Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction...Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction(NSTEMI).[1]In China,AMI is widely recognized as a predominant cause of mortality in both urban and rural demographics,based on the 2022 Report on Cardiovascular Health and Diseases in China;moreover,its mortality rate has been reported to be rising,with a recurrence rate of 2.5%within one year.展开更多
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 ...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.展开更多
Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk fa...Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.展开更多
Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspira...Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspiration(TA),recent large trials have questioned its routine use.This review examines the role of thr-ombectomy in the management of AMI,focusing on its potential to improve my-ocardial perfusion and mitigate no-reflow risk.Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion.Similarly,standardising TA techn-iques and ensuring appropriate patients’selection may also improve enhance our understanding of the role of thrombectomy in AMI.Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.展开更多
In this article,we comment on the article by Zheng et al.This case report shed light on concomitant cerebrocardiac ischemic(CCI)in a 27-year-old male patient,which is defined as a concurrent acute ischemic stroke(AIS)...In this article,we comment on the article by Zheng et al.This case report shed light on concomitant cerebrocardiac ischemic(CCI)in a 27-year-old male patient,which is defined as a concurrent acute ischemic stroke(AIS)and acute myocardial infarction event.The patient received urgent systemic thrombolysis at the sta-ndard dose for AIS and then planned percutaneous coronary intervention was successfully conducted for ST-segment elevation myocardial infarction treatment.Considering the rarity of the comorbidity,the narrow time window for treatment of both AIS and acute myocardial infarction,as well as the complexity and severity of the condition,there are still no guidelines or consensus that have systematically recommended optimal treatment strategies.The successful treat-ment of this 27-year-old man suggests that urgent thrombolysis followed by planned percutaneous coronary intervention might be an alternative treatment options in the management of concomitant CCI.However,emergency treatment plans need to be developed according to the specific situation of the patients.A number of factors should be considered when making decision,including the location of occlusion of heart and brain,the hemodynamic instability,the ongoing ischemic symptoms,the presence of contraindications to thrombolysis,and the speed of response of cardiologists or neurointerventionists.Future,further res-earch involving multidisciplinary experts,including neurologist,cardiologist,and specialists in critical care medicine is needed to improve the understanding and management of concomitant CCI.展开更多
BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI ca...BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.展开更多
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 W...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.展开更多
The current study aimed to evaluate the efficacy and safety of Compound Danshen Dripping Pills(CDDP)in improving cardiac function in patients with acute anterior ST-segment elevation myocardial infarction(AAMI).Betwee...The current study aimed to evaluate the efficacy and safety of Compound Danshen Dripping Pills(CDDP)in improving cardiac function in patients with acute anterior ST-segment elevation myocardial infarction(AAMI).Between February 2021 and February 2023,247 eligible patients with AAMI after primary percutaneous coronary intervention were enrolled and randomly assigned(1∶1)to receive CDDP(n=126)or placebo(n=121),with a follow-up of 48 weeks.Compared with the placebo group,the CDDP group demonstrated a significant increase in left ventricular ejection fraction values after 24 weeks of treatment(least squares mean:3.31;95%confidence interval[CI]:1.72–4.90;P<0.001)and at the 48-week follow-up(least squares mean:4.35;95%CI:2.76–5.94;P<0.001).Significant reductions in N-terminal pro-B-type natriuretic peptide levels were observed in both groups at the 24-and 48-week visits with no significant difference between the two groups(P>0.1 for all).The incidence of major adverse cardiovascular and cerebrovascular events was 6.35%in the CDDP group and 5.79%in the placebo group(P=0.822).Notably,no serious adverse events were attributed to CDDP.These findings suggest that CDDP may be well tolerated and could improve left ventricular ejection fraction in patients with AAMI at 24 and 48 weeks.展开更多
AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to con...AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im⁃proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu⁃mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi⁃bition of ferroptosis.展开更多
OBJECTIVE To explore the mechanism of action of Qihuang Zhuyu formula(QHZYF)in improving depression after myocardial infarction(MI),with a focus on revealing its regulatory effect on the inflammatory response of the h...OBJECTIVE To explore the mechanism of action of Qihuang Zhuyu formula(QHZYF)in improving depression after myocardial infarction(MI),with a focus on revealing its regulatory effect on the inflammatory response of the heart and brain.METHODS The active ingredients of QHZYF and the action targets for intervening in depression after MI were analyzed by using ultra-performance liquid chromatography-high-resolution mass spectrometry(UPLC-Q-TOF/MS)combined with network pharmacology and molecular docking.A rat model of depression after MI was established by ligation of the left anterior descending coronary artery combined with chronic restraint stress.Echocardiography was used to evaluate cardiac function,hematoxylin-eosin(HE)and Masson staining were used to evaluate myocardial injury,behavioral tests were used to detect melancholic behaviors,Nissl staining was used to evaluate hippocampal neuron injury.Western blot detection of tumor necrosis factor receptor 2(TNFR2),phosphatidylinositol-3-kinase(PI3K),phosphorylated seronine protein kinase(p-AKT),seronine protein kinase(AKT),tumor necrosis factor receptor 1(TNFR1),phosphorylated nuclear factorκB(p-NF-κB),and nuclear factorκB(NF-κB)in cardiac and hippocampal tissues was conducted.The levels of serum IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay(ELISA),and the expression of TNFR1 and TNFR2 was detected by immunohistochemical technique(IHC).In vitro experiments,co-culture of rat cardiomyocyte line H9C2 cells and rat adrenal pheochromocytoma cell line with high differentiation PC12 cells was conducted,TNFR1 inhibitor(H398)and TNFR2 agonist(C-6His)were administered for intervention,and the expression of TNFR2,PI3K,p-AKT,AKT,TNFR1,NF-κB,p-NF-κB was detected by Western blot.Observe the apoptosis of cells by TUNEL staining,ELISA was used to detect the levels of IL-6 and IL-10 in the cell supernatant.RESULTS Network pharmacological analysis indicates that the TNF signaling pathway was a key target for the treatment of depression after MI with the QHZYF.In vivo experiments have confirmed that the intervention of QHZYF could significantly improve the cardiac function,myocardial tissue and hippocampal neuron structure damage of depressed rats after MI,and improve their depression-like behaviors.At the molecular level,the high-dose group of QHZYF significantly upregulated TNFR2,p-AKT/AKT,and IL-10 in cardiac and hippocampal tissues(P<0.01),and downregulated TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01).In vitro experiments showed that the drug-containing serum of QHZYF significantly upregulated the expression of TNFR2,p-AKT/AKT and IL-10 in H9C2 and PC12 cells(P<0.01),downregulated the expression of TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01),and significantly inhibited cell apoptosis(P<0.01).Furthermore,experiments on the combined application of H398 or C-6His further confirmed that its protective and anti-inflammatory effects were mediated by regulating the TNFR2/PI3K/AKT and TNFR1/NF-κB pathways.CONCLUSION QHZYF improves the homeostasis of heart and brain inflammation by regulating the TNF pathway,and ameliorates myocardial injury and depressive state in depressed rats after MI.展开更多
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 derive...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.展开更多
With the accelerated pace of population aging in China,the number of patients suffering from myocardial infarction(MI)is increasing annually.During disease progression,patients are at significantly higher risk of deve...With the accelerated pace of population aging in China,the number of patients suffering from myocardial infarction(MI)is increasing annually.During disease progression,patients are at significantly higher risk of developing severe negative emotions,and emerging evidence suggests that post-traumatic stress disorder(PTSD)is significantly associated with cardiovascular disease,which seriously affects patients’quality of life.Objective:The aim of this study was to comprehensively assess the prevalence and influencing factors of PTSD in MI patients through systematic review and Meta-analysis.Methods:A computerized search of PubMed,the Cochrane Library,Embase,Web of Science,PsycINFO,China Knowledge Network(CNKI),WanFang Data,VIP,and China Biomedical Literature Database(CBM)was conducted to collect longitudinal studies,case-control studies,and cross-sectional studies related to PTSD prevalence rates and influencing factors in MI patients published up to August 1,2024.Literature screening,data extraction and quality assessment were done independently by two researchers and Meta-analysis was done using Stata 16.0 software.This study has been registered on the PROSPERO platform,registration number:CRD42024577243.Results:A total of 16 papers were included,with a total sample size of 3,768 cases involving 8 influencing factors.The results of the Meta-analysis showed that the prevalence of PTSD in patients with MI was 20.4%(95%CI=15.0–26.5%).Female(OR=3.12,95%CI=1.97–4.97,P<0.001),high neuroticism score(OR=2.21,95%CI=1.20–4.07,P=0.011),and high intrusive rumination score(OR=2.95,95%CI=1.50–5.83,P=0.002)were the risk factors for PTSD in MI patients.While age(OR=1.01,95%CI=0.98–1.04,P=0.440),education level(OR=0.55,95%CI=0.07–4.48,P=0.574),social support rating scale(OR=0.81,95%CI=0.52–1.26,P=0.346),Killip cardiac function classification(OR=2.29,95%CI=0.91–5.80,P=0.080)and creatine kinase isoenzyme(OR=1.03,95%CI=0.99–1.05,P=0.124)were not associated with the development of PTSD in MI patients.Conclusion:The prevalence of PTSD was higher in patients with MI.The prevalence varied by evaluation tool and study area.Risk factors were multifactorial,including general factors(female)and overall assessment(high neuroticism score,high invasive rumination score).Therefore,early intervention and proper de-escalation of PTSD symptoms in patients with MI by medical staff are needed in clinical practice to reduce the risk of PTSD.展开更多
Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It ...Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.展开更多
Myocardial infarction(MI)is one of the leading causes of death globally among cardiovascular diseases,necessitating modern and accurate diagnostics for cardiac patient conditions.Among the available functional diagnos...Myocardial infarction(MI)is one of the leading causes of death globally among cardiovascular diseases,necessitating modern and accurate diagnostics for cardiac patient conditions.Among the available functional diagnostic methods,electrocardiography(ECG)is particularly well-known for its ability to detect MI.However,confirming its accuracy—particularly in identifying the localization of myocardial damage—often presents challenges in practice.This study,therefore,proposes a new approach based on machine learning models for the analysis of 12-lead ECG data to accurately identify the localization of MI.In particular,the learning vector quantization(LVQ)algorithm was applied,considering the contribution of each ECG lead in the 12-channel system,which obtained an accuracy of 87%in localizing damaged myocardium.The developed model was tested on verified data from the PTB database,including 445 ECG recordings from both healthy individuals and MI-diagnosed patients.The results demonstrated that the 12-lead ECG system allows for a comprehensive understanding of cardiac activities in myocardial infarction patients,serving as an essential tool for the diagnosis of myocardial conditions and localizing their damage.A comprehensive comparison was performed,including CNN,SVM,and Logistic Regression,to evaluate the proposed LVQ model.The results demonstrate that the LVQ model achieves competitive performance in diagnostic tasks while maintaining computational efficiency,making it suitable for resource-constrained environments.This study also applies a carefully designed data pre-processing flow,including class balancing and noise removal,which improves the reliability and reproducibility of the results.These aspects highlight the potential application of the LVQ model in cardiac diagnostics,opening up prospects for its use along with more complex neural network architectures.展开更多
BACKGROUND Pancreatic carcinoma is recognized as one of the most prothrombotic malig-nancies,carrying a high risk of thrombotic events,which may even precede the diagnosis of the underlying occult tumor.Acute renal in...BACKGROUND Pancreatic carcinoma is recognized as one of the most prothrombotic malig-nancies,carrying a high risk of thrombotic events,which may even precede the diagnosis of the underlying occult tumor.Acute renal infarction(ARI)as the initial presenting feature in patients with pancreatic cancer is a rare occurrence,and misdiagnosis is common during early evaluation.CASE SUMMARY We report a patient who presented with ARI as the initial manifestation prior to the diagnosis of pancreatic cancer.The 50-year-old male was admitted to our emergency department with sharp,left-sided abdominal pain and was subse-quently transferred to our department following the detection of a pancreatic space-occupying lesion on computed tomography(CT).CT angiography prom-ptly identified the cause of his pain,confirming right renal infarction.Urgent interventional treatment was initiated to alleviate symptoms and restore renal perfusion.Despite aggressive thrombolytic and anticoagulant therapy,the thrombotic event rapidly worsened,leading to multiple cerebral infarctions.The patient’s condition ultimately deteriorated under palliative care.CONCLUSION This case illustrates that arterial thromboembolism,when diagnosed at an ad-vanced stage of pancreatic cancer,appears to be a terminal event that portends a poor prognosis.Establishing an arterial thrombosis prediction model will po-tentially identify the profile of high-risk patients with thrombotic consequences for primary prevention.展开更多
Objective:To explore the effect of narrative nursing combined with exercise training on health beliefs and cardiac rehabilitation in patients with acute myocardial infarction(AMI)after interventional treatment.Methods...Objective:To explore the effect of narrative nursing combined with exercise training on health beliefs and cardiac rehabilitation in patients with acute myocardial infarction(AMI)after interventional treatment.Methods:A total of 111 patients with acute myocardial infarction(AMI)who received interventional therapy in Department of Cardiology of Hefei First People’s Hospital from January 2022 to September 2023 were selected as the study subjects.They were randomly divided into a control group(n=55)and a study group(n=56)using a random table method.Both groups received routine nursing care,while the control group received exercise training on top of it.The study group received narrative nursing care on top of the control group.Both groups were intervened until the patients were discharged.The health beliefs,heart function,psychological status,and quality of life after intervention were compared between two groups using a 6-minute walk test(6MWT).Results:After intervention,the scores of the TSK-SV Heart in all dimensions(fear of movement,functional disorders,risk perception,and avoidance of movement)decreased in both groups,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,the scores of the Self Rating Anxiety Scale(SAS)and Self Rating Depression Scale(SDS)in both groups decreased,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,both groups showed an increase in left ventricular ejection fraction(LVEF)and left ventricular early diastolic peak flow velocity/left ventricular late diastolic peak flow velocity(E/A),with the study group being higher than the control group.The left ventricular end diastolic diameter(LVEDD)and left atrial volume index(LAVI)decreased,and the study group was lower than the control group,with statistical significant differences(P<0.05).The walking distance of the study group at 6MWT(488.8±31.4)m was greater than that of the control group(425.54±30.7)m,with statistical significant differences(P<0.05).The quality of life measurement scale(CROQ-PTCA-Post)of the study group after coronary intervention treatment had higher scores in all dimensions(physical function,satisfaction,psychosocial function,adverse reactions,symptoms,cognitive function)than the control group,with statistical significant differences(P<0.05).Conclusion:Narrative nursing combined with exercise training can enhance the health beliefs of AMI patients towards exercise training after intervention therapy,which is beneficial for cardiac rehabilitation and can improve psychological status and quality of life.展开更多
Objective:To explore and analyze the impact of follow-up nursing combined with collaborative nursing model on patients after mechanical thrombectomy for acute cerebral infarction.Methods:A hundred patients with acute ...Objective:To explore and analyze the impact of follow-up nursing combined with collaborative nursing model on patients after mechanical thrombectomy for acute cerebral infarction.Methods:A hundred patients with acute cerebral infarction who underwent mechanical thrombectomy in the Department of Neurology,Guangdong Provincial People’s Hospital from January 2023 to January 2025 were randomly divided into control group(routine nursing,n=50)and intervention group(follow-up nursing combined with collaborative nursing,n=50).Differences in neurological function,living ability,complication rate,nursing satisfaction,and medication compliance were observed between the two groups.Results:After nursing,the intervention group had lower NIHSS and mRS scores,and higher Barthel index scores compared to the control group(P<0.05).Additionally,the intervention group had lower complication and readmission rates,and higher nursing satisfaction and medication compliance scores(P<0.05).Conclusion:The combination of follow-up nursing and collaborative nursing model has significant value in improving outcomes for patients after mechanical thrombectomy for acute cerebral infarction,and is worthy of promotion and application.展开更多
Objective This study aimed to investigate the neuroprotective effects of cholecalciferol cholesterol emulsion(CCE),a vitamin D(VD)precursor,in a murine model of acute cerebral infarction(ACI)and to elucidate the role ...Objective This study aimed to investigate the neuroprotective effects of cholecalciferol cholesterol emulsion(CCE),a vitamin D(VD)precursor,in a murine model of acute cerebral infarction(ACI)and to elucidate the role of the Nrf2 signaling pathway in mediating these effects.Methods Forty C57BL/6J mice(male and female)were divided into five groups(n=10 per group):control,control+CCE,ACI,ACI+CCE,and ACI+CCE+ML385(an Nrf2 inhibitor).ACI was induced by middle cerebral artery occlusion(MCAO).CCE was administered for three weeks prior to ACI induction,and ML385 was administered intravenously to inhibit Nrf2.Neurological function,brain edema,and infarct size,as well as inflammatory and apoptotic marker levels,were assessed post-ACI.Statistical analyses were conducted via one-way ANOVA and Student's t test,with P<0.05 considered significant.Results Compared to ACI group,CCE significantly reduced neurological deficits,brain edema,and infarct size(P<0.01).The ACI+CCE group presented improved short-term memory retention,as evidenced by shorter avoidance latency in shuttle avoidance tests(P<0.01).CCE administration attenuated the expression of inflammatory markers(IL-6,MIF,Lp-PLA2)while increasing IL-10 levels(P<0.001).Furthermore,CCE increased Nrf2 and HO-1 expression and reduced apoptosis by decreasing the Bax/Bcl-2 ratio in brain tissue(P<0.001).ML385 abolished these neuroprotective effects,confirming the role of the Nrf2 pathway in mediating the benefits of VD.Conclusion VD,via VD receptor-mediated activation of the Nrf2/HO-1 pathway,reduces inflammation,apoptosis,and neurological damage following ACI.These findings support the therapeutic potential of VD in the treatment of ischemic stroke and highlight the importance of Nrf2 in mediating these effects.展开更多
Myocardial infarction (MI) continues to be the primary cause of death globally. Oxidative stress in the initial phase of MI, followed by uncontrolled and excessive myocardial fibrosis, significantly impedes cardiac re...Myocardial infarction (MI) continues to be the primary cause of death globally. Oxidative stress in the initial phase of MI, followed by uncontrolled and excessive myocardial fibrosis, significantly impedes cardiac repair efficiency post-MI, culminating in adverse ventricular remodeling and potential heart failure. To address the diverse pathological stages of MI, an injectable composite hydrogel containing versatile nanoparticles was developed. In this study, mesoporous silicon nanoparticles (MSNs) served as carriers for encapsulating microRNA-29b (miR-29b) mimics with antifibrotic activity, subsequently coated with a complex of natural antioxidant tannic acid and zinc ions (TA/Zn). These nanoparticles were then embedded into a biocompatible alginate hydrogel to enhance retention within the infarcted myocardium. Upon injection into the infarcted region of MI mice, the composite hydrogel gradually released the nanoparticles as it degraded. Initially, the TA/Zn complex on the outer layer scavenged reactive oxygen species, thereby inhibiting cell apoptosis. The subsequent dissociation of the TA/Zn complex led to the release of the encapsulated miR-29b mimics that could inhibit the activation of cardiac fibroblasts and collagen production, thereby alleviating fibrosis progression. Overall, this composite hydrogel demonstrated the potential to reduce infarct size and improve cardiac function, suggesting its promise as a synergistic therapeutic approach for repairing infarcted myocardium.展开更多
Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous cor...Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.展开更多
基金supported by the Natural Science Foundation of Shandong Province(ZR2021QH096,ZR2020MH024)the National Natural Science Foundation of China(82300354,882070345)+2 种基金the Academic Promotion Program of Shandong First Medical University(2019QL012)the Shandong Taishan Scholarship(to SHY)fund of Tianjin Zhongxin Pharmaceutical Group Co.,Ltd。
文摘Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction(NSTEMI).[1]In China,AMI is widely recognized as a predominant cause of mortality in both urban and rural demographics,based on the 2022 Report on Cardiovascular Health and Diseases in China;moreover,its mortality rate has been reported to be rising,with a recurrence rate of 2.5%within one year.
文摘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.
基金supported by the First Department of Cardiology,School of Medicine in Katowice,Medical University of Silesia,Katowice,Poland.
文摘Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.
文摘Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspiration(TA),recent large trials have questioned its routine use.This review examines the role of thr-ombectomy in the management of AMI,focusing on its potential to improve my-ocardial perfusion and mitigate no-reflow risk.Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion.Similarly,standardising TA techn-iques and ensuring appropriate patients’selection may also improve enhance our understanding of the role of thrombectomy in AMI.Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.
基金Supported by the National Natural Science Foundation of China,No.82170327 and No.82370332Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-029A.
文摘In this article,we comment on the article by Zheng et al.This case report shed light on concomitant cerebrocardiac ischemic(CCI)in a 27-year-old male patient,which is defined as a concurrent acute ischemic stroke(AIS)and acute myocardial infarction event.The patient received urgent systemic thrombolysis at the sta-ndard dose for AIS and then planned percutaneous coronary intervention was successfully conducted for ST-segment elevation myocardial infarction treatment.Considering the rarity of the comorbidity,the narrow time window for treatment of both AIS and acute myocardial infarction,as well as the complexity and severity of the condition,there are still no guidelines or consensus that have systematically recommended optimal treatment strategies.The successful treat-ment of this 27-year-old man suggests that urgent thrombolysis followed by planned percutaneous coronary intervention might be an alternative treatment options in the management of concomitant CCI.However,emergency treatment plans need to be developed according to the specific situation of the patients.A number of factors should be considered when making decision,including the location of occlusion of heart and brain,the hemodynamic instability,the ongoing ischemic symptoms,the presence of contraindications to thrombolysis,and the speed of response of cardiologists or neurointerventionists.Future,further res-earch involving multidisciplinary experts,including neurologist,cardiologist,and specialists in critical care medicine is needed to improve the understanding and management of concomitant CCI.
文摘BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘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.
基金supported by Tasly Pharmaceutical Group Co.,Ltd.(Grant No.303100031BA20)。
文摘The current study aimed to evaluate the efficacy and safety of Compound Danshen Dripping Pills(CDDP)in improving cardiac function in patients with acute anterior ST-segment elevation myocardial infarction(AAMI).Between February 2021 and February 2023,247 eligible patients with AAMI after primary percutaneous coronary intervention were enrolled and randomly assigned(1∶1)to receive CDDP(n=126)or placebo(n=121),with a follow-up of 48 weeks.Compared with the placebo group,the CDDP group demonstrated a significant increase in left ventricular ejection fraction values after 24 weeks of treatment(least squares mean:3.31;95%confidence interval[CI]:1.72–4.90;P<0.001)and at the 48-week follow-up(least squares mean:4.35;95%CI:2.76–5.94;P<0.001).Significant reductions in N-terminal pro-B-type natriuretic peptide levels were observed in both groups at the 24-and 48-week visits with no significant difference between the two groups(P>0.1 for all).The incidence of major adverse cardiovascular and cerebrovascular events was 6.35%in the CDDP group and 5.79%in the placebo group(P=0.822).Notably,no serious adverse events were attributed to CDDP.These findings suggest that CDDP may be well tolerated and could improve left ventricular ejection fraction in patients with AAMI at 24 and 48 weeks.
基金Supported by Guangdong Medical Research Foundation(No.A2024382)Guangdong Provincial Bureau of Traditional Chinese Medicine research project(No.20231321)Scientific Research Start Plan of Shunde Hospital,Southern Medical University(No.SRSP2022012,No.SRSP2022016)。
文摘AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im⁃proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu⁃mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi⁃bition of ferroptosis.
文摘OBJECTIVE To explore the mechanism of action of Qihuang Zhuyu formula(QHZYF)in improving depression after myocardial infarction(MI),with a focus on revealing its regulatory effect on the inflammatory response of the heart and brain.METHODS The active ingredients of QHZYF and the action targets for intervening in depression after MI were analyzed by using ultra-performance liquid chromatography-high-resolution mass spectrometry(UPLC-Q-TOF/MS)combined with network pharmacology and molecular docking.A rat model of depression after MI was established by ligation of the left anterior descending coronary artery combined with chronic restraint stress.Echocardiography was used to evaluate cardiac function,hematoxylin-eosin(HE)and Masson staining were used to evaluate myocardial injury,behavioral tests were used to detect melancholic behaviors,Nissl staining was used to evaluate hippocampal neuron injury.Western blot detection of tumor necrosis factor receptor 2(TNFR2),phosphatidylinositol-3-kinase(PI3K),phosphorylated seronine protein kinase(p-AKT),seronine protein kinase(AKT),tumor necrosis factor receptor 1(TNFR1),phosphorylated nuclear factorκB(p-NF-κB),and nuclear factorκB(NF-κB)in cardiac and hippocampal tissues was conducted.The levels of serum IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay(ELISA),and the expression of TNFR1 and TNFR2 was detected by immunohistochemical technique(IHC).In vitro experiments,co-culture of rat cardiomyocyte line H9C2 cells and rat adrenal pheochromocytoma cell line with high differentiation PC12 cells was conducted,TNFR1 inhibitor(H398)and TNFR2 agonist(C-6His)were administered for intervention,and the expression of TNFR2,PI3K,p-AKT,AKT,TNFR1,NF-κB,p-NF-κB was detected by Western blot.Observe the apoptosis of cells by TUNEL staining,ELISA was used to detect the levels of IL-6 and IL-10 in the cell supernatant.RESULTS Network pharmacological analysis indicates that the TNF signaling pathway was a key target for the treatment of depression after MI with the QHZYF.In vivo experiments have confirmed that the intervention of QHZYF could significantly improve the cardiac function,myocardial tissue and hippocampal neuron structure damage of depressed rats after MI,and improve their depression-like behaviors.At the molecular level,the high-dose group of QHZYF significantly upregulated TNFR2,p-AKT/AKT,and IL-10 in cardiac and hippocampal tissues(P<0.01),and downregulated TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01).In vitro experiments showed that the drug-containing serum of QHZYF significantly upregulated the expression of TNFR2,p-AKT/AKT and IL-10 in H9C2 and PC12 cells(P<0.01),downregulated the expression of TNFR1,p-NF-κB/NF-κB and IL-6(P<0.01),and significantly inhibited cell apoptosis(P<0.01).Furthermore,experiments on the combined application of H398 or C-6His further confirmed that its protective and anti-inflammatory effects were mediated by regulating the TNFR2/PI3K/AKT and TNFR1/NF-κB pathways.CONCLUSION QHZYF improves the homeostasis of heart and brain inflammation by regulating the TNF pathway,and ameliorates myocardial injury and depressive state in depressed rats after MI.
文摘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.
文摘With the accelerated pace of population aging in China,the number of patients suffering from myocardial infarction(MI)is increasing annually.During disease progression,patients are at significantly higher risk of developing severe negative emotions,and emerging evidence suggests that post-traumatic stress disorder(PTSD)is significantly associated with cardiovascular disease,which seriously affects patients’quality of life.Objective:The aim of this study was to comprehensively assess the prevalence and influencing factors of PTSD in MI patients through systematic review and Meta-analysis.Methods:A computerized search of PubMed,the Cochrane Library,Embase,Web of Science,PsycINFO,China Knowledge Network(CNKI),WanFang Data,VIP,and China Biomedical Literature Database(CBM)was conducted to collect longitudinal studies,case-control studies,and cross-sectional studies related to PTSD prevalence rates and influencing factors in MI patients published up to August 1,2024.Literature screening,data extraction and quality assessment were done independently by two researchers and Meta-analysis was done using Stata 16.0 software.This study has been registered on the PROSPERO platform,registration number:CRD42024577243.Results:A total of 16 papers were included,with a total sample size of 3,768 cases involving 8 influencing factors.The results of the Meta-analysis showed that the prevalence of PTSD in patients with MI was 20.4%(95%CI=15.0–26.5%).Female(OR=3.12,95%CI=1.97–4.97,P<0.001),high neuroticism score(OR=2.21,95%CI=1.20–4.07,P=0.011),and high intrusive rumination score(OR=2.95,95%CI=1.50–5.83,P=0.002)were the risk factors for PTSD in MI patients.While age(OR=1.01,95%CI=0.98–1.04,P=0.440),education level(OR=0.55,95%CI=0.07–4.48,P=0.574),social support rating scale(OR=0.81,95%CI=0.52–1.26,P=0.346),Killip cardiac function classification(OR=2.29,95%CI=0.91–5.80,P=0.080)and creatine kinase isoenzyme(OR=1.03,95%CI=0.99–1.05,P=0.124)were not associated with the development of PTSD in MI patients.Conclusion:The prevalence of PTSD was higher in patients with MI.The prevalence varied by evaluation tool and study area.Risk factors were multifactorial,including general factors(female)and overall assessment(high neuroticism score,high invasive rumination score).Therefore,early intervention and proper de-escalation of PTSD symptoms in patients with MI by medical staff are needed in clinical practice to reduce the risk of PTSD.
文摘Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.
基金funded by the Ministry of Science and Higher Education of the Republic of Kazakhstan,grant numbers AP14969403 and AP23485820.
文摘Myocardial infarction(MI)is one of the leading causes of death globally among cardiovascular diseases,necessitating modern and accurate diagnostics for cardiac patient conditions.Among the available functional diagnostic methods,electrocardiography(ECG)is particularly well-known for its ability to detect MI.However,confirming its accuracy—particularly in identifying the localization of myocardial damage—often presents challenges in practice.This study,therefore,proposes a new approach based on machine learning models for the analysis of 12-lead ECG data to accurately identify the localization of MI.In particular,the learning vector quantization(LVQ)algorithm was applied,considering the contribution of each ECG lead in the 12-channel system,which obtained an accuracy of 87%in localizing damaged myocardium.The developed model was tested on verified data from the PTB database,including 445 ECG recordings from both healthy individuals and MI-diagnosed patients.The results demonstrated that the 12-lead ECG system allows for a comprehensive understanding of cardiac activities in myocardial infarction patients,serving as an essential tool for the diagnosis of myocardial conditions and localizing their damage.A comprehensive comparison was performed,including CNN,SVM,and Logistic Regression,to evaluate the proposed LVQ model.The results demonstrate that the LVQ model achieves competitive performance in diagnostic tasks while maintaining computational efficiency,making it suitable for resource-constrained environments.This study also applies a carefully designed data pre-processing flow,including class balancing and noise removal,which improves the reliability and reproducibility of the results.These aspects highlight the potential application of the LVQ model in cardiac diagnostics,opening up prospects for its use along with more complex neural network architectures.
文摘BACKGROUND Pancreatic carcinoma is recognized as one of the most prothrombotic malig-nancies,carrying a high risk of thrombotic events,which may even precede the diagnosis of the underlying occult tumor.Acute renal infarction(ARI)as the initial presenting feature in patients with pancreatic cancer is a rare occurrence,and misdiagnosis is common during early evaluation.CASE SUMMARY We report a patient who presented with ARI as the initial manifestation prior to the diagnosis of pancreatic cancer.The 50-year-old male was admitted to our emergency department with sharp,left-sided abdominal pain and was subse-quently transferred to our department following the detection of a pancreatic space-occupying lesion on computed tomography(CT).CT angiography prom-ptly identified the cause of his pain,confirming right renal infarction.Urgent interventional treatment was initiated to alleviate symptoms and restore renal perfusion.Despite aggressive thrombolytic and anticoagulant therapy,the thrombotic event rapidly worsened,leading to multiple cerebral infarctions.The patient’s condition ultimately deteriorated under palliative care.CONCLUSION This case illustrates that arterial thromboembolism,when diagnosed at an ad-vanced stage of pancreatic cancer,appears to be a terminal event that portends a poor prognosis.Establishing an arterial thrombosis prediction model will po-tentially identify the profile of high-risk patients with thrombotic consequences for primary prevention.
文摘Objective:To explore the effect of narrative nursing combined with exercise training on health beliefs and cardiac rehabilitation in patients with acute myocardial infarction(AMI)after interventional treatment.Methods:A total of 111 patients with acute myocardial infarction(AMI)who received interventional therapy in Department of Cardiology of Hefei First People’s Hospital from January 2022 to September 2023 were selected as the study subjects.They were randomly divided into a control group(n=55)and a study group(n=56)using a random table method.Both groups received routine nursing care,while the control group received exercise training on top of it.The study group received narrative nursing care on top of the control group.Both groups were intervened until the patients were discharged.The health beliefs,heart function,psychological status,and quality of life after intervention were compared between two groups using a 6-minute walk test(6MWT).Results:After intervention,the scores of the TSK-SV Heart in all dimensions(fear of movement,functional disorders,risk perception,and avoidance of movement)decreased in both groups,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,the scores of the Self Rating Anxiety Scale(SAS)and Self Rating Depression Scale(SDS)in both groups decreased,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,both groups showed an increase in left ventricular ejection fraction(LVEF)and left ventricular early diastolic peak flow velocity/left ventricular late diastolic peak flow velocity(E/A),with the study group being higher than the control group.The left ventricular end diastolic diameter(LVEDD)and left atrial volume index(LAVI)decreased,and the study group was lower than the control group,with statistical significant differences(P<0.05).The walking distance of the study group at 6MWT(488.8±31.4)m was greater than that of the control group(425.54±30.7)m,with statistical significant differences(P<0.05).The quality of life measurement scale(CROQ-PTCA-Post)of the study group after coronary intervention treatment had higher scores in all dimensions(physical function,satisfaction,psychosocial function,adverse reactions,symptoms,cognitive function)than the control group,with statistical significant differences(P<0.05).Conclusion:Narrative nursing combined with exercise training can enhance the health beliefs of AMI patients towards exercise training after intervention therapy,which is beneficial for cardiac rehabilitation and can improve psychological status and quality of life.
文摘Objective:To explore and analyze the impact of follow-up nursing combined with collaborative nursing model on patients after mechanical thrombectomy for acute cerebral infarction.Methods:A hundred patients with acute cerebral infarction who underwent mechanical thrombectomy in the Department of Neurology,Guangdong Provincial People’s Hospital from January 2023 to January 2025 were randomly divided into control group(routine nursing,n=50)and intervention group(follow-up nursing combined with collaborative nursing,n=50).Differences in neurological function,living ability,complication rate,nursing satisfaction,and medication compliance were observed between the two groups.Results:After nursing,the intervention group had lower NIHSS and mRS scores,and higher Barthel index scores compared to the control group(P<0.05).Additionally,the intervention group had lower complication and readmission rates,and higher nursing satisfaction and medication compliance scores(P<0.05).Conclusion:The combination of follow-up nursing and collaborative nursing model has significant value in improving outcomes for patients after mechanical thrombectomy for acute cerebral infarction,and is worthy of promotion and application.
基金supported by the Medical Science Research Project Program of Hebei Province(20211722).
文摘Objective This study aimed to investigate the neuroprotective effects of cholecalciferol cholesterol emulsion(CCE),a vitamin D(VD)precursor,in a murine model of acute cerebral infarction(ACI)and to elucidate the role of the Nrf2 signaling pathway in mediating these effects.Methods Forty C57BL/6J mice(male and female)were divided into five groups(n=10 per group):control,control+CCE,ACI,ACI+CCE,and ACI+CCE+ML385(an Nrf2 inhibitor).ACI was induced by middle cerebral artery occlusion(MCAO).CCE was administered for three weeks prior to ACI induction,and ML385 was administered intravenously to inhibit Nrf2.Neurological function,brain edema,and infarct size,as well as inflammatory and apoptotic marker levels,were assessed post-ACI.Statistical analyses were conducted via one-way ANOVA and Student's t test,with P<0.05 considered significant.Results Compared to ACI group,CCE significantly reduced neurological deficits,brain edema,and infarct size(P<0.01).The ACI+CCE group presented improved short-term memory retention,as evidenced by shorter avoidance latency in shuttle avoidance tests(P<0.01).CCE administration attenuated the expression of inflammatory markers(IL-6,MIF,Lp-PLA2)while increasing IL-10 levels(P<0.001).Furthermore,CCE increased Nrf2 and HO-1 expression and reduced apoptosis by decreasing the Bax/Bcl-2 ratio in brain tissue(P<0.001).ML385 abolished these neuroprotective effects,confirming the role of the Nrf2 pathway in mediating the benefits of VD.Conclusion VD,via VD receptor-mediated activation of the Nrf2/HO-1 pathway,reduces inflammation,apoptosis,and neurological damage following ACI.These findings support the therapeutic potential of VD in the treatment of ischemic stroke and highlight the importance of Nrf2 in mediating these effects.
基金supported by the Natural Science Foundation of Jiangsu Province(No.BK20231314)the National Natural Science Foundation of China(No.92168203)+4 种基金the National Key R&D Program of China(No.2022YFA1104300)the Jiangsu Cardiovascular Medicine Innovation Center(No.CXZX202210)the Suzhou“Science and Education Revitalize Health”Youth Science and Technology Project(No.KJXW2021001)the Suzhou“Science and Education Revitalize Health”Youth Science and Technology Project(No.KJXW2021001)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Myocardial infarction (MI) continues to be the primary cause of death globally. Oxidative stress in the initial phase of MI, followed by uncontrolled and excessive myocardial fibrosis, significantly impedes cardiac repair efficiency post-MI, culminating in adverse ventricular remodeling and potential heart failure. To address the diverse pathological stages of MI, an injectable composite hydrogel containing versatile nanoparticles was developed. In this study, mesoporous silicon nanoparticles (MSNs) served as carriers for encapsulating microRNA-29b (miR-29b) mimics with antifibrotic activity, subsequently coated with a complex of natural antioxidant tannic acid and zinc ions (TA/Zn). These nanoparticles were then embedded into a biocompatible alginate hydrogel to enhance retention within the infarcted myocardium. Upon injection into the infarcted region of MI mice, the composite hydrogel gradually released the nanoparticles as it degraded. Initially, the TA/Zn complex on the outer layer scavenged reactive oxygen species, thereby inhibiting cell apoptosis. The subsequent dissociation of the TA/Zn complex led to the release of the encapsulated miR-29b mimics that could inhibit the activation of cardiac fibroblasts and collagen production, thereby alleviating fibrosis progression. Overall, this composite hydrogel demonstrated the potential to reduce infarct size and improve cardiac function, suggesting its promise as a synergistic therapeutic approach for repairing infarcted myocardium.
文摘Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.
