Abstract:Objective To investigate the effect of progressive cardiac rehabilitation on endothelial cell function in patients with coronary atherosclerotic heart disease(CHD)after percutaneous coronary intervention(PCI).Methods The clinical data of 120 patients with CHD were selected,who received treatment at Beijing Rehabilitation Hospital Affiliated to Capital Medical University from Jan.2023 to Jan.2025,and the patients were divided into an experimental group(n=61)and a control group(n=59)using a random digital table method.The control group was given routine clinical treatment and health education,while the experimental group received progressive cardiac rehabilitation.The maximum oxygen uptake(VO2 max),maximum heart rate(HRmax),left ventricular ejection fraction(LVEF),vascular endothelial growth factor(VEGF),endothelin-1(ET-1),nitric oxide(NO),exercise tolerance,6-minute walk distance(6MWD),scores of activities of daily living(ADL),scores of Coronary Heart Disease Quality of Life Scale(CQQC)and the incidence of adverse cardiovascular events were compared between 2 groups.Results After intervention,HRmax was lower in experimental group than that in control group(P<0.050),while VO2max and LVEF were higher in experimental group than those in control group.The NO level was higher in experimental group than that in control group(P<0.050),whereas VEGF and ET-1 levels were lower in experimental group than those in control group.The levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI)and creatine kinase-MB isoenzyme(CK-MB)were lower in experimental group than those in control group,and 6MWD was higher in experimental group than that in control group(P<0.050).The scores of ADL and CQQC were higher in experimental group than those in control group(P<0.050).The statistical results of adverse cardiovascular events showed 3 cases(4.92%)in experimental group and 10 cases(16.95%)in control group(P<0.050).Conclusion Progressive cardiac rehabilitation yields favorable outcomes and can effectively improve endothelial cell function in the treatment for CHD patients.

Abstract:Objective To investigate the relationship among ascending aortic diameter(AOD),left ventricular ejection fraction(LVEF)and prognosis in patients with left ventricular noncompaction(LVNC).Methods A retrospective analysis was conducted on 160 LVNC patients treated in Sichuan Provincial People's Hospital from Jan.2019 to Jan.2024,with a 1-y follow-up.According to the survival status,the patients were divided into a favorable prognosis group(n=125)and a poor prognosis group(n=35).Clinical data of 2 groups were collected and compared,along with echocardiographic parameters on admission.The prognostic factors were identified using Logistic regression analysis in LVNC patients,and the predictive value of each indicator for the prognosis was analyzed using receiver operating characteristic(ROC)curve analysis in LVNC patients.Results Compared with favorable prognosis group,patients in the poor prognosis group were older and had a higher proportion of New York Heart Association(NYHA)functional class Ⅲ-Ⅳ(P<0.050).In addition,poor prognosis group had lower LVEF,larger left atrial diameter(LAD)and AOD than those in favorable prognosis group(P<0.050).Logistic regression analysis showed that low LVEF and high AOD were risk factors affecting the prognosis of LVNC patients.ROC curve analysis indicated that LVEF had a higher predictive value for the prognosis of LVNC patients than AOD,and the combined predictive value of the two indicators was significantly higher(P<0.050).Conclusion Low LVEF and high AOD are risk factors affecting the prognosis of LVNC patients,which can serve as indicators for judging the prognosis of LVNC patients.

Abstract:Objective To evaluate the efficacy and safety of landiolol,an ultra-short-acting β-blocker,in preventing tachyarrhythmias after elective percutaneous coronary intervention(PCI).Methods A prospective randomized controlled trial(RCT)was conducted,enrolling 81 patients with coronary artery disease(CAD)who underwent elective PCI at the Air Force Medical Center from January 1,2024 to June 30,2024.The patients were randomly divided into landiolol group(n=38)and control group(n=43).The incidence of tachyarrhythmias within 7 d after surgery,and the dynamic changes in heart rate(HR)and blood pressure(BP)within 72 h after surgery were assessed.Results The incidence of tachyarrhythmias was significantly lower in landiolol group than that in control group after PCI(P=0.001).The average HR was significantly lower in landiolol group than that in control group within 72 h after surgery(P<0.01).The results of intragroup analysis showed that the average HR decreased significantly in landiolol group compared with the baseline(P<0.001),while there was no significant change in HR in control group within 72 hours after surgery.There were no statistically significant differences in systolic blood pressure(SBP)and diastolic blood pressure(DBP)between 2 groups,and there was no obvious difference in the changing trends of BP between 2 groups within 72 h after surgery(P>0.050).Conclusion Early administration of landiolol after PCI can significantly reduce the risk of tachyarrhythmias,achieve precise HR control without impairing hemodynamic stability.

Abstract:Objective To investigate the predictive value of the venous excess ultrasound score(VExUS)based on point-of-care ultrasound for acute kidney injury(AKI)in patients with acute heart failure(AHF).Methods We retrospectively analyzed 162 patients with AHF hospitalized in Zhengzhou No.7 People's Hospital from January 2022 to July 2023.Baseline clinical data were collected.All-cause mortality events within 28 days and AKI events were recorded,the clinical data was compared between the AKI group and control group,binary logistic regression analysis was applied to determine the risk factors of AKI in patients with AHF,all-cause mortality rate within 28 days and AKI were compared between the VExUS normal group and VExUS abnormal group.Results AKI occurred in 60 patients(37.0%),compared with the control group,patients in AKI group had higher proportion of chronic kidney diseases[43.3%(44/60)vs.29.4%(32/102)],serum creatinine[154(86,302)μmol/L vs.79(63,126)μmol/L],c-reactive protein[(63.1±61.0)mg/L vs.(33.4±42.7)mg/L],procalcitonin[1.15(0.08,4.60)ng/ml vs.0.10(0.04,0.62)ng/ml],and VExUS srore[2.0(1.0,3.0)vs.1.0(0.0,2.0)](P<0.050),lower proportion of smoking history[16.7%(10/60)vs.31.4%(32/102),P<0.050].Binary logistic regression analysis demonstrated that VExUS srore(OR=3.497,95%CI:1.148～10.652,P=0.028)were independent risk factors for AKI in patients with AHF.All-cause death within 28 days occurred in 28 patients(17.3%),the all-cause mortality rate[23.5%(24/102)vs.6.7%(4/60)]and the incidence of AKI[47.1%(48/102)vs.20.0%(12/60)]were higher in the abnormal VExUS group than that of the normal VExUS group(both P<0.010).Conclusion The VExUS score is an independent risk factor for AKI in AHF patients and demonstrates strong predictive value for 28-day adverse events,highlighting its potential for clinical application.

Abstract:A certain proportion of clinical practice guidelines for integrated traditional Chinese and Western medicine include recommendations for Chinese patent medicines(CPMs).Given the characteristics of CPMs-such as a large variety of formulations,overlapping indications,and widespread off-label use-their selection has become a critical methodological issue.Scientific screening of CPMs prior to evidence retrieval and evaluation is a prerequisite for ensuring the scientific rigor and clinical applicability of such guidelines.This paper analyzes the deficiencies in the selection process of existing CPM-related guidelines,including an incomplete retrieval scope,insufficient transparency in the screening process,and a lack of support from systematic clinical investigations.Based on these findings,five basic principles for CPM selection are proposed:legality and normative compliance of drugs,alignment with clinical indications,clinical investigation-based evidence,support from evidence-based medicine,and independent consideration of dosage forms.Taking CPMs for hypertension treatment as an example,a comprehensive screening process is outlined,encompassing multi-source evidence retrieval,dynamic supplementation,verification of legality and normative compliance,and clinical investigation combined with dynamic revision.Stringent screening ensures the standardization and targeting of CPM selection;clinical investigations reflect real-world clinical medication needs;evidence-based evaluation optimizes resource allocation;and independent consideration of dosage forms achieves a multi-dimensional balance.This approach is conducive to improving the scientific rigor,transparency and traceability of CPM-related guidelines,enabling drug selection criteria to reflect the latest evidence and clinical practice,and ultimately enhancing the credibility and practical value of the guidelines.

Abstract:Objective To explore the mechanism of action of Yiqi Jiangzhuo Decoction in the treatment of unstable angina(UA)based on network pharmacology.Methods The main active components and their corresponding targets of Yiqi Jiangzhuo Decoction were screened via the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and the targets were converted into gene names using the UniProt database.UA-related genes were retrieved from the Comparative Toxicogenomics Database(CTD)and Therapeutic Target Database(TTD).A Venn diagram was constructed to obtain the common target genes of Yiqi Jiangzhuo Decoction for UA,followed by the establishment of a protein-protein interaction(PPI)network on the STRING platform to identify key protein modules.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed using R 4.4.1,and a"component-target"network was built with Cytoscape V3.10.0.Results A total of 223 common targets of Yiqi Jiangzhuo Decoction for UA were identified,with core targets including serine/threonine-protein kinase 1,tumor protein p53(TP53)gene,and proto-oncogene protein JUN.There were 51 active components of Yiqi Jiangzhuo Decoction for UA treatment screened out,and the key components included quercetin,kaempferol,luteolin,formononetin,β-sitosterol,and isorhamnetin.The results of enrichment analysis revealed that the therapeutic mechanism of Yiqi Jiangzhuo Decoction for UA might be closely associated with multiple signaling pathways,such as lipid and atherosclerosis pathway,interleukin 17(IL-17)signaling pathway,tumor necrosis factor(TNF)signaling pathway,phosphatidylinositol 3-kinase/protein kinase B(PI3K/Akt)signaling pathway,p53 signaling pathway,and hypoxia-inducible factor 1(HIF-1)signaling pathway.Conclusion Yiqi Jiangzhuo Decoction may exert a therapeutic effect on UA by acting on key targets such as protein kinase B1(Akt1),tumor protein p53,and proto-oncogene c-Jun,thereby regulating lipid metabolism and inflammatory responses.

Abstract:Objective To investigate the association between the changes of iron metabolism levels and occurrence of major adverse cardiovascular events(MACE)in elderly heart failure patients with different ejection fractions.Methods A total of 181 elderly patients with heart failure(HF)were enrolled from the Department of Cardiology of Shunyi District Hospital of Beijing from July 2023 to Apr.2025.According to the examination results of left ventricular ejection fraction(LVEF),the patients were divided into 3 groups:heart failure with preserved ejection fraction(HFpEF)group(HFpEF group,LVEF≥50.0%,n=65),heart failure with mildly reduced ejection fraction(HFmrEF)group(HFmrEF group,LVEF 40%～50%,n=54),and heart failure with reduced ejection fraction(HFrEF)group(HFrEF group,LVEF≤40.0%,n=62).In addition,70 healthy subjects were selected as control group who underwent physical examination in Shunyi District Hospital of Beijing during the same period.The levels of iron metabolism indicators were compared among all groups.All patients were followed up for 3 months after discharge,and were further divided into MACE group(n=46)and the non-MACE group(n=135)according to the occurrence of MACE.The risk factors associated with MACE were analyzed by applying Logistic regression model,and the predictive efficacy of iron metabolism-related indicators for MACE was evaluated by using receiver operating characteristic(ROC)curve.Results Compared with control group,the serum iron,serum ferritin,total iron-binding capacity and transferrin saturation decreased in turn in HFpEF,HFmrEF and HFrEF groups(P<0.050).Among them,HFrEF group had the most significant decrease,followed by HFmrEF group and HFpEF group(P<0.050).After 3 months of follow-up,46 of 181 patients experienced MACE,and 135 did not.The levels of LVEF,serum iron,serum ferritin,total iron-binding capacity and transferrin saturation were significantly lower in MACE group than those in non-MACE group(P<0.050).The results of multivariate Logistic regression analysis showed that LVEF,serum iron,serum ferritin,total iron-binding capacity and transferrin saturation were risk factors for MACE in elderly HF patients(P<0.050).The results of ROC curve analysis revealed that the area under the curve(AUC),sensitivity and specificity of the combined prediction of serum iron,serum ferritin,total iron-binding capacity and transferrin saturation were higher than those of a single indicator,and the combined predictive efficacy of these 4 indicators was better(P<0.050).Conclusion The levels of serum iron,serum ferritin,total iron-binding capacity and transferrin saturation are the lowest,and are risk factors for MACE occurrence in elderly HF patients,and the combination of these 4 indicators has a higher predictive value to MACE occurrence.

Abstract:Objective To investigate the effect of establishing an emergency response plan for cardiovascular events in the outpatient department of a tertiary general hospital on improving the efficiency and quality of emergency management for cardiovascular events.Methods Taking the Outpatient Department of Jiangsu Provincial People's Hospital as the pilot site,an emergency response plan for outpatient cardiovascular events was formulated and implemented from Jan.2023 to Jan.2024.A total of 35 patients who experienced cardiovascular events were enrolled as study group in the outpatient department during this period.For the period from Jan.2021 to Dec.2022,the routine management protocol for outpatient cardiovascular events was adopted,and 51 patients with cardiovascular events were included as control group in the outpatient department during this period.The differences in time indicators(time from symptom onset to initiation of first aid,emergency consultation waiting time,definitive diagnosis time,interventional therapy waiting time,length of hospital stay),rescue outcomes,and patient satisfaction were analyzed between 2 groups under different cardiovascular event management protocols.Results The time from symptom onset to first aid initiation,emergency consultation waiting time,definitive diagnosis time,and interventional therapy waiting time were all significantly shorter in study group than those in control group(P<0.050).There was no statistically significant difference in the success rate of first aid between 2 groups(P>0.050).However,the length of hospital stay was shorter in study group than that in control group,and the incidence of major adverse cardiovascular events was lower than that in the control group(P<0.050).Patient satisfaction with emergency management was significantly higher in study group than that in control group(P<0.050).Conclusion The emergency response plan for outpatient cardiovascular events can improve the efficiency and effectiveness of emergency management for patients with acute cardiovascular events in outpatient department,with higher patient satisfaction.

Abstract:Objective To evaluate the psychometric properties of self-management assessment tools for patients with chronic heart failure,aiming to provide guidance for selecting appropriate instruments in the future.Methods A systematic search was conducted in databases including CNKI,VIP,Wanfang,Web of Science,PubMed,and Embase for literature evaluating the psychometric properties of self-management scales for patients with chronic heart failure.The search covered publications from the inception of each database until December 31,2024.Based on the COSMIN guideline,the quality of measurement properties and risk of bias were assessed using standardized checklists to formulate recommendations.Results Nine studies were included,involving five Chinese versions of self-management assessment scales for chronic heart failure patients.Most scales lacked evaluation in measurement error,responsiveness,and cross-cultural validity.All scales received a Grade B recommendation.Conclusion The Chinese version of the Self-Care of Heart Failure Index(SCHFI v7.2-C)is temporarily recommended.This scale consists of 29 items covering various aspects of daily self-management in chronic heart failure patients,and its psychometric properties are the most comprehensively evaluated among the included tools.However,further refinement of its measurement properties is still needed.

Abstract:Objective To observe the influence of dapagliflozin on cardiac diastolic function and peripheral blood biomarkers of inflammation and myocardial function in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods HFpEF patients(n=120)were selected and divided into guideline group and combination group(each n=60)by using random digital table in the Zhengzhou Seventh People's Hospital from Jan.2021 to June 2022.The guideline group was given routine medication,and combination group was additionally given dapagliflozin.The cardiac diastolic function,inflammatory response indicators[microRNA-146a(miR-146a),interleukin 1 receptor-associated kinase 1(IRAK-1),tumor necrosis factor-α(TNF-α)],myocardial function indicators[N-terminal brain natriuretic peptide precursor(NT-proBNP),microtubule junction protein(Nexilin)],and scores of Minnesota Living with Heart Failure Questionnaire(MLHFQ)were compared between 2 groups before treatment and after treatment for 6 months.The incidence of adverse reactions and major adverse cardiovascular and cerebrovascular events(MACCE)were statistically analyzed in 2 groups.Results Before treatment,the comparison in cardiac diastolic function showed the difference had no statistical significance between 2 groups(P>0.050).After treatment for 6 months,left ventricular ejection fraction(LVEF)increased in 2 groups,which was higher in combination group than that in guideline group(P<0.050).The left ventricular mass index(LVMI),left atrial volume index(LAVI),and ratio of peak value of mitral valve flow spectrum E to peak value of maximum mitral ring movement E'in early diastolic period(E/e')decreased in 2 groups,which were lower in combination group than those in guideline group(P<0.050).The comparison in inflammatory response indicators showed the difference had no statistical significance between 2 groups before treatment(P>0.050).After treatment for 6 months,IRAK-1 increased,and miR-146a and TNF-α decreased in 2 groups(P<0.05),while IRAK-1 was higher,and miR-146a and TNF-α were lower in combination group than those in guideline group(P<0.05).The comparison in myocardial function indicators showed the difference had no statistical significance between 2 groups before treatment(P>0.050).After treatment for 6 months,NT-proBNP and Nexilin decreased in 2 groups(P<0.05),while NT-proBNP and Nexilin were lower in combination group than those in guideline group(P<0.050).The comparison in MLHFQ scores showed the difference had no statistical significance between 2 groups before treatment(P>0.050).After treatment for 6 months,MLHFQ scores decreased,while MLHFQ scores were lower in combination group than those in guideline group(P<0.050).The incidence of urinary tract infections was higher in combination group than that in guideline group(11.67%vs.1.67%).The incidence of MACCE was lower in combination group than that in guideline group(8.33%vs.20.00%,P>0.050).Conclusion Dapagliflozin can improve cardiac diastolic function in elderly HFpEF patients,regulate the expressions of peripheral blood inflammatory indicators(miR-146a,IRAK-1,TNF-α)and myocardial function indicators(NT-proBNP,Nexilin).It may increase the risk of urinary tract infections,thus close monitoring and preventive measures are required for populations at high risk of urinary tract infections in clinical practice.

Abstract:Objective To investigate the association among stress-induced hypertension(SIH)developed after admission and the incidence of major adverse cardiovascular events(MACE)following percutaneous coronary intervention(PCI),as well as postoperative complications of PCI during hospitalization,in patients with unstable angina pectoris(UAP).Methods The UAP patients(n=875)without a history of hypertension who underwent PCI were consecutively enrolled at Hebei Yiling Hospital from Jan.2021 to Jan.2024.According to the presence of transient blood pressure>140/90 mmHg on admission,the patients were divided into SIH group(n=291)and non-SIH group(n=584).The primary outcome was MACE,including cardiac death,non-fatal myocardial infarction,repeat revascularization and stroke.The secondary outcomes were postoperative complications of coronary angiography,including acute coronary occlusion,pseudoaneurysm,arrhythmia and adverse reactions to contrast medium.The difference in survival rate was analyzed by using Kaplan-Meier curve,and the association between SIH and MACE incidence was evaluated by using Cox proportional hazards regression model within 1 y after PCI.The relationship between SIH and incidence of in-hospital postoperative complications of PCI was assessed by adopted chi-square test.Results There were no significant differences in baseline characteristics between SIH group and non-SIH group.The results of Kaplan-Meier curve analysis revealed a significant difference in the cumulative incidence of MACE within 12 months between SIH group and non-SIH group(Log-rank P=0.028).After adjusting for confounding factors in Cox regression analysis,SIH was found to be associated with an increased risk of MACE(HR=1.45,95%CI:1.01-2.09,P=0.042).The results of sensitivity analysis and subgroup analysis were consistent.The results of Chi-square test indicated no association between SIH and in-hospital postoperative complications of PCI.Conclusion SIH is an dependent risk factor affecting MACE incidence within 1 y after PCI in UAP patients.

Abstract:Objective To discuss the incidence of low cardiac output syndrome(LCOS)and analyze its risk factors in patients after cardiac valve replacement,and provide basis for formulating targeted clinical prevention and interventional strategies.Methods A total of 148 patients was enrolled,who underwent cardiac valve replacement at the Seventh People's Hospital of Zhengzhou from Dec.2022 to Nov.2023.The number and incidence of postoperative LCOS were recorded.According to the occurrence of postoperative LCOS,the patients were divided into LCOS group and non-LCOS group.The general data,preoperative cardiac function,imaging indicators,laboratory indicators,surgery-related indicators,postoperative indicators and prognostic indicators were collected in 2 groups.The indicators with significant differences were screened by using univariate analysis,the independent high-risk factors for LCOS were identified by applied a multivariate Logistic regression model.The predictive efficacy of each independent high-risk factor for LCOS was analyzed by performing receiver operating characteristic(ROC)curve.Results Among the 148 patients,7 cases(4.73%)developed postoperative LCOS.The results of univariate analysis showed that there were statistically significant differences between LCOS group and non-LCOS group in terms of age,body mass index(BMI),complicated diabetes mellitus(DM),New York Heart Association(NYHA)cardiac function grade Ⅲ～Ⅳ,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),pulmonary arterial hypertension(PAH),estimated glomerular filtration rate(eGFR),hemoglobin(Hb),albumin,surgical type,operation duration,cardiopulmonary bypass(CPB)time,aortic occlusion(AO)time,intraoperative blood transfusion volume,postoperative 24 h peak level of cardiac troponin I(cTnI),postoperative 6-h level of arterial blood lactic acid(LA),mechanical ventilation(MV)time,ICU stay time,postoperative hospital stay,30-d mortality and 30-d readmission rate(P<0.050).The results of Logistic regression analysis revealed that NYHA cardiac function grade Ⅲ～Ⅳ,decreased LVEF,PAH,prolonged CPB time and elevated postoperative 6-h level of arterial blood LA were independent risk factors for LCOS occurrence in patients after cardiac valve replacement(P<0.050).The results of ROC curve analysis indicated that the area under the curve(AUC)of the combined prediction of LCOS by the five indicators(NYHA cardiac function grade Ⅲ～Ⅳ,LVEF<48.5%,PAH,prolonged CPB time and elevated postoperative 6 h level of arterial blood LA)was 0.946,with a sensitivity of 92.9%and a specificity of 87.2%,and the predictive efficacy was superior to that of a single indicator.Conclusion The incidence of LCOS following cardiac valve replacement is relatively high with multiple risk factors involved.Notably,LCOS risk increases significantly when LVEF is less than 48.5%.Combining multiple independent risk factors can improve the predictive efficacy for LCOS.Targeted intervention measures should be actively implemented to reduce LCOS incidence and improve the prognosis of patients.

Abstract:Objective To perform survival analysis in patients with aortic dissection who received conservative treatment,and to establish a simple and practical nomogram model for predicting patient survival rate.Methods Patients diagnosed with aortic dissection were enrolled as the research subjects in the Affiliated Hospital of Jining Medical University from Jan.2019 to Dec.2021,and their survival time was followed up.The Kaplan-Meier method was used to plot survival curves,Log-rank test was employed to compare survival rate differences among patients with different Stanford classifications.LASSO regression was applied to screen variables with non-zero coefficients,which were then included in multivariate Cox regression survival analysis.The stepwise backward regression method with the minimum Akaike Information Criterion(AIC)was adopted to determine the final model,and a nomogram of the prediction model was plotted.The C-index was used to evaluate the discrimination of the model,calibration curves were drawn to assess the calibration of the model,and decision curve analysis was performed to evaluate the clinical benefit of the model.Results A total of 128 patients with aortic dissection were included in this study,with an overall mortality rate of 45.31%(58/128).The overall survival rates at 3 months,6 months and 1 y after conservative treatment were 61.72%,59.38%and 54.69%,respectively.The mortality rate was significantly higher in patients with Stanford type A aortic dissection than that in patients with type B(62.07%vs.31.43%,P<0.001).Through LASSO regression,8 variables with non-zero coefficients were identified,including age,myoglobin(Mb),hemoglobin(Hb),platelets,fibrinogen(FIB),sinus involvement,false lumen range and complications.The variables finally included in the multivariate Cox regression model were age(HR=1.011,P=0.073),Hb(HR=0.983,P=0.090),FIB(HR=0.804,P=0.023),sinus involvement(HR=2.134,P=0.018),false lumen range(HR=1.495,P=0.036)and complications(HR=4.484,P<0.001).A nomogram prediction model for 3-month,6-month and 1-y survival rates in patients with aortic dissection after conservative treatment was further constructed.The C-index of the model was 0.824,calibration curves indicated good calibration of the model,and decision curve analysis demonstrated favorable clinical benefits of the model.Conclusion The nomogram prediction model constructed based on age,hemoglobin,fibrinogen,sinus involvement,false lumen range and complications has good predictive performance,and can be used to evaluate the 3-month,6-month and 1-y survival in patients with aortic dissection undergoing conservative treatment.

Abstract:Objective To establish a model of irradiation(Ir)injury of human umbilical vein endothelial cells(HUVECs),and discuss the mechanism of Ir-mediated mitophagy in vascular endothelial cell injury based on PINK1/Parkin signaling pathway.Methods Purchased HUVECs were divided into control group(0 Gy)and experimental groups(3 Gy,6 Gy,9 Gy,12 Gy).The cell viability was detected by using CCK-8 assay in each group,and cell apoptosis rate and levels of reactive oxygen species(ROS)were measured by using flow cytometry.The optimal Ir dose for model establishment was screened according to the above results.Based on the screening outcomes,9 Gy was selected as the modeling dose,and a control group and an Ir model group were set up.The ultrastructure of mitochondria was observed by using transmission electron microscopy in each group;cell migration rate cell was determined by using scratch assay;cell apoptosis index was detected by using TUNEL immunofluorescence staining.The expression levels of PINK1,Parkin,and LC3-II/LC3-I proteins were detected by using Western blotting assay.Results With the increase of Ir dose,cell viability showed a gradual decreasing trend,while cell apoptosis rate and ROS levels presented a gradual increasing trend.Compared with control group,the cell viability,apoptosis rate and ROS levels all had statistically significant differences in 3 Gy,6 Gy,9 Gy and 12 Gy groups(P<0.050).There were statistically significant differences in cell viability,apoptosis rate and ROS levels between 6 Gy group and 9 Gy group(P<0.050),while no statistically significant differences were found between 9 Gy group and 12 Gy group(P>0.050).When 9 Gy was selected as the modeling dose,compared with control group,the Ir model group exhibited obvious mitochondrial structural damage,reduced cell migration rate,increased cell apoptosis index,and significantly up-regulated expression levels of PINK1 and Parkin proteins as well as the LC3-II/LC3-I ratio(P<0.050).Conclusion Ir may induce HUVEC injury by activating the PINK1/Parkin signaling pathway and up-regulating mitophagy.

Abstract:Objective To discuss the effect of the combination of mini-clinical evaluation exercise(Mini-CEX)assessment and scenario-based simulation teaching in the clinical teaching and training of emergency medicine.Methods A total of 20 postgraduate interns and standardized training residents were enrolled as the research subjects,who rotated at Beijing Anzhen Hospital Affiliated to Capital Medical University from Jan.2023 to Dec.2023.The Mini-CEX teaching assessment scale and the Clinical Skill(Cardiopulmonary Resuscitation Section)Rating Scale of Beijing Anzhen Hospital Affiliated to Capital Medical University were used to assess the subjects'post competency(including medical interview,physical examination,professional attitude,clinical judgment,communication skills,organizational efficiency and overall performance)as well as clinical skills of cardiopulmonary resuscitation(CPR)combined with defibrillation at the time of admission to and discharge from the department,respectively.A satisfaction questionnaire survey was conducted among the subjects after the completion of the rotation training.Results The score of clinical skills for CPR combined with defibrillation was(82.40±3.78)in the subjects at admission to the department,which increased significantly to(95.50±2.01)at discharge,with an improvement range of 2 to 21 points and a mean of(13.10±4.23)points,showing a statistically significant difference(P<0.001).The scores of all 7 dimensions of post competency were significantly higher than those at admission(all P<0.001),among which communication skills had the largest improvement and medical interview had the smallest.In the discharge assessment,defibrillation was the item with the most score loss,and the main problems were safety awareness and operation methods.The satisfaction survey showed that most of the responses were"very satisfied"or"satisfied",some were"fair",and a few were"dissatisfied".The application of Mini-CEX combined with scenario-based simulation teaching can significantly improve the emergency rescue skills and post competency of the subjects in emergency medicine training,and has been unanimously recognized by them,which is worthy of wide promotion in emergency medicine teaching.

Abstract:Objective To explore the application effect of the three-track integrated teaching model of evidence-based medicine,case-based learning and problem-based learning(EBM-CBL-PBL)combined with mind mapping in cultivating the clinical thinking ability of interns in department of cardiology.Methods A total of 40 interns were selected as research subjects and randomly divided into two groups,who practiced in Department of Geriatric Cardiology of the First Affiliated Hospital of Kunming Medical University.Group A received the traditional teaching model,while group B adopted the EBM-CBL-PBL three-track integrated teaching model combined with mind mapping.The clinical thinking ability,medical record analysis ability and decision-making ability were compared in 2 groups.Results After the teaching intervention,the assessment scores of theoretical knowledge,case analysis,skill operation and the total scores were significantly higher in group B than those in group A(P<0.050).In terms of the recognition that the teaching model could improve learning enthusiasm,literature retrieval ability,problem-finding ability,problem-analyzing ability and cultivate team spirit,the approval rate was higher in group B than that in group A(P<0.050).The scores were higher in group B than those in group A in all dimensions of the Critical Thinking Disposition Inventory for Chinese Version(CTDI-CV,P<0.050).In addition,the satisfaction to teaching methods,teaching effects and self-evaluation was higher in group B than that in group A(P<0.050).Conclusion The EBM-CBL-PBL three-track integrated teaching model combined with mind mapping can improve the clinical thinking ability of cardiology interns,as well as their academic performance and teaching satisfaction.

Abstract:Objective To analyze the causal association between adult-onset Still's disease(AOSD)and coronary atherosclerotic heart disease(CHD)by using the Mendelian randomization(MR)method.Methods Two-sample MR analysis was performed via the genome-wide association study(GWAS)summary database,adopting the inverse variance weighting(IVW)method,weighted median method and MR-Egger regression method.The credibility of the results was further evaluated by the multivariable Mendelian randomization(MVMR)method.Results A causal association was identified between AOSD and CHD increased risk(IVW:OR=1.039,95%CI:1.014～1.064,P=0.001).In the MR analysis,no horizontal pleiotropy or heterogeneity was found in the instrumental variables.Sensitivity analysis using leave-one-out method(LOO)confirmed the robustness of the MR results.Additionally,after adjusting for confounding factors by MVMR method,the above causal association remained statistically significant(OR=1.104,95%CI:1.022～1.192,P=0.012).Conclusion The results of MR analysis indicate that AOSD has a causal association with CHD elevated risk.

Abstract:Objective By analyzing the literature on hypertension and sleep quality published in the China National Knowledge Infrastructure(CNKI)and Web of Science databases from 2000 to 2025,to explore the research status,hotspots and development trends in this field,so as to provide a scientific basis for optimizing sleep management in hypertensive patients and guiding future research.Methods A total of 4146 retrieved literatures(1,808 in Chinese and 2338 in English)were retrieved to bibliometric and visual analysis using CiteSpace(6.3.R1)software.Results The United States ranked first in the number of published English literatures(n=645),followed by China(n=406).Harvard Medical School(n=93)was the institution with the highest number of publications overseas,while Beijing University of Chinese Medicine(n=37)emerged as the core domestic research institution.Li Nanfang,from the Hypertension Center of the People's Hospital of Xinjiang Uygur Autonomous Region and Pepin Jean-Louis,form Grenoble University Hospital in France have published the largest number of papers(n=8).English literatures focused on sleep quality,risk factors and blood pressure levels,whereas Chinese studies emphasized nursing interventions and risk factor analysis.Timeline analysis revealed that research on hypertension and sleep quality entered a period of rapid growth after 2009,and"negative emotions"and"blood pressure levels"became emerging burst terms after 2020.Conclusion Research on sleep quality in hypertensive patients shows a trend of interdisciplinary integration.The United States takes a leading position in this field,and the research focus has shifted from basic sleep monitoring to psychosocial factors and personalized interventions.Sleep assessment applications combining wearable devices with artificial intelligence,and the gut microbiota-brain-blood pressure axis mechanism represent the two cutting-edge directions in this field.However,the cross-regional cooperation network remains imperfect and needs further strengthening.It is suggested to deepen collaborative research in clinical and public health fields,thereby constructing an integrated sleep-blood pressure management model.

Abstract:Objective To explore and evaluate the teaching practice effect of diversified cardiac teaching model in the clinical rotation of residents undergoing standardized training in cardiac ultrasound.Methods A total of 28 residents were divided into a teaching experimental group and a control group,who received standardized training in Department of Ultrasound Medicine of the 56th Medical Center of Chinese PLA General Hospital from June 2022 to June 2024.The experimental group adopted the diversified cardiac teaching model,and scores of the rotation exit assessment and the results of questionnaire survey were compared between 2 groups.Results The score of rotation exit assessment was(81.8±7.52)in experimental group,which was higher than that in control group[(77.5±9.2),P=0.047].The results showed that the learning interest of the residents in experimental group was significantly higher than that in control group(P<0.050),and the residents achieved a significant self-improvement in operational skills.Conclusion The application of the diversified cardiac teaching model is conducive to improving residents'learning interest,strengthening their practical skills and enhancing teaching satisfaction in the cardiology rotation teaching for residents undergoing standardized ultrasound training.Compared with traditional teaching model,it can better accomplish the teaching tasks.

Abstract:Objective To review the effect of noninvasive glucose monitoring system(GluRing)based on optical principle in intervention of blood sugar control and self-management in patients with coronary heart disease(CHD)complicated by type 2 diabetes mellitus(T2DM).Methods The patients with stable CHD complicated by T2DM(n=79)were selected from the Seventh Medical Center of Chinese PLA General Hospital from June 2024 to Dec.2024,and they were randomly divided into experimental group(continuous glucose monitoring group)and control group(routine management),with a 3-month follow-up.The accuracy of blood glucose measurement,changes in glycated hemoglobin(HbA1c)before and after the trial,and the scores of the Summary of Diabetes Self-Care Activities(SDSCA)were evaluated.Results There was no statistically significant difference between the results of GluRing and venous blood testing.The level of HbA1c decreased significantly in experimental group compared to that before 3 months(7.40±1.61,Δ=-0.67±2.30,P<0.05),and SDSCA score was improved significantly(46.79±14.93,P<0.05).Conclusion GluRing can help patients to get continuous blood glucose monitoring,and improve self-management and treatment compliance through real-time feedback,demonstrating potential for clinical promotion.