Successful emergency surgical intervention in acute non-STsegment elevation myocardial infarction with rupture:A case report

BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.

Functional metabolomics analysis of the protective mechanism of total flavonoids of Scutellaria baicalensis on acute myocardial ischemia rats

Background:The study aimed to investigate the protective effect and mechanism of total flavonoids of Scutellaria baicalensis(TFSB)on acute myocardial ischemia(AMI)rats by using functional metabonomics.Methods:Rats were divided into the Control,Model,AMI positive control(Propranolol hydrochloride,30 mg/kg),low dose TFSB(50 mg/kg),and high dose TFSB(100 mg/kg)groups.Rats received the corresponding treatment by intragastric administration once daily for 10 consecutive days.Electrocardiogram,myocardial enzyme,triphenyltetrazolium chloride staining,hematoxylin-eosin,and enzyme-linked immunosorbent assay were performed to evaluate the protective effect of TFSB on AMI rats.Then,the UHPLC-Q-Orbitrap MS method based on serum metabolomics was utilised to search for metabolic biomarkers and metabolic pathways.Subsequently,Western blot and RT-PCR techniques were employed to identify the respective genes and proteins.Results:Pharmacodynamics revealed that TFSB could ameliorate AMI in rats.The results of the metabolomics analysis indicated that the alterations in metabolic profile observed in rats with AMI were partially improved by treatment with TFSB.Moreover,the mRNA expression levels of 5-lipoxygenase(5-LOX)and 15-lipoxygenase(15-LOX)and the protein expression levels of 5-LOX,15-LOX,interleukin-1β(IL-1β),and NF-κB p65 were reduced following treatment with TFSB.Conclusion:The potential treatment of TFSB in AMI may be ascribed to its ability to regulate arachidonic acid metabolism.

Hemogram-derived ratios as prognostic markers for major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction

BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events(MACE)in NSTEMI patients,potentially improving clinical outcomes.METHODS A prospective,observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla,Bosnia and Herzegovina.The study included 170 patients with NSTEMI,who were divided into a group with MACE and a control group without MACE.Furthermore,the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis.Alongside hematological parameters,an additional 13 hematological-derived ratios(HDRs)were monitored,and their prognostic role was investigated.RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction(NSTEMI)patients with MACE and a control group at T1 and T2.However,significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE.Notably,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were elevated in lethal outcomes.Furthermore,C-reactive protein-to-lymphocyte ratio(CRP/Ly)at T1(>4.737)demonstrated predictive value[odds ratio(OR):3.690,P=0.024].Both NLR at T1(>4.076)and T2(>4.667)emerged as significant predictors,with NLR at T2 exhibiting the highest diagnostic performance,as indicated by an area under the curve of 0.811(95%CI:0.727-0.859)and OR of 4.915(95%CI:1.917-12.602,P=0.001),emphasizing its important role as a prognostic marker.CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients.During follow-up,NLR,PLR,and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.

Bivalirudin for anticoagulation in elderly acute coronary syndrome:Effects on myocardial microcirculation and adverse events

The management of acute coronary syndrome(ACS)in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes.Bivalirudin,a direct inhibitor of thrombin,serves as an alternative to traditional therapies.This drug is particularly effective in enhancing myocardial microcircu-lation and reducing adverse events after clinical interventions.The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS.Compared with unfractionated heparin,bivalirudin markedly reduced the emergency response time and improved cardiac function indicators.It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions.These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications,thus serving as a safe,effective anticoagulation agent for older patients with ACS.Nonetheless,further large-scale,high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes.Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care,balancing efficacy and safety.Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.

Isoproterenol mechanisms in inducing myocardial fibrosis and its application as an experimental model for the evaluation of therapeutic potential of phytochemicals and pharmaceuticals

Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.

Glycemic Control and Diabetes Duration in Relation to Subsequent Myocardial Infarction among Patients with Coronary Heart Disease and Type 2 Diabetes

Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.

Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome

BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.

Dapagliflozin and sacubitril on myocardial microperfusion in patients with post-acute myocardial infarction heart failure and type 2 diabetes

BACKGROUND Coronary heart disease and type 2 diabetes mellitus(T2DM)frequently coexist,creating a complex and challenging clinical scenario,particularly when complicated with acute myocardial infarction(AMI).AIM To examine the effects of dapagliflozin combined with sakubactrovalsartan sodium tablets on myocardial microperfusion.METHODS In total,98 patients were categorized into control(n=47)and observation(n=51)groups.The control group received noxital,while the observation group was treated with dapagliflozin combined with noxital for 6 months.Changes in myocardial microperfusion,blood glucose level,cardiac function,N-terminal prohormone of brain natriuretic peptide(NT-proBNP)level,growth differentiation factor-15(GDF-15)level,and other related factors were compared between the two groups.Additionally,the incidence of major adverse cardiovascular events(MACE)and adverse reactions were calculated.RESULTS After treatment,in the observation and control groups,the corrected thrombolysis in myocardial infarction frame counts were 37.12±5.02 and 48.23±4.66,respectively.The NT-proBNP levels were 1502.65±255.87 and 2015.23±286.31 pg/mL,the N-terminal pro-atrial natriuretic peptide(NT-proANP)levels were 1415.69±213.05 and 1875.52±241.02 ng/mL,the GDF-15 levels were 0.87±0.43 and 1.21±0.56 g/L,and the high-sensitivity C-reactive protein(hs-CRP)levels were 6.54±1.56 and 8.77±1.94 mg/L,respectively,with statistically significant differences(P<0.05).The cumulative incidence of MACEs in the observation group was significantly lower than that in the control group(P<0.05).The incidence of adverse reactions was 13.73%(7/51)in the observation group and 10.64%(5/47)in the control group,with no statistically significant difference(P>0.05).CONCLUSION Dapagliflozin combined with nocinto can improve myocardial microperfusion and left ventricular remodeling and reduce MACE incidence in patients with post-AMI heart failure and T2DM.The underlying mechanism may be related to the reduction in the expression levels of NT-proANP,GDF-15,and hs-CRP.

Bipartite consensus problems of Lurie multi-agent systems over signed graphs: A contraction approach

This paper examines the bipartite consensus problems for the nonlinear multi-agent systems in Lurie dynamics form with cooperative and competitive communication between different agents. Based on the contraction theory, some new conditions for the nonlinear Lurie multi-agent systems reaching bipartite leaderless consensus and bipartite tracking consensus are presented. Compared with the traditional methods, this approach degrades the dimensions of the conditions, eliminates some restrictions of the system matrix, and extends the range of the nonlinear function. Finally, two numerical examples are provided to illustrate the efficiency of our results.

Use of Beta-Blocker in Acute ST-Elevation Myocardial Infarction

This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.

One Case of Primary Thrombocythemia with Concealed Hypokalemia Complicated by Acute Myocardial Infarction

Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 109/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.

Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis:a 5-year analysis in an Asian population

BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.

Revisiting the Electron Radius in Light of Length Contraction

In previous work, the electron radius was identified as the “actual electron radius.” However, this is more accurately described as the electron radius at rest. This study reexamines the electron with an emphasis on the electron radius under motion, incorporating the effects of length contraction. The findings suggest that the radius is subject to Lorentz contraction, which has interesting implications for relativistic effects at the subatomic level.

Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

Integrated network pharmacology and metabolomics to explore the mechanisms of Shenzao dripping pill against chronic myocardial ischemia

Background:Shenzao dripping pill(SZDP)is empirically prescribed for treating cardiac diseases.Nevertheless,there is a lack of comprehensive knowledge regarding the underlying mechanisms contributing to its therapeutic effects.The objective of this study is to investigate the underlying mechanism of SZDP against chronic myocardial ischemia(CMI)in a rat model.Methods:In this study,we utilized electrocardiographic and echocardiographic detection along with pathological tissue analysis to evaluate the efficacy of SZDP.The integration of network pharmacology and metabolomics was conducted to investigate the mechanisms.Molecular docking and molecular dynamics simulations were used to validate the binding energy between the compounds of SZDP and the associated targets.Results:The results showed that SZDP was able to improve T wave voltage,reverse CMI abnormalities in ejection fraction and fractional shortening,and restore histopathological heart damage.Metabolomics results indicated that disturbances of metabolic profile in CMI rats were partly corrected after SZDP administration,mainly affecting purine metabolism.13-Docosenamide may be the potential metabolic biomarker of the therapeutic application of SZDP for CMI.Integrating network pharmacology and metabolomics,thiopurine S-methyltransferase(TPMT),xanthine dehydrogenase/oxidase(XDH),bifunctional purine biosynthesis protein ATIC(ATIC),and cytochrome p4501A1(CYP1A1)were identified as possible targets of SZDP to exert therapeutic effects by enhancing the metabolic levels of L-Tryptophan,Deoxyribose 1-phosphate and Phosphoribosyl formamidocarboxamide.Conclusion:SZDP has a therapeutic effect on CMI by regulating metabolite levels,acting on the targets of TMPT,XDH,ATIC,and CYP1A1,and reducing cardiomyocyte injury and myocardial fibrosis.

Impact of depression on in-hospital outcomes for adults with type 2 myocardial infarction:A United States population-based analysis

BACKGROUND Type 2 myocardial infarction(T2MI)is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event.However,though there is a rising prevalence of depression and its potential association with type 1 myocardial infarction(T1MI),data remains nonexistent to evaluate the asso-ciation with T2MI.AIM To identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes.METHODS We queried the National Inpatient Sample(2019)to identify T2MI hospitalizations using Internal Classification of Diseases-10 codes in hospitalized adults(≥18 years).In addition,we compared sociodemographic and comorbidities in the T2MI cohort with vs without comorbid depression.Finally,we used multivariate regression analysis to study the odds of T2MI hospitalizations with vs without depression and in-hospital outcomes(all-cause mortality,cardiogenic shock,cardiac arrest,and stroke),adjusting for confounders.Statistical significance was RESULTS There were 331145 adult T2MI hospitalizations after excluding T1MI(median age:73 years,52.8%male,69.9%white);41405(12.5%)had depression,the remainder;289740 did not have depression.Multivariate analysis revealed lower odds of T2MI in patients with depression vs without[adjusted odds ratio(aOR)=0.88,95%confidence interval(CI):0.86-0.90,P=0.001].There was the equal prevalence of prior MI with any revascularization and a similar prevalence of peripheral vascular disease in the cohorts with depression vs without depression.There is a greater prevalence of stroke in patients with depression(10.1%)vs those without(8.6%).There was a slightly higher prevalence of hyperlipidemia in patients with depression vs without depression(56.5%vs 48.9%),as well as obesity(21.3%vs 17.9%).There was generally equal prevalence of hypertension and type 2 diabetes mellitus in both cohorts.There was no significant difference in elective and non-elective admissions frequency between cohorts.Patients with depression vs without depression also showed a lower risk of all-cause mortality(aOR=0.75,95%CI:0.67-0.83,P=0.001),cardiogenic shock(aOR=0.65,95%CI:0.56-0.76,P=0.001),cardiac arrest(aOR=0.77,95%CI:0.67-0.89,P=0.001)as well as stroke(aOR=0.79,95%CI:0.70-0.89,P=0.001).CONCLUSION This study revealed a significantly lower risk of T2MI in patients with depression compared to patients without depression by decreasing adverse in-hospital outcomes such as all-cause mortality,cardiogenic shock,cardiac arrest,and stroke in patients with depression.

Circulating CCRR serves as potential novel biomarker for predicting acute myocardial infarction

Objective:Cold regions exhibit a high prevalence of cardiovascular disease,particularly acute myocardial infarction(AMI),which is one of the leading causes of death associated with cardiovascular conditions.Cardiovascular disease is closely linked to the abnormal expression of long non-coding RNA(lncRNA).This study investigates whether circulating levels of lncRNA cardiac conduction regulatory RNA(CCRR)could serve as a biomarker for AMI.Materials and methods:We measured circulating CCRR from whole blood samples collected from 68 AMI patients and 69 non-AMI subjects.An AMI model was established using C57BL/6 mice.Quantitative reverse transcription PCR(qRT-PCR)was used to assess CCRR expression.Exosomes were isolated from cardiomyocytes,and their characteristics were evaluated using electron microscope and nanoparticle tracking analysis.The exosome inhibitor GW4869 was employed to examine the effect of exosomal CCRR on cardiac function using echocardiography.Protein expression was detected using Western blot and immunofluorescence staining.Results:The circulating level of CCRR was significantly higher in AMI patients(1.93±0.13)than in non-AMI subjects(1.00±0.05,P<0.001).The area under the ROC curve(AUC)of circulating CCRR was 0.821.Similar changes in circulating CCRR levels were consistently observed in an AMI mouse model.Exosomal CCRR derived from hypoxia-induced cardiomyocytes and cardiac tissue after AMI were increased,a change that was reversed by GW4869.Additionally,CCRR-overexpressing exosomes improved cardiac function in AMI.Conclusion:Circulating lncRNA CCRR is a potential predictor of AMI.Exosomal CCRR plays a role in the communication between the heart and other organs through circulation.

Allocation of Public Service Facilities in Villages and Towns from the Perspective of Smart Contraction: A Case Study of Zixi County, Jiangxi Province

The limitation of traditional layout system and the continuous contraction of villages and towns have brought challenges to the layout of public service facilities.It is an imperative task against this background to integrate space resources and allocate public service facilities scientifically and reasonably.This paper took the system and method of rural public service facility allocation from the perspective of smart contraction as the theoretic support,and Zixi County in Jiangxi Province for example,built the four-level life circle of“county-fundamental-basic-routine”based on the influence factors of facility allocation,village and town contraction strength,rural comprehensive assessment results,residents’trip willingness and demands on public service facilities,finally proposed the suggestions for optimizing the allocation of village and town public service facilities.

Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient:A case report

BACKGROUND The combination of acute ST-segment elevation myocardial infarction(STEMI)and gastric ulcers poses a challenge to primary percutaneous coronary intervention(PPCI),particularly for young patients.The role of drug-coated balloons(DCBs)in the treatment of de novo coronary artery lesions in large vessels remains unclear,especially for patients with STEMI.Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.CASE SUMMARY A 54-year-old male patient presented to the emergency department due to chest pain on June 24,2019.Within the first 3 minutes of the initial assessment in the emergency room,the electrocardiogram(ECG)showed significant changes.There was atrial fibrillation with ST-segment elevation.Subsequently,atrial fibrillation terminated spontaneously and reverted to sinus rhythm.Soon after,the patient experienced syncope.The ECG revealed torsades de pointes ventricular tachycardia.A few seconds later,it returned to sinus rhythm.High-sensitivity tropon in I was normal.The diagnosis was acute STEMI.Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery.Considering the patient's age and history of peptic ulcer disease,after the intracoronary injection of prourokinase,percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning,and paclitaxel drug-eluting balloon angioplasty was performed without any stents,achieving favorable outcomes.CONCLUSION A PPCI without stents may be a viable treatment strategy for select patients with STEMI,and further research is warranted.

Guicao Baidu decoction in mitigating chemotherapy-induced myocardial injury:case report and mechanism investigation

To observe the effects of GuiCaoBaiDu Decoction(GCBD)on chemotherapy especially doxorubicin(DOX)-induced myocardial cardiotoxicity(DIC)and explore the mechanisms.The present study presents a case demonstrating the preventive and therapeutic effects of GCBD on myocardial injury following chemotherapy.Then network pharmacology was employed to predict the targets of GCBD.Subsequently,a DOX-induced apoptosis model of H9C2 cardiomyocytes was established and co-cultured with serum containing GCBD serum.The viability and myocardial enzyme levels were evaluated using CCK8 assay and ELISA assay,TUNEL was using for apoptosis test.The GCBD effect was confirmed by tests of ROS andα-actinin levels,evaluation of mitochondrial morphology,and BAX co-localization with mitochondria.Furthermore,the expression levels of apoptosis-related molecules were determined via Western blotting.Additionally,a mouse model exhibiting DOX-induced cardiac functional impairment was generated and subsequently treated with GCBD.Myocardial enzyme level was tested at first,then echocardiography was tested,myocardial apoptosis in mice was observed through HE staining while related proteins were detected using IHC.Network pharmacological analyses revealed that GCBD exerts its effects on BAX,Caspase7,and other related molecules.Initially,we demonstrated the effective amelioration of DIC in cardiomyocyte viability,LDH/CK levels,α-actinin and ROS levels,and apoptosis by GCBD through improvements in TUNEL test,mitochondrial morphology and WB.The efficacy of GCBD in enhancing cardiac function in DIC mice has been validated through animal experiments.Taken together,our study showed that GCBD could significantly alleviate DOX induced myocardial injury by regulating mitochondrial apoptosis.The utilization of GCBD can effectively contribute to the prevention and treatment of chemotherapy-induced myocardial injury when anthracycline chemotherapy is employed in clinical practice.