随着人口老龄化的日益加重，心力衰竭及慢性肾脏病（CKD）的发病率和病死率逐年攀升。心力衰 竭与CKD常合并存在，全球约50%的心力衰竭患者合并CKD，这类患者的预后更差，且其治疗缺乏具体的指导。近年 来，新型口服降糖药钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在治疗心力衰竭合并CKD方面受到越来越多的关注， 其心脏及肾脏获益为心力衰竭合并CKD患者的治疗提供了新的思路。本文对SGLT2i治疗心力衰竭合并CKD患者的机 制、临床证据、不良反应及安全性做一综述。
目的 探讨脑小血管病（CSVD）患者发生认知障碍的影响因素，构建风险预测列线图模型并进行验 证。方法 回顾性收集2016年12月—2022年12月空军军医大学第一附属医院收治的CSVD患者415例。收集患者的临床 资料，根据认知障碍发生情况将患者分为认知障碍组和认知功能正常组。采用多因素Logistic回归分析探讨CSVD患者 发生认知障碍的影响因素；采用R 4.3.0软件中rms包建立CSVD患者发生认知障碍影响因素的风险预测列线图模型；绘 制校准曲线评估该列线图模型预测CSVD患者发生认知障碍的效能；采用ROC曲线分析ApoA、CysC、Hcy、TyG指数、 CSVD高负荷及该列线图模型对CSVD患者发生认知障碍的预测价值。结果 415例CSVD患者发生认知障碍206例，发生 率为49.6%。认知障碍组年龄大于认知功能正常组，高血压发生率、饮酒率、吸烟率、空腹血糖（FBG）、三酰甘油 （TG）、载脂蛋白B（ApoB）、尿酸（UA）、胱抑素C（CysC）、同型半胱氨酸（Hcy）、三酰甘油-葡萄糖（TyG） 指数、CSVD高负荷发生率高于认知功能正常组，高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A（ApoA）低于认知功 能正常组（P＜0.05）。多因素Logistic回归分析结果显示，ApoA、CysC、Hcy、TyG指数、CSVD高负荷为CSVD患者 发生认知障碍的独立影响因素（P＜0.05）。ApoA、CysC、Hcy、TyG指数、CSVD高负荷预测CSVD患者发生认知障碍 的AUC分别为0.641、0.649、0.676、0.734、0.795。基于多因素Logistic回归分析结果，构建CSVD患者发生认知障碍的 风险预测列线图模型。Hosmer-Lemeshoe拟合优度检验结果显示，该列线图模型拟合较好（χ2 =54.853，P=0.860）。 ROC曲线分析结果显示，该列线图模型预测CSVD患者发生认知障碍的AUC为0.890〔95%CI（0.859～0.921）〕。结论 ApoA、CysC、Hcy、TyG指数、CSVD高负荷为CSVD患者发生认知障碍的独立影响因素，TyG指数、CSVD高负荷对 CSVD患者发生认知障碍具有一定预测价值，基于上述因素构建的列线图模型具有较好的区分能力和校准度，且预测 价值较高。
《2024年GOLD慢性阻塞性肺疾病诊断、管理及预防全球策略》（以下简称《GOLD 2024》）于2023- 11-13重磅更新。总体来说，《GOLD 2024》与《2023年GOLD慢性阻塞性肺疾病诊断、管理及预防全球策略》大致相 同，但其内容更加精炼，并对目前研究的热点问题如保留比率的肺功能受减损（PRISm）、肺过度充气和COPD的诊 断、筛查、评估及戒烟等13个方面进行了扩充和新增。本文主要介绍《GOLD 2024》各部分要点及重点更新内容。
Myocardial amyloidosis(CA)refers to the deposition of proteins in the heart after misfolding,leading to specific restrictive cardiomyopathy,mainly with diastolic dysfunction,often leading to refractory heart failure or other organ failure even death.The early diagnosis of CA is still difficult because of the diverse clinical manifestations.The two patients reported in this article were presented with non-specific symptoms such as chest tightness and dyspnea.CA diagnosis was confirmed by clinical symptoms,two-dimensional spot tracking imaging examination results,and pathological examination results of adipose tissue,symptomatic treatment such as diuresis,myocardial nutrition,anticoagulation and electrolyte maintenance was given,and the patient's,symptoms improved.This article also analyzed the pathogenesis,classification,clinical manifestations,diagnosis,treatment and prognosis of CA through literature review,in order to provide reference for clinical diagnosis and treatment of CA.
Hypertension is a highly heterogeneous disease,the prevalence rate,morbidity and disability rate of hypertension are increased significantly with age.The pathogenesis of elderly hypertension is complex,and its onset is influenced by environmental and genetic factors.Besides,the hyperactivity of sympathetic nervous system and renin-angiotensin-aldosterone system and insulin are also involved in its onset.In addition,as age increases,persistence of chronic low-grade inflammation of the immune system,abnormal regulation of non-coding genes and changes in the brain-gut axis can aggravate vascular endothelial dysfunction and target organ damage,which eventually lead to the occurrence and development of hypertension.This article mainly reviews the pathogenesis of elderly hypertension from the perspectives of immune mechanism,non-coding gene regulation,and brain-gut axis regulation.
Objective To analyze the application effect of health management program for young and middle-aged hypertensive patients based on transtheoretical model(TTM).Methods A total of 240 young and middle-aged(aged 19-60)patients with primary hypertension who were registered at representative community health service centers in the urban area of Zhenjiang City(selected based on the scope and quantity of services within the jurisdiction,including Jiankanglu Community Health Service Center,Dashikou Community Health Service Center of Jingkou District,Liming Community Health Service Center)from July 2021 to January 2022 were selected as the research subjects.The patients were divided into control group and observation group using a random number table method,with 120 cases in each group.The control group was intervened with the conventional community health management plan,while the observation group was intervened with health management program for young and middle-aged hypertensive patients based on TTM on the basis of the control group.The intervention lasted for a total of 6 months.The general data,Hypertension Knowledge-Level Scale(HK-LS)scores,Self-efficiency Assessment Scale for Hypertensives scores and hypertension control rate before intervention and after 6 months of intervention were compared between the two groups.Results During the intervention process,5 patients in the control group were lost to follow-up,4 patients in the observation group were lost to follow-up,and finally,115 patients were included in the control group and 116 patients were included in the observation group.After 6 months of intervention,the HK-LS score of the observation group was higher than that of the control group(P<0.05).The HK-LS scores of the control group and the observation group after 6 months of intervention were higher than those before intervention respectively(P<0.05).After 6 months of intervention,the Self-efficiency Assessment Scale for Hypertensives scores in observation group were higher than those in control group(P<0.05).After 6 months of intervention,the Self-efficiency Assessment Scale for Hypertensives scores in control group and observation group were higher than those before intervention respectively(P<0.05).After 6 months of intervention,the hypertension control rate in the observation group was higher than that in the control group(P<0.05).The hypertension control rate of control group and observation group after 6 months of intervention was higher than that before intervention respectively(P<0.05).Conclusion The health management program for young and middle-aged hypertensive patients based on TTM can effectively improve the knowledge level of hypertension,self-efficacy level and hypertension control rate of young and middle-aged hypertension patients.
Objective To investigate the medication regularity of phlegm and blood atasis in the treatment of carotid atherosclerotic(CAS)based on the platform of traditional Chinese medicine inheritance.Methods The database of CNKI,VIP,Wanfang Data,Chinese Biomedical Database,PubMed and Cochrane library were retrieved to search for randomized controlled trial on the phlegm and blood atasis in the treatment of CAS.The search time was from the establishment of the database to July 2023.The traditional Chinese medicine inheritance platform(V2.5)was used for descriptive statistics and association rules analysis,and network visualization of core traditional Chinese medicine.Results A total of 62 articles were included,and a total of 62 prescriptions were obtained.There were 137 flavors of traditional Chinese medicine involved,and the total frequency of use was 662 times,of which 7 flavors of traditional Chinese medicine with frequency of≥20 times were followed by salvia miltiorrhiza,rhizome of Chuanxiong,astragalus membranaceus,leech,Poria cocos,hawthorn and rhizoma alismatis.The four Qi of 137 flavors of traditional Chinese medicine was mainly warm and cold,and the five flavors of them were mainly bitter and sweet;and they were mainly attributed to the liver meridian and spleen meridian.Set the support level to 12,the confidence level to 0.600,and the Chinese medicine combination frequency was sorted according to the frequency of use,and 19 traditional Chinese drugs combinations with using frequency of≥10 times and 12 association rules of traditional Chinese drugs were obtained.The results of network visualization of core traditional Chinese medicine analysis showed that there were 12 core traditional Chinese drugs.Conclusion The traditional Chinese medicine of phlegm and blood atasis in the treatment of CAS mainly includes salvia miltiorrhiza,rhizome of Chuanxiong,astragalus membranaceus,leech,Poria cocos,hawthorn and rhizoma alismatis.The four Qi of them are mainly warm and cold,the five flavors of them are mainly bitter and sweet,and they are mainly attributed to the liver meridian and spleen meridian.
Stroke has the characteristics of high incidence rate,high disability rate and high mortality rate,and limb dysfunction after stroke will seriously affect the physical and mental health and daily life of patients,bringing heavy burden to individuals,families and society.Paraffin therapy is a traditional Chinese medicine external treatment that has been passed down and innovated by generations of physicians.It has a definite therapeutic effect in assisting in the treatment of limb dysfunction after stroke,effectively reducing the degree of limb pain and spasticity of patients,and improving the motor function of patients,and significantly improving their quality of life and learning and work abilities.This article first introduces the origin and mechanism of paraffin therapy,and then reviews its application status in limb dysfunction after stroke,in order to provide reference for the treatment research of this disease.
Atrial fibrillation mediated cardiomyopathy(AMC)refers to paroxysmal or persistent atrial fibrillation(AF)causing heart enlargement,resulting in impaired ventricular systolic and diastolic function,decreased left ventricular ejection fraction,and ultimately heart failure(HF).The symptoms of heart enlargement and HF can be completely or almost completely reversed after the patient returns to sinus rhythm or ventricular rate is strictly controlled.The clinical incidence of AMC is not low,and early diagnosis and intervention can significantly improve the prognosis of patients.However,at present,the diagnosis of AMC can only be made after excluding other causes,which lacks specific diagnostic indicators,and the pathological process of AMC is still unclear.This article starts with calcium homeostasis imbalance,introduces its role in AF and HF,and analyzes its relationship with AMC,in order to provide direction for the clinical diagnosis and treatment of AMC.
载脂蛋白（Apo）能与血浆脂质结合形成脂蛋白，是决定脂蛋白的结构、功能和代谢的核心组分。 ApoA是最重要的Apo，其对脂质代谢的作用机制及与心血管病之间的关系一直是研究的热点。近年来，研究表明ApoA 在氧化应激和炎症调节、老化、淀粉样变性、肺纤维化、肿瘤中也有重要作用。本文就ApoA功能的最新研究进展进行 综述。
慢性阻塞性肺疾病(COPD)与冠心病均是严重危害人类健康的常见慢性病且二者关系密切.研究表明,COPD患者发生冠心病的风险是非COPD患者的1.24倍,而冠心病患者COPD发病率为18％～41％,与单纯COPD或单纯冠心病患者相比,COPD与冠心病共病患者预后更差.本文主要综述了COPD与冠心病共病的危险因素、发病机制、预防及治疗,旨在提高临床医生对COPD与冠心病共病的诊疗水平.
Objective To evaluate the incidence,clinical characteristics,treatment and prognosis of COVID-19-related pulmonary aspergillosis(CAPA)by Meta-analysis.Methods PubMed,Web of Science,Cochrane Library,Embase,Chinese Biomedical Literature Database,VIP,Wanfang Data,and CNKI were searched for literature on CAPA from inception to March 1,2023.Meta-analysis was performed using RevMan 5.3 software to calculate the incidence,clinical characteristics,treatment and prognosis of CAPA.Results A total of 18 high-quality literature were included,including 6 329 patients with COVID-19 and 1 028 patients with CAPA.The results of Meta-analysis showed that:the incidence of CAPA was 0.11[95%CI(0.10,0.11)].The proportion of male patients with CAPA was higher,which was 0.75[95%CI(0.72,0.78)].The incidence of fever,cough and shortness of breath was higher in CAPA patients,which was 0.90[95%CI(0.86,0.93)],0.64[95%CI(0.58,0.70)]and 0.64[95%CI(0.56,0.72)],respectively.The detection rates of patchy infiltration and consolidation in CAPA patients were higher,which were 0.88[95%CI(0.83,0.94)]and 0.73[95%CI(0.68,0.79)],respectively.The utilization rate of corticosteroid was the highest in CAPA patients,which was 0.96[95%CI(0.95,0.98)].The mortality rate of CAPA patients was 0.52[95%CI(0.48,0.56)].The funnel plot of the literature reporting the proportion of males was drawn.Conclusion The incidence of CAPA is 11%,and most of them are male.The main clinical manifestations of CAPA are cough,fever and shortness of breath.Most CAPA patients receive corticosteroid treatment.The main CT manifestations of CAPA patients are patchy infiltration and consolidation,and the mortality rate of CAPA is 52%.
Objective To analyze the causal relationship between body mass index(BMI)and coronary heart disease by Mendelian randomization(MR)methods.Methods In this study,BMI was the exposure factor and coronary heart disease was the outcome.The samples were obtained by IEU OpenGWAS prodect,and the included samples were all from the European population.The sample size of BMI data set was 461 460 cases,the number of single nucleotide polymorphism(SNP)was 9 851 867;the sample size of coronary heart disease data set was 361 194 cases,the number of SNP was 13 295 130.SNP highly related to BMI were selected from the BMI data set,and SNP related to BMI were selected from the coronary heart disease data set,and their intersections were taken as instrumental variables.Five regression models including MR-Egger regression,weighted median method(WME),inverse variance weighting(IVW),simple model and weighted model were used to analyze the causal relationship between BMI and coronary heart disease.Results In this study,458 SNP highly related to BMI and 460 SNP highly correlated with BMI were screened from the coronary heart disease dataset,and then 17 palindromic SNP with intermediate alleles and 2 repetitively named SNP were deleted,and 441 SNP were finally included.The results of MR-Egger regression,WME and IVW showed that elevated BMI was a risk factor for coronary heart disease(P<0.01).While the results of the simple model and the weighted model showed that the elevated BMI was not a risk factor for coronary heart disease(P>0.05),but the results of the simple and weighted models showed that the beta values were in the same direction as those of the MR-Egger regression,WME,and IVW.The results of Cochran Q test showed that there was statistical heterogeneity among SNP(Q=598.844,P<0.001),so the IVW results were mainly concerned.The results of MR-Egger intercept method showed that the MR-Egger intercept term was<0.001(P=0.083),suggesting that there was no horizontal pleiotropy in this study.The results of the leave-one-out analysis showed that after the SNP were removed one by one,the remaining SNP were still on the right side of the invalid line,and their OR value and 95%CI did not change significantly,suggesting that the MR results of this study were more robust.The results of funnel plot analysis showed that the distribution of all SNP was basically symmetrical,suggesting that when SNP was used as an instrumental variable,the causal relationship inferred was less affected by potential factors.Conclusion Elevated BMI is a risk factor for coronary heart disease,therefore,it is recommended to prevent coronary heart disease by controlling BMI.
Objective To investigate the value of high mobility group protein B1(HMGB1),lipoprotein-associated phospholipase A2(Lp-PLA2),and neutrophil to lymphocyte ratio(NLR)in the diagnosis of hypertension patients complicated with acute cerebral infarction(ACI)and their relationship with the severity of the disease.Methods A total of 157 hypertensive patients admitted to the Third People's Hospital of Nantong from February 2020 to February 2023 were selected as the research subjects.The patients were divided into the combined group(n=102)and the non-combined group(n=55)according to whether they had ACI.Gender,age,BMI,smoking history,drinking history,diabetes,systolic blood pressure,diastolic blood pressure,total cholesterol,and urea nitrogen of all patients were collected.Meanwhile,family history of ACI,infarct location,infarct volume,and infarction type of patients in the combined group were collected.The levels of HMGB1,Lp-PLA2 and NLR of all patients were detected.Patients in the combined group were divided into mild subgroup(n=41),moderate subgroup(n=32)and severe subgroup(n=29)according to the severity of the disease.HMGB1,Lp-PLA2 and NLR were compared between combined group and non-combined group.The ROC curve was used to explore the value of the HMGB1,Lp-PLA2 and NLR in diagnosing ACI in hypertension patients.The general data,HMGB1,Lp-PLA2,NLR were compared in mild subgroup,moderate subgroup and severe subgroup.Results HMGB1,Lp-PLA2 and NLR in the combined group were higher than those in the non-combined group(P<0.05).ROC curve analysis showed that the AUC of the HMGB1,Lp-PLA2,NLR in diagnosing ACI in hypertension patients was 0.798,0.892,0.912,and the best cut-off values were 6.69 μg/L,156.02 μg/L,3.11,the sensitivities were 0.657,0.853,0.931,and specificities were 0.818,0.764,0.891,respectively.HMGB1,Lp-PLA2 and NLR in moderate subgroup were higher than those in mild subgroup,and HMGB1,Lp-PLA2 and NLR in severe subgroup were higher than those in mild subgroup and moderate subgroup(P<0.05).Conclusion HMGB1,Lp-PLA2 and NLR are significantly elevated in hypertension patients complicated with ACI,and HMGB1,Lp-PLA2 and NLR have certain value in the diagnosis of ACI in hypertension patients,which are related to the severity of the patients'disease.
Dual specificity phosphatase(DUSP)1 is an important member of the DUSP protein family,which can dephosphorylate tyrosine and serine/threonine residues.It also plays an important role in various pathophysiological processes such as cell growth cycle regulation,oxidative stress and inflammation.In recent years,a number of studies have pointed out that DUSP1 is involved in the occurrence and development of a variety of cardiovascular diseases such as myocardial infarction,heart failure,ventricular remodeling and myocardial fibrosis,and can alleviate myocardial ischemia-reperfusion injury(MIRI)by mediating signal transduction pathways,reversing apoptosis and inhibiting inflammatory response,thereby improving cardiac function of patients.In this paper,we first analyzed the pathophysiological mechanism of MIRI,and then reviewed the structure,biological function and action mechanism of DUSP1 in MIRI,in order to provide theoretical basis for DUSP1 as a therapeutic target of MIRI.
Myocardial infarction is one of the major diseases affecting human health.Reperfusion is the main treatment in clinic,and myocardial ischemia-reperfusion injury(MIRI)is a common complication after reperfusion.Hypoxia-inducible factor(HIF)-1α,as an important molecule in hypoxia response,can enhance the body's ability to adapt to hypoxia and participate in the occurrence and development of many diseases.In recent years,many studies have shown that HIF-1α can restore mitochondrial function,resist oxidative stress,and activate cardio-protective signaling pathways,thereby alleviating MIRI,so it may be an important target for MIRI treatment.This article mainly introduces the discovery process,structure and biological effects of HIF-1α and its mechanism of action in MIRI,and summarizes the current research status of treatment of MIRI based on HIF-1α,in order to provide new ideas and theoretical basis for the diagnosis and treatment of MIRI.
Objective To explore the influencing factors of prehospital delay in Chinese patients with acute ischemic stroke through meta-analysis.Methods A computer search was conducted for literature on related factors or influencing factors of prehospital delay in Chinese patients with acute ischemic stroke published by CNKI,Wanfang Data,VIP,Chinese Biomedical Database,PubMed,Web of Science and Cochrane Library.The retrieval time was from the establishment of the database to May 2023.All references included in the study were manually searched.Literature screening and data extraction were conducted independently by two researchers.The quality of the literature was evaluated using the Newcastle-Ottawa Scale(NOS)by two investigators.Meta-analysis was performed using Stata 12.0 software.Results After screening,17 literature were finally included,including 5 769 patients with acute ischemic stroke,including 2 958 patients in the delayed group and 2 811 patients in the non-delayed group.The NOS scores of all literature ranged from 6 to 8.The results of meta-analysis showed that living alone[OR=2.116,95%CI(1.726,2.595)],lack of knowledge about stroke diseases[OR=2.008,95%CI(1.564,2.579)],rural residence[OR=3.278,95%CI(1.909,5.627)],non-ambulance transport mode[OR=5.242,95%CI(3.377,8.138)],no history of atrial fibrillation[OR=1.993,95%CI(1.438,2.763)],and referral[OR=3.686,95%CI(2.197,6.185)]were risk factors for prehospital delay in Chinese patients with acute ischemic stroke(P<0.05).Sensitivity analysis results showed that meta-analysis results of other influencing factors did not significantly change except National Institutes of Health Stroke Scale(NIHSS)score.Egger's test results showed that there was publication bias among literature reporting living alone,lack of knowledge about stroke diseases,rural residence,and NIHSS score(P<0.05),while there was no publication bias among literature reporting non-ambulance transport mode,no history of atrial fibrillation,and referral(P>0.05).Conclusion Living alone,lack of knowledge about stroke diseases,rural residence,non-ambulance transport mode,no history of atrial fibrillation,and referral are risk factors for prehospital delay in Chinese patients with acute ischemic stroke.
Objective To explore the predictive value of serum γ-glutamyltransferase(GGT)for no-reflow phenomenon after PCI in patients with acute ST elevation myocardial infarction(STEMI).Methods A retrospective study was conducted on 236 patients with acute STEMI who underwent PCI in the Third Central Hospital of Tianjin from January 2020 to September 2022.The clinical data and laboratory examination indicators of the patients were collected,and the patients were divided into no-reflow group(n=34)and control group(n=202)according to the occurrence of no-reflow phenomenon after PCI.Multivariate Logistic regression analysis was used to explore the influencing factors of no-reflow phenomenon after PCI in patients with acute STEMI.The ROC curve was used to explore the predictive value of the age,heart rate,systolic blood pressure,time from onset to balloon opening,and serum GGT for no-reflow phenomenon after PCI in patients with acute STEMI.Results There were significant differences in age,heart rate,systolic blood pressure,proportion of patients with Killip grading of≥Ⅱ,time from onset to balloon opening,white blood cell count,serum GGT,ALT,AST,and creatine kinase isoenzymes(CK-MB)between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age[OR=1.047,95%CI(1.007,1.090)],heart rate[OR=1.029,95%CI(1.005,1.054)],systolic blood pressure[OR=0.970,95%CI(0.950,0.991)],time from onset to balloon opening[OR=1.174,95%CI(1.030,1.339)],and serum GGT[OR=1.013,95%CI(1.004,1.022)]were the independent influencing factors of no-reflow phenomenon after PCI in patients with acute STEMI(P<0.05).ROC curve analysis showed that the AUC of the age,heart rate,systolic blood pressure,time from onset to balloon opening,and serum GGT for predicting no-reflow phenomenon after PCI in patients with acute STEMI were 0.608,0.613,0.628,0.616,0.662,the optimal cut-off values were 65 years old,78 times/min,124 mm Hg,2.2 h,28 U/L,respectively.Conclusion Age,heart rate,systolic blood pressure,time from onset to balloon opening,and serum GGT are the independent influencing factors of no-reflow phenomenon after PCI in patients with acute STEMI.While the predictive value of serum GGT for no-reflow phenomenon after PCI in patients with acute STEMI is average.
Objective To investigate the protective effect and mechanism of pretreatment of Gualou Xiebai Banxia decoction on myocardial ischemia-reperfusion injury(MIRI)model rats.Methods This experiment was conducted from February 2022 to February 2023.A total of 40 rats were divided into sham group(A group),model group(B group),Gualou Xiebai Banxia decoction group(C group),and nuclear factor-κB(NF-κB)inhibitor group(D group)using random number table method,10 rats in each group.Rats in groups C and D were pretreated with Gualou Xiebai Banxia decoction,while rats in groups A and B were pretreated with an equal amount of 0.9%sodium chloride solution.All four groups were continuously intervened for 7 days.Rats in group A underwent thoracotomy at 1 hour after the last administration,but were not ligated;while rats in groups B,C,and D were used to prepare MIRI models using the left anterior descending branch ligation method at 1 hour after the last administration.Rats in group D were intraperitoneally injected with ammonium pyrrolidine dithioformate at 10 minutes before reperfusion.The percentage of myocardial infarction area,myocardial tissue morphology,serum inflammatory factor(IL-1β and TNF-α)levels,serum oxidative stress indicators[malondialdehyde(MDA),superoxide dismutase(SOD),lactate dehydrogenase(LDH)],myocardial tissue ultrastructure,Toll like receptor 4(TLR4),NF-κB p65 protein expression level and relative mRNA expression level in myocardial tissue were compared in the four groups of rats.Results The percentage of myocardial infarction area in group B was higher than that in group A,the percentage of myocardial infarction area in groups C and D was lower than that in group B,while the percentage of myocardial infarction area in group D was higher than that in group C(P<0.05).The HE staining results showed that the fiber arrangement,morphological changes,and transverse structural changes of myocardial tissue in group C were superior to those in group B,and the nuclei of group D were scattered and obvious on the outer side.The results of Masson staining showed that the arrangement of myocardial cells in group B was disordered,and a few collagen fibers were positively stained;the arrangement of cells in groups C and D was relatively regular,with almost no positive staining of collagen fibers.Serum levels of IL-1β,TNF-α,MDA and serum LDH activity in group B were higher than those in group A,while the serum SOD activity was lower than that in group A(P<0.05);serum levels of IL-1β,TNF-α,MDA and serum LDH activity in groups C and D were lower than those in group B,while the serum SOD activity was higher than that in group B(P<0.05);serum levels of IL-1β,TNF-α,MDA and serum LDH activity in group D were lower than those in group C,while the serum SOD activity was higher than that in group C(P<0.05).The scanning results of the projection electron microscope showed that there were many vacuoles and autophagosomes in the cytoplasm of group B,a few autophagosomes in the cytoplasm of group C,and partial cytoplasmic vacuolization of group D.The protein expression level and mRNA relative expression level of TLR4 and NF-κB p65 in myocardial tissue of group B were higher than those of group A,the protein expression level and mRNA relative expression level of TLR4 and NF-κB p65 in myocardial tissue of groups C and D were lower than those of group B,while the protein expression level and mRNA relative expression level of TLR4 and NF-κB p65 in myocardial tissue of group D were lower than those of group C(P<0.05).Conclusion Pretreatment of Gualou Xiebai Banxia decoction can reduce inflammatory response,oxidative stress,and inhibit the production of autophagosomes in myocardial cells,thereby reducing the myocardial infarction area and protecting myocardial cells in MIRI model rats.Its mechanism may be related to the inhibition of TLR4/NF-κB signal pathway by Gualou Xiebai Banxia decoction.
Objective To explore the influencing factors of fear of disease progression(FoP)in elderly patients with chronic heart failure(CHF)and construct its risk prediction nomogram model.Methods Elderly CHF patients treated in Affiliated Hospital of Yangzhou University from January 2021 to November 2022 were selected by random sampling method.The Baseline Information Questionnaire,Fear of Progression Questionnaire-Short Form(FOP-Q-SF),Social Support Rating Scale(SSRS)and General Self-Efficacy Scale(GSES)were used to investigate the baseline data,the occurrence of FoP,the level of social support and the level of self-efficacy of the patients.Multivariate Logistic regression analysis was used to explore the influencing factors of FoP in elderly CHF patients.R software(4.0.2)was used to construct the risk prediction nomogram model for FoP in elderly CHF patients.ROC curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and fit of the nomogram model.Results A total of 245 questionnaires were sent out in this study,and 223 were effectively collected,with an effective recovery rate of 91.0%.The FoP-Q-SF score of 223 patients was(33.3±7.0),of which 107 patients developed FoP,with an incidence rate of 48.0%.There were statistically significant differences in per capita monthly income,course of disease,NYHA grading,left ventricular ejection fraction(LVEF),the number of other chronic diseases,social support level,and self-efficacy level between FoP patients and non-FOP patients(P<0.05).The results of multivariate Logistic regression analysis showed that per capita monthly income,course of disease,NYHA grading,LVEF,the number of other chronic diseases,social support level,and self-efficacy level were the influencing factors for FoP in elderly CHF patients(P<0.05).Based on the results of multivariate Logistic regression analysis,the risk prediction nomogram model for FoP in elderly CHF patients was constructed.The results of ROC curve analysis showed that the AUC of the nomogram model for predicting FoP in elderly CHF patients was 0.855[95%CI(0.806,0.904)],the best cut-off value was 0.550,the sensitivity was 76.4%,and the specificity was 82.9%.The Hosmer-Lemeshow goodness of fit test showed that the nomogram model fitted well(χ2=8.128,P=0.421).Conclusion Per capita monthly income,course of disease,NYHA grading,LVEF,the number of other chronic diseases,social support level,and self-efficacy level are the influencing factors of FoP in elderly CHF patients.The risk prediction nomogram model for FoP in elderly CHF patients constructed based on the above influencing factors has a certain degree of discrimination.
