Plasma metabolites and risk of myocardial infarction:a bidirectional Mendelian randomization study

BACKGROUND Myocardial infarction(MI)is a critical cardiovascular event with multifaceted etiology,involving several genetic and environmental factors.It is essential to understand the function of plasma metabolites in the development of MI and unravel its complex pathogenesis.METHODS This study employed a bidirectional Mendelian randomization(MR)approach to investigate the causal relationships between plasma metabolites and MI risk.We used genetic instruments as proxies for plasma metabolites and MI and conducted MR analyses in both directions to assess the impact of metabolites on MI risk and vice versa.In addition,the large-scale genome-wide association studies datasets was used to identify genetic variants associated with plasma metabolite(1400 metabolites)and MI(20,917 individuals with MI and 440,906 individuals without MI)susceptibility.Inverse variance weighted was the primary method for estimating causal effects.MR estimates are expressed as beta coefficients or odds ratio(OR)with 95%CI.RESULTS We identified 14 plasma metabolites associated with the occurrence of MI(P<0.05),among which 8 plasma metabolites[propionylglycine levels(OR=0.922,95%CI:0.881–0.965,P<0.001),gamma-glutamylglycine levels(OR=0.903,95%CI:0.861–0.948,P<0.001),hexadecanedioate(C16-DC)levels(OR=0.941,95%CI:0.911–0.973,P<0.001),pentose acid levels(OR=0.923,95%CI:0.877–0.972,P=0.002),X-24546 levels(OR=0.936,95%CI:0.902–0.971,P<0.001),glycine levels(OR=0.936,95%CI:0.909–0.964,P<0.001),glycine to serine ratio(OR=0.930,95%CI:0.888–0.974,P=0.002),and mannose to trans-4-hydroxyproline ratio(OR=0.912,95%CI:0.869–0.958,P<0.001)]were correlated with a decreased risk of MI,whereas the remaining 6 plasma metabolites[1-palmitoyl-2-arachidonoyl-GPE(16:0/20:4)levels(OR=1.051,95%CI:1.018–1.084,P=0.002),behenoyl dihydrosphingomyelin(d18:0/22:0)levels(OR=1.076,95%CI:1.027–1.128,P=0.002),1-stearoyl-2-docosahexaenoyl-GPE(18:0/22:6)levels(OR=1.067,95%CI:1.027–1.109,P=0.001),alpha-ketobutyrate levels(OR=1.108,95%CI:1.041–1.180,P=0.001),5-acetylamino-6-formylamino-3-methyluracil levels(OR=1.047,95%CI:1.019–1.076,P<0.001),and N-acetylputrescine to(N(1)+N(8))-acetylspermidine ratio(OR=1.045,95%CI:1.018–1.073,P<0.001)]were associated with an increased risk of MI.Furthermore,we also observed that the mentioned relationships were unaffected by horizontal pleiotropy(P>0.05).On the contrary,MI did not lead to significant alterations in the levels of the aforementioned 14 plasma metabolites(P>0.05 for each comparison).CONCLUSIONS Our bidirectional MR study identified 14 plasma metabolites associated with the occurrence of MI,among which 13 plasma metabolites have not been reported previously.These findings provide valuable insights for the early diagnosis of MI and potential therapeutic targets.

Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.

Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI) are available.METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months(interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level(< 170 mg/L) and those with the high prealbumin level(≥ 170 mg/L).RESULTS A total of 114 patients(4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class Ⅲ(9.9%vs. 4.4%, P = 0.034), cardiovascular death(8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events(19.2%vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level(< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events(odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cutoff value of prealbumin level for predicting in-hospital death was 170 mg/L(area under the curve = 0.703, 95% CI: 0.651–0.754, P< 0.001;sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level(170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results.CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

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.

Delay Times and Clinical Outcomes in Acute Myocardial Infarction: Comparison of Periods before and during the COVID-19 Pandemic—Myocardial Infarction and the Pandemic

Introduction: At the beginning of the COVID-19 pandemic, a drop in the number of patients treated for cardiac emergencies raised concern about cardiovascular mortality in that period. An increase in care delay for patients with ST-segment elevation myocardial infarction (STEMI) may have affected clinical outcomes. Objectives: To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), before and during the COVID-19 pandemic. Methods: Retrospective observational study that included patients with STEMI undergoing PPCI from December 2018 to July 2021. The COVID-19 pandemic cases were divided into two groups: pandemic I—from March to August 2020;and pandemic II—from September 2020 to July 2021. Patients were compared according to the period of hospitalization. Primary outcomes were delay times in assistance and clinical outcomes (acute kidney injury [AKI], post-procedural vascular complications and in-hospital mortality). Results: 108 patients were included, 39 (36.1%) in the pre-pandemic period, 13 (12.1%) in pandemic I and 56 (51.8%) in pandemic II. Time from onset of symptoms to arrival at the service and door-to-balloon time did not differ significantly among groups. Vascular complications were more frequent during the pandemic (I and II) than in the pre-pandemic period (2.5% pre-pandemic vs 15.4% pandemic vs 12.5% pandemic II;p = 0.03). AKI incidence was similar in all three periods. There was a non-significant increase in in-hospital mortality during the COVID-19 pandemic. Conclusion: In patients with STEMI, there was an increase in vascular complications and a trend toward increased mortality during the COVID-19 pandemic. Delay times to admission and reperfusion did not differ significantly between before and during the pandemic.

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.

Artificial intelligence software for assessing brain ischemic penumbra/core infarction on computed tomography perfusion:A real-world accuracy study

BACKGROUND With the increasingly extensive application of artificial intelligence(AI)in medical systems,the accuracy of AI in medical diagnosis in the real world deserves attention and objective evaluation.AIM To investigate the accuracy of AI diagnostic software(Shukun)in assessing ischemic penumbra/core infarction in acute ischemic stroke patients due to large vessel occlusion.METHODS From November 2021 to March 2022,consecutive acute stroke patients with large vessel occlusion who underwent mechanical thrombectomy(MT)post-Shukun AI penumbra assessment were included.Computed tomography angiography(CTA)and perfusion exams were analyzed by AI,reviewed by senior neurointerventional experts.In the case of divergences among the three experts,discussions were held to reach a final conclusion.When the results of AI were inconsistent with the neurointerventional experts’diagnosis,the diagnosis by AI was considered inaccurate.RESULTS A total of 22 patients were included in the study.The vascular recanalization rate was 90.9%,and 63.6%of patients had modified Rankin scale scores of 0-2 at the 3-month follow-up.The computed tomography(CT)perfusion diagnosis by Shukun(AI)was confirmed to be invalid in 3 patients(inaccuracy rate:13.6%).CONCLUSION AI(Shukun)has limits in assessing ischemic penumbra.Integrating clinical and imaging data(CT,CTA,and even magnetic resonance imaging)is crucial for MT decision-making.

Clinical Efficacy of Metoprolol Succinate Extended-Release Tablets in the Treatment of Post-Myocardial Infarction Ventricular Arrhythmias

Objective:To investigate the clinical efficacy of metoprolol succinate extended-release tablets in the treatment of post-myocardial infarction ventricular arrhythmias.Methods:The clinical data of 84 patients with post-myocardial infarction ventricular arrhythmia included in the study were collected and they were divided into Groups A and B with 42 cases each using the randomization method.Group A was treated with oral glucosamine hydrochloride,while Group B was administered oral metoprolol succinate extended-release tablets.Combined indicators were used to evaluate the improvement of clinical indicators,therapeutic effects,and the incidence of adverse reactions in the two groups.Results:The baseline data of the two groups of patients were not statistically significant(Pall>0.05);after treatment,the QT dispersion,corrected QT dispersion,and heart rate of Group B were lower than that of Group A(Pall=0.000<0.001);the 2 total clinical effectiveness of Group B was 95.24%,which was significantly higher than 80.95%in Group A(χ=4.087,P=0.043<0.05);the total incidence of adverse reactions in Group B was 4.76%,which was significantly lower than 219.04%in Group A(χ=4.087,P=0.043<0.05).Conclusion:In the treatment of post-myocardial infarction ventricular arrhythmia,the use of metoprolol succinate extended-release tablets can effectively correct the QT dispersion of patients,improve their heart rate,increase clinical effectiveness,and reduce the incidence of adverse reactions.

STEMI患者外周血单个核细胞中MAPK通路与炎症反应及PCI后无复流的关系

目的 研究ST段抬高型心肌梗死(STEMI)患者外周血单个核细胞(PBMCs)中丝裂原活化蛋白激酶(MAPK)通路与炎症反应及经皮冠状动脉介入术(PCI)后无复流的关系。方法 选取郑州市第七人民医院2021年2月至2022年10月进行PCI治疗的STEMI患者和同期进行体检的健康志愿者,分别作为STEMI组(n=92)和对照组(n=100)。采用荧光定量PCR法检测PBMCs中p38MAPK、JNK的表达水平,根据中位数将STEMI组患者分为p38MAPK、JNK高表达和低表达。检测STEMI患者血清ICAM-1、TNF-α、IL-6含量,评估STEMI患者心肌损伤程度及无复流情况。结果 STEMI组患者PBMCs中p38MAPK、JNK的表达水平高于对照组,差异有统计学意义(t=5.386、5.126,P<0.05);STEMI组中p38MAPK、JNK高表达患者的CK-MB峰值、cTnT峰值及ICAM-1、TNF-α、IL-6含量均高于p38MAPK、JNK低表达患者,差异有统计学意义(t=7.143、4.999、9.528、6.805、6.890、6.226、8.132、7.807、7.162、7.588,P<0.05);STEMI组中无复流患者PBMCs中p38MAPK、JNK的表达水平高于血流正常患者,差异有统计学意义(t=5.208、4.240,P<0.05);经ROC曲线分析,PBMCs中p38MAPK、JNK的表达水平对STEMI患者PCI后无复流具有预测价值(P<0.05)。结论 STEMI患者MAPK通路中p38MAPK、JNK的高表达与炎症反应激活、PCI后无复流有关。

阿司匹林抗血小板相关基因多态性在汉族NSTEMI患者人群中的分布

目的:分析汉族非ST段抬高型心肌梗死(NSTEMI)患者人群中与阿司匹林抗血小板药理作用相关的GPⅢa PLA2(rs5918)、PEAR1(rs12041331)和PTGS1(rs10306114)基因的基因型结果及等位基因分布特征,为汉族NSTEMI患者的个体化治疗提供参考。方法:选取2016年1月~2022年12月首都医科大学附属北京潞河医院收治的汉族NSTEMI患者107例为研究对象。采用荧光染色原位杂交的方法对GPⅢa PLA2(rs5918)、PEAR1(rs12041331)和PTGS1(rs10306114)3个基因多态性位点进行检测分型,研究分析其基因型频率分布及等位基因分布情况,并分析汉族NSTEMI患者人群与1000 Genomes数据库中部分人群相关等位基因的分布是否存在统计学差异。结果:汉族NSTEMI患者人群中,GPⅢa PLA2(rs5918)位点上基因型频率为TT 97.20%、TC 2.80%、CC 0%,等位基因频率为T 98.60%、C 1.40%;PEAR1(rs12041331)位点上基因型频率为GG 42.06%、GA 44.86%、AA 13.08%,等位基因频率为G64.49%、A 35.51%;PTGS1(rs10306114)位点上基因型均为AA(100%),未见AG或GG型。结论:在汉族NSTEMI患者人群中,与阿司匹林抗血小板药理作用相关的GPⅢa PLA2(rs5918)位点上突变少见,PTGS1(rs10306114)位点上未见突变,这2个多态性位点上均以野生型纯合子为主,而PEAR1(rs12041331)位点上突变多见。本研究中部分结果与既往报道或相关数据库中收录的其他人群类似,也有部分结果与既往报道或其他人群存在明显差异。

HFACS-MI改进模型在危险化学品仓储事故人因分析中的应用

为了研究危险化学品仓储事故的关键人因,通过人因分析与分类系统-煤矿(Human Factors Analysis and Classification System-Mine,HFACS-MI)改进模型从员工的不安全行为、影响不安全行为的前提条件、监督行为、组织影响和企业外部因素5个层次系统地分析65起危险化学品仓储事故,并运用卡方检验和让步比分析了产生不安全行为的原因和各层次间的内在关系。结果表明,外部管理、组织过程、监督不充分、个人因素、技能差错和违规是导致危险化学品仓储事故发生的重要因素。HFACS-MI改进模型上下层级的人为因素间存在显著的因果关系,且主要的危险化学品仓储事故致因路径共有5条,其中“外部管理因素—组织过程漏洞—监督不充分—个人因素—违规”是最关键的致因路径。改进的HFACS-MI模型可以有效分析危险化学品仓储事故人因因素。

AMI多支病变患者PCI术前应用替格瑞洛对其术后NF-κB信号通路、血小板聚集及心肌微循环灌注的影响

目的:探讨急性心肌梗死(AMI)多支病变患者经皮冠状动脉介入(PCI)术前应用替格瑞洛对其术后核因子(NF)-κB信号通路、血小板聚集及心肌微循环灌注的影响。方法:选择我院收治的AMI合并多支病变患者120例,随机均分氯吡格雷组和替格瑞洛组。PCI术前后给予相应的药物治疗,观察两组服药前后NF-κB信号通路相关指标、血小板聚集率、心肌微循环指标及主要不良心脑血管事件发生情况。结果:PCI术后7 d,与氯吡格雷组比较,替格瑞洛组冠脉微循环指标中左前降支(LAD)[(23.83±2.69)帧比(20.48±3.05)帧]、左回旋支(LCX)[(20.93±2.82)帧比(18.35±2.37)帧]及右冠状动脉(RCA)[(23.68±3.15)帧比(21.13±2.79)帧]校正的心肌梗死溶栓试验(CTFC)帧数均显著减少(P均=0.001);治疗30d后,与氯吡格雷组比较,替格瑞洛组血小板最大聚集率、ST段最大下降幅度、ST段下降时间、24h缺血发作次数及Toll样受体4(TLR4)蛋白、NF-κB蛋白、肿瘤坏死因子(TNF)-α和白介素(IL)-6水平均显著减少(P均=0.001)。6个月内,两组主要不良心脑血管事件发生率无统计学意义(P=0.186)。结论:替格瑞洛能改善AMI合并多支病变患者PCI术后心肌微循环,抑制血小板聚集,减轻机体炎症反应,其机制可能与替格瑞洛抑制NF-κB信号通路活性有关。

无线紫外光MIMO通信系统信道容量估算方法

无线紫外光通信系统易受大气散射等因素的影响,导致通信信道容量估算准确率较低。为此,提出一种无线紫外光多入多出(Multiple-Input Multiple-Output, MIMO)通信系统信道容量估算方法。根据信道特征,构建无线紫外光MIMO通信系统的信道容量估计模型,获取无线紫外光的单次散射传输特性,利用符号补码式的方法改进空时编码,设定高级检测器中符号的接收能耗,使每个符号保持在标准功率数值范围内,完成通信系统信道检测式编码。根据不同发射角和接收角计算无线紫外光通信的路径损耗比,通过泊松随机分布获得最终通信系统信道容量的估算结果。实验结果表明,所提方法的传输速率可高达8 Mbps,误码率始终低于10-3bit/s,估算准确率在90%以上,估计时间低于4 ms,估算效果好,可为通信行业发展提供理论依据。

心脏磁共振在MINOCA患者管理中的应用规范和研究进展

冠状动脉非阻塞性心肌梗死(myocardial infarction without obstructive coronary artery, MINOCA)是指在即冠状动脉管腔面积狭窄≤50%的情况下发生的心肌梗死(myocardial infarction, MI),占总MI的1%~14%。MINOCA的病因复杂多样,正确诊断并明确MINOCA的潜在病因,对于指导后续临床管理至关重要。基于心肌组织特征成像的独特优势,非侵入性的心脏磁共振(cardiac magnetic resonance,CMR)检查在MINOCA患者管理中的价值已被广泛认可。CMR检查可排除类似MI的疾病,如心肌炎、应激心肌病,明确导致MINOCA的潜在病因,是诊断流程中的必要检查手段,有助于减少MINOCA的过度诊断、误诊以及真性MINOCA的漏诊。目前已被美国心脏学会(American Heart Association,AHA)及欧洲心脏学会(European Society of Cardiology,ESC)推荐为MINOCA管理流程中必不可少的检查手段。此外,与冠状动脉阻塞患者相比,MINOCA患者的短期预后较好,但在长期随访中MINOCA患者出现不良预后的风险增加,有必要对MINOCA患者的预后及风险分层提高重视,纳入管理流程。传统的MI预后评价系统对MINOCA患者并不完全适用,CMR检查可为MINOCA患者的预后评估提供有价值的信息。当前,对于CMR在MINOCA患者管理中的应用,国内尚无标准化规范、指南。本文旨在对CMR技术在MINOCA临床管理中的应用规范和预后价值进行介绍,为临床提供参考,以增进对这种特殊MI病变的理解和管理。

An easily misdiagnosed and rare cause of traumatic back pain: bilateral renal infarction caused by traumatic bilateral renal artery dissection

Dear editor,The incidence of renal infarction in patients admitted to the emergency department(ED) is approximately 0.004%.[1]Among patients with renal infarction, bilateral renal involvement has been reported in 28.6% of patients.[2]However, there are very few cases of bilateral renal infarction after a traumatic injury.

血清miR-124、CD146及Angptl2水平与急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系研究

目的探讨血清微小RNA-124(miR-124)、CD146、血管生成素样蛋白2(Angptl2)与急性脑梗死(ACI)患者颈动脉粥样硬化(CAS)斑块稳定性的关系,为ACI患者的早期防治提供参考依据。方法选择2020年1月至2023年2月在邯郸市中心医院就诊的ACI患者191例作为ACI组,另选取同期在该院体检的健康志愿者61例作为对照组。根据颈动脉彩色多普勒超声结果将ACI患者分为不稳定斑块组(56例)、稳定斑块组(71例)、无斑块组(64例)。采用实时荧光定量聚合酶链式反应(RT-qPCR)技术检测所有对象血清miR-124表达水平,采用酶联免疫吸附试验(ELISA)检测血清CD146、Angptl2水平,采用单因素及多因素Logistic回归分析ACI患者CAS斑块不稳定的影响因素;采用受试者工作特征(ROC)曲线分析血清miR-124、CD146联合Angptl2对ACI患者CAS斑块不稳定的预测价值。结果ACI组血清CD146、Angptl2水平高于对照组,miR-124表达水平低于对照组(P<0.05)。单因素分析结果显示,ACI患者CAS斑块的稳定性与患者年龄、合并高血压、合并高脂血症、纤维蛋白原(FIB)、血清C反应蛋白(CRP)、血清胱抑素C(CyC)、CD146、Angptl2、miR-124有关(P<0.05);多因素Logistic回归分析结果显示,血清miR-124下降、CD146升高、Angptl2升高、合并高脂血症是ACI患者CAS斑块稳定性的危险因素(P<0.05)。血清miR-124、CD146、Angptl2及三项指标联合应用预测ACI患者CAS斑块不稳定的ROC曲线下面积(AUC)分别为0.741、0.719、0.781和0.834。结论血清miR-124表达水平及CD146、Angptl2水平是ACI患者CAS斑块不稳定的影响因素,可能参与ACI患者CAS斑块形成及发展过程,三者联合检测对ACI患者CAS斑块不稳定具有较好的预测效能。

血管内超声参数联合microRNA-206评估非ST段抬高型急性心肌梗死患者病变严重程度及预后的价值

目的探讨血管内超声(IVUS)参数联合microRNA-206(miR-206)评估非ST段抬高型急性心肌梗死(NSTEAMI)患者病变严重程度及预后的价值。方法选取2019年3月-2021年4月河北北方学院附属第一医院收治的105例NSTEAMI患者,所有患者行经皮冠状动脉介入术(PCI),根据病变严重程度将患者分为单支病变组(55例)、双支病变组(32例)、多支病变组(18例)。对比不同病变程度患者IVUS参数、血清miR-206,分析IVUS参数、血清miR-206与NSTEAMI患者病变严重程度的相关性。随访2年,根据是否发生MACE分为发生组与非发生组。对比发生组与非发生组的临床资料,采用多因素逐步Logistic回归模型分析NSTEAMI患者发生主要不良心脏事件(MACE)的影响因素。绘制受试者工作特征(ROC)曲线,评估IVUS参数、血清miR-206预测NSTEAMI患者发生MACE的效能。结果多支病变组斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于单支、双支组(P<0.05),且双支病变组均高于单支病变组(P<0.05)。Pearson相关性分析结果显示,血管外弹力膜面积与NSTEAMI患者病变严重程度无相关性(r=0.271,P=0.325);斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206与NSTEAMI患者病变严重程度呈正相关(r=0.416、0.382、0.423、0.507和0.394,均P=0.000)。随访2年,失访2例,剩余103例患者中32例(31.07%)发生MACE,71例(68.93%)未发生MACE。发生组多支病变、血运未重建占比、斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于非发生组(P<0.05),淋巴细胞计数、血红蛋白水平均低于非发生组(P<0.05)。多因素逐步Logistic回归分析结果显示:多支病变[OR=3.466(95%CI:1.523,7.884)]、血运未重建[OR=2.776(95%CI:1.220,6.315)]、斑块负荷[OR=3.155(95%CI:1.387,7.177)]、重构指数[OR=3.842(95%CI:1.689,8.740)]、偏心指数[OR=4.166(95%CI:1.831,9.477)]、血清miR-206[OR=4.500(95%CI:1.978,10.236)]为NSTEAMI患者发生MACE的危险因素(P<0.05)。ROC曲线结果显示,斑块负荷、重构指数、偏心指数、血清miR-206四者联合预测NSTEAMI患者发生MACE的敏感性为88.52%(95%CI:0.674,0.957),特异性为92.86%(95%CI:0.713,0.968),曲线下面积为0.900(95%CI:0.812,0.953)。结论IVUS参数(斑块负荷、重构指数、偏心指数)、血清miR-206在评估NSTEAMI患者病变严重程度与预后中具有重要价值,且四者联合具有更高的预测价值。

Application of a hospital–community–family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction

BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.

Omental infarction diagnosed by computed tomography,missed with ultrasonography:A case report

BACKGROUND Omental infarction(OI)is a surgical abdominal disease that is not common in adults and is very rare in children.Similar to various acute abdominal pain diseases including appendicitis,diagnosis was previously achieved by diagnostic laparotomy but more recently,ultrasonography or computed tomography(CT)examination has been used.CASE SUMMARY A 6-year-old healthy boy with no specific medical history visited the emergency room with right lower abdominal pain.He underwent abdominal ultrasonography by a radiologist to rule out acute appendicitis.He was discharged with no significant sonographic finding and symptom relief.However,the symptoms persisted for 2 more days and an outpatient visit was made.An outpatient abdominal CT was used to make a diagnosis of OI.After laparoscopic operation,his symptoms resolved.CONCLUSION In children’s acute abdominal pain,imaging studies should be performed for appendicitis and OI.

Prognostic Factors of Mortality in Post-Myocardial Infarction Patients: A 24-Hour Rhythmic Holter Observational Study

Background: Heart dysfunction and sudden death are common complications in post-myocardial infarction. Purpose: This study aims to contribute to improving patient’s management by determining the factors correlated to the occurrence of left ventricular dysfunction or post-infarction sudden death. Method: It was a transversal, descriptive and analytical study conducted from January to October 2021. Results: The variables studied covered epidemiological, therapeutic and electrocardiographic aspects. There were 102 patients admitted for a recent revascularized myocardial infarction or not who had received a 24-hour ECG Holter after the acute phase of coronary event. The study population was predominantly men 88% versus 12% women with a sex ratio of 0.15. The discharge prescription was 74% antiarrhythmic, 91% platelet antiaggregator and 14% anticoagulant. Electrical abnormalities consisted of supraventricular extrasystoles in 45% of cases, ventricular extrasystoles in 61%, atrial fibrillation in 19% and supraventricular tachycardias in 11% (p Conclusion: The prognostic factors associated with the onset of post-infarction complications were ventricular arrhythmias (p .