence of pulmonary infection.At the same time,the occurrence of pulmonary infection is associated with gene polymorphisms of TLR3 rs5743303 locus and CHRNA3-1923 locus.

Abstract:Objective To explore the predictive value of serum angiopoietin-like protein 8(ANGPTL8)and endothelial nitric oxide synthase(eNOS)for the occurrence of cerebral infarction(CI)in patients with transient ischemic attack(TIA).Methods A total of 125 TIA patients admitted to Department of Neurology of First Hospital of Hebei Medical University between May 2021 and May 2024 were recruited,and according to their ABCD2 score for stroke risk,they were divided into severe(score:6～7,31 cases),moderate(score:4～5,52 cases)and mild(score:≤3,42 cases)risk groups.And,based on CI occurrence within 3 months,they were also assigned into a non-CI group(81 cases)and a CI group(44 cases).ELISA was used to measure serum levels of ANGPTL8 and ENOS.Logistic regression model was used to analyze the influencing factors of CI in TIA patients.ROC curve was plotted to evaluate the predictive value of serum ANGPTL8 and eNOS levels for the occurrence of CI in TIA patients.Results The serum level of ANGPTL8 was gradually increased,and that of eNOS was progressively declined in the mild,moderate and severe risk groups in turn(P<0.05).The CI group exhibited significantly higher serum ANGPTL8 level and longer duration of symptoms,and lower serum eNOS level when compared with the non-CI group(P<0.01).Multivariate logistic regression analysis revealed that serum ANGPTL8 and symptom duration were risk factors,while serum eNOS was a protective factor for CI occurrence in TIA patients(P<0.05,P<0.01).ROC curve analysis showed that the AUC value of serum ANGPTL8 and eNOS and their combination was 0.737,0.841 and 0.907,respectively,and the combination showed the best predictive performance,with a sensitivity of 88.54%and a specificity of 80.25%.Conclusion The serum level of ANGPTL8 is increased and that of eNOS is decreased in TIA patients with CI.Their combination has high predictive value for CI occurrence after TIA.