Cardiac amyloidosis, a manifestation of systemic amyloidosis, presents diagnostic challenges due to diverse clinical presentations. A 56-year-old woman with a history of hypertension presented with recurrent chest tightness, palpitations, decreased exercise tolerance, and nocturnal dyspnea. Diagnostic workup revealed reduced left ventricular function, thickened interventricular septum, and left atrial enlargement on echocardiography and electrocardiogram. Immunohistochemical staining confirmed AL amyloidosis in bone marrow biopsy specimens. Treatment involved supportive care and chemotherapy for plasma cell dyscrasia. Prompt identification and intervention for AL amyloidosis are crucial, highlighting the diagnostic role of electrocardiograms and echocardiograms. Management strategies included supportive care and chemotherapy for plasma cell dyscrasia. This case underscores the significance of timely recognition and intervention for cardiac amyloidosis, contributing to improved understanding and management approaches.

Background: Atherosclerosis (AS) is a chronic progressive inflammatory disease, and plaque stability plays a critical role in preventing acute events. Tanyu Tongzhi formula (TTF), a traditional Chinese medicine, has potential therapeutic effects on AS. Methods: We used an AS animal model to examine the effects of TTF on atherosclerotic plaque vulnerability and CD40+ monocyte differentiation. AS plaque area, collagen content, and lipid area were assessed using histological staining. AS plaque-related biomarkers (monocyte chemoattractant protein 1 (MCP-1), monocyte plus macrophage (MOMA-2), von Willebrand factor (vWF), CD31, and alpha-smooth muscle actin (alpha-SMA)) were detected using immunohistochemistry. Inflammatory cytokines were determined using enzyme-linked immunosorbent assay. CD40 mRNA expression was detected by real-time quantitative PCR. CD40+ monocyte differentiation was evaluated by flow cytometry analysis in ApoE-/- mice and peripheral blood mononuclear cells (PBMCs). AMPK/NF-kappa B signaling pathways-related protein expression was investigated through western blotting. Results: TTF treatment reduced AS plaque area, collagen content, and lipid area in AS model mice. Levels of MCP-1, MOMA-2, vWF, and CD31 were decreased, while alpha-SMA level was increased by TTF in model mice. TTF reduced inflammatory cytokines levels, including tumor necrosis factor receptor-alpha (TNF-alpha), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6). TTF inhibited CD40+ monocyte differentiation and decreased the number of CD40+/CD40-and Ly6C+/Ly6C-cells and M1/M2 ratio in AS model mice and human PBMCs. Additionally, TTF modulated the AMPK/NF-kappa B signaling pathway in human PBMCs. Conclusion: TTF attenuates atherosclerotic plaque vulnerability by inhibiting CD40+ monocyte differentiation, possibly through the regulation of the AMPK/NF-kappa B signaling pathway. These findings suggest that TTF could be a potential therapeutic agent for preventing plaque rupture and subsequent cardiovascular events in patients with AS.

Objectives: To explore and evaluate the clinical effect of enhanced external counter pulsation in the treatment of patients with chronic heart failure and low blood pressure. Method: The retrospective study was conducted from January, 1, 2023, to January 31, 2024, at the Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, China, and comprised data from January to October 2023 of chronic heart failure in patients who also had low blood pressure. The patients were divided into two groups on the basis of the treatment received. Group A patients had been treated with enhanced external counter pulsation, while group B patients had been asked to do regular exercises. Both the groups had been treated for cumulatively 35 hours. The change in blood pressure was the main outcome measure, and it was measure at baseline and 24h after treatment. Data was analysed using SPSS 20. Results: Of the 111 patients, 61(55%) were in group A; 36(59%) females and 25(41%) males with mean age 59.33±9.01 years. There were 50(45%) patients in group B; 29(58%) females and 21(42%) males with mean age 56.47±11.23 years. Baseline systolic blood pressure was not significantly different between the groups (p>0.05). Post-intervention, both the groups showed significant increase in in systolic blood pressure (p<0.05), but the change from baseline was more significant in group A compared to group B (p<0.05). Conclusion: Enhanced external counter pulsation had a significantly better therapeutic effect in the treatment of patients with chronic heart failure and low blood pressure. Key Words: Enhanced external counter pulsation, Heart failure, Low blood pressure, Cardiac rehabilitation.

The Cardiovascular-Kidney-Metabolic (CKM) syndrome underscores the complex interactions among metabolic disorders, kidney disease, and cardiovascular conditions. Insulin resistance (IR) and inflammation are crucial in CKM syndrome development, but their combined effect in stages 0–3 remains unclear. Using data from the National Health and Nutrition Examination Survey (NHANES), we included 18,295 participants with CKM syndrome stages 0–3 from 10 cycles between 1999 and 2018. IR was assessed using the estimated glucose disposal rate (eGDR), and systemic inflammation was evaluated using the Systemic Inflammation Response Index (SIRI). The primary endpoint was all-cause mortality, and the secondary endpoint was cardiovascular disease (CVD) mortality. Over an average follow-up period of 121 months, we recorded 1,998 all-cause deaths and 539 CVD deaths. Both eGDR and SIRI were independent risk factors for mortality. The hazard ratios (HR) for eGDR were 0.90 (0.86, 0.94) for all-cause mortality and 0.85 (0.78, 0.93) for CVD mortality, per unit increase in eGDR. For SIRI, the HRs were 1.16 (1.11, 1.21) for all-cause mortality and 1.33 (1.19, 1.46) for CVD mortality, per unit increase in SIRI. Compared to individuals with high eGDR and low SIRI levels, those with low eGDR and high SIRI levels exhibited significantly higher mortality risks, with HRs of 1.97 (1.58, 2.44) for all-cause mortality and 2.35 (1.48, 3.73) for CVD mortality. Subgroup analysis revealed that the combined impact of eGDR and SIRI was particularly significant in patients under 60 years old. In CKM syndrome stages 0–3, eGDR and SIRI have joint effect on mortality. Combining these markers can help identify high-risk individuals early, enabling timely monitoring and intervention to improve outcomes. What is currently known about this topic? What is the key research question? What is new? How might this study influence clinical practice?

In recent years, the application of aspirin for coronary artery disease has become increasingly common, and aspirin-related enteropathy has gradually garnered more attention. It has increasingly been recognized that the related enteropathy after the long-term use of NSAIDs may have potentially fatal side effects. However, it remains controversial how to select alternative medications for these patients with coronary heart disease, particularly for those who have recently undergone stent implantation. Our case presented with recurrent chest pain and coronary angiography revealed he had severe stenosis in the left anterior descending artery, nearly 90% at the opening, 80% at the middle segments, and a total occlusion at the distal segment, accompanied by a TIMI blood flow grade of 2. However, after five years of taking aspirin, the patient often felt fatigued and was found have megaloblastic anemia and thrombocytopenia. We attempted to prescribe indobufen as an alternative to aspirin for antiplatelet therapy. Fortunately, after several months of follow-up, the patient's symptoms were alleviated, and his hemoglobin and platelet levels returned to normal. Indobufen might be a potential alternative medication for these patients in clinical practice in the future.

Following the publication of the above paper, it was drawn to the Editor's attention by a concerned reader that, regarding the lower left quadrants of certain of the flow cytometric plots shown in Fig. 3A on p. 7159, these appeared to show similar groupings of dots, which would not have been anticipated if these experiments had been performed discretely under different experimental conditions, suggesting a fundamental flaw either in the way in which these experiments were performed or in how the results were outputted. Moreover, these data were also strikingly similar in appearance to data that had been submitted to the same journal around the same time in an article written by different authors at a different research institute. The Editor of Molecular Medicine Reports has decided that this paper should be retracted from the Journal on account of a lack of confidence in the presentation and the originality of the data. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Molecular Medicine Reports 17: 7156‑7162, 2018; DOI: 10.3892/mmr.2018.8774].

CONTEXT:Tanyu Tongzhi Formula (TTF) exhibits potential against atherosclerosis; however, its mechanisms remain unclear. OBJECTIVE:This study explores the pharmacological mechanisms of TTF in treating atherosclerosis. MATERIALS AND METHODS:Network pharmacology, molecular docking, mendelian randomization (MR), and liquid chromatography-mass spectrometry (LC-MS) analyses were utilized to reveal potential targets and compounds of TTF against atherosclerosis. After exploring the appropriate concentration of TTF to treat HCAECs using Cell Counting Kit-8 (CCK-8), the HCAECs were divided into three groups: control, oxidized low-density lipoprotein (ox-LDL, 50 μg/mL), and ox-LDL (50 μg/mL) + TTF (1 mg/mL). After 24-h incubation, the efficacy of TTF was verified by CCK-8, Oil red O staining, and ELISA. The expression of key targets was detected by real-time polymerase chain reaction (qPCR) and western blotting. RESULTS:A total of 137 active compounds and 127 potential TTF targets against atherosclerosis were identified. MR identified ALB, TNF, PPARα, and PPARγ as key targets. Molecular docking indicated that baicalin, naringenin, and curcumin exhibited suitable binding activities to these targets, further confirming by LC-MS analysis. The IC50 of TTF in HCAECs was 18.25 mg/mL. TTF treatment significantly improved atherosclerosis by enhancing cell viability, reducing lipid accumulation, and inhibiting inflammation factors (IL6, IL1B and TNF-α) in ox-LDL-treated HCAECs. Moreover, qPCR or western blotting indicated that TTF could up-regulate PPARα and PPARγ while down-regulate TNF expression. DISCUSSION AND CONCLUSIONS:Our results revealed active compounds, key pathways, and core targets of TTF against atherosclerosis, providing experimental support for its application in treating of atherosclerosis.

Background: Nicorandil and verapamil can improve coronary blood flow and coronary microcirculation during percutaneous coronary intervention. However, the effects of intracoronary (IC) administration of nicorandil and verapamil on hemodynamics remain unclear. Aims: To clarify the safety and effects of IC administration of nicorandil and verapamil on blood pressure (BP) and heart rate (HR) to provide evidence-based basis for clinical intervention. Methods: The study cohort included 70 patients with coronary artery stenosis recruited from Zhejiang Provincial Hospital of Traditional Chinese Medicine. The patients were randomly assigned to the intervention group (IC administration of 2 mg/2 ml of nicorandil and 200 mu g/2 ml of verapamil) or the control group (IC administration of 2 ml of saline). BP and HR were compared before medication, after medication, and when stabilized. Results: IC administration of verapamil at 200 mu g significantly reduced systolic BP as compared to the control group (113.72 +/- 3.40 vs. 123.63 +/- 3.33 mmHg, respectively, p <0.05) for a short period of time, and returned to baseline within 2 min, but had no effect on diastolic BP and HR. IC administration injection of nicorandil at 2 mg had no effect on BP or HR. There were no instances of major cardiovascular events. Conclusion: IC administration of nicorandil at 2 mg is safe as an adjunctive medication during interventional angiography. Verapamil can also be used as an IC adjuvant, although BP and HR must be monitored for patients with low basal BP, especially systolic BP.

Background : Catheter ablation (CA) is an effective therapy for atrial fibrillation (AF) and, although radiofrequency ablation (RFA) is the standard treatment for pulmonary vein isolation (PVI), it is complex and time-consuming. Laser balloon ablation (LBA) has been introduced to simplify the conventional RFA; however, results of studies comparing LBA and RFA remain controversial. As such, this investigation aimed to comprehensively evaluate the efficacy and safety of LBA versus RFA. Methods : The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for relevant studies. The primary endpoints were the freedom from atrial tachyarrhythmia (ATA) and procedure -related complications. Results : Twelve studies including 1274 subjects were included. LBA and RFA yielded similar rates of freedom from ATA (72.5% vs. 68.7%, odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.0-1.7, p = 0.11) and procedure -related complications (7.7% vs. 6.5%, OR = 1.17, 95% CI 0.72-1.90, p = 0.536). LBA with the second- and third -generation laser balloons (LB2/3) yielded remarkably higher rates of freedom from ATA than RFA using contact -force technology (RFA-CF) (OR = 1.91, p = 0.013). Significantly lower pulmonary vein (PV) reconnection rates (OR = 0.51, p = 0.021), but higher phrenic nerve palsy (PNP) rates (OR = 3.42, p = 0.023) were observed in the LBA group. LBA had comparable procedure (weighted mean difference [WMD] = 8.43 min, p = 0.337) and fluoroscopy times (WMD = 3.09 min, p = 0.174), but a longer ablation time (WMD = 12.57 min, p = 0.00) than those for RFA. Conclusions : LBA and RFA treatments were comparable in terms of freedom from ATA and postprocedural complications in patients with AF. Compared with RFA, LBA was associated with significantly lower PV reconnection rates, but a higher incidence of PNP and longer ablation time.

目的经皮冠状动脉(下称冠脉)介入术(PCI)是急性冠脉综合征和慢性冠脉综合征的重要血运重建策略.随着介入技术的进步以及新型支架的引进,PCI术后主要心血管不良事件的发生率已经降低,但手术相关心脏生物标志物升高的发生率并没有明显下降,导致PCI相关心肌损伤和梗死的发生率居高不下(将肌钙蛋白作为心脏生物标志物时,围术期心肌损伤和梗死的发生率分别为52％和10％),此现象已经开始引起当前介入治疗研究的关注.本文重点对PCI相关心肌损伤和心肌梗死的发生率及其与预后的相关性作一综述.

Exercise-induced tachycardia-dependent atrioventricular block with a normal electrocardiogram at rest is rare. Herein, we present a case of a 65-year-old woman with exercise-related chest suppression and treadmill exercise test-induced second- and third-degree atrioventricular blocks with narrow QRS wave and normal resting electrocardiogram. High atrioventricular block leads to tissue and organ insufficiency, resulting in exercise intolerance, dyspnea, dizziness, and syncope. Ths diagnosis was exercise-induced high-degree atrioventricular block. For lack of effective medicines, the patient received a permanent dual chamber pacemaker to ensure atrioventricular sequential pacing during exercise. No exercise-related discomfort occurred during follow up.

目的:从细胞实验水平研究痰瘀同治含药血清对人脐静脉内皮细胞(HUVEC)血管生成活性的作用和机制.方法:以HUVEC为研究对象,分为空白血清组、痰瘀同治低剂量组(TYTZ低组)、痰瘀同治高剂量组(TYTZ高组)、罗格列酮组和GW9662+TYTZ高组.空白血清组加10％空白大鼠血清,TYTZ低组加5％痰瘀同治大鼠血清,TYTZ高组加10％痰瘀同治大鼠血清,罗格列酮组加10％罗格列酮大鼠血清,GW9662+TYTZ高组加入GW9662及10％痰瘀同治大鼠血清.分别干预后,采用MTT法检测细胞增殖活性;Transwell法检测细胞迁移能力;Tube formation实验检测细胞血管生成能力;Western Blot法检测各组细胞PPAR γ、NF-κB和VEGF蛋白表达变化.结果:痰瘀同治含药血清能显著抑制HUVEC的增殖、迁移和血管生成能力,GW9662能够拮抗痰瘀同治含药血清的上述作用(P＜0.05).与空白血清组比较,TYTZ低组、TYTZ高组及罗格列酮组均能够显著增加细胞内PPARγ蛋白表达水平,减少NF-κB、VEGF蛋白表达水平(P＜0.05).结论:痰瘀同治含药血清通过调控PPAR γ/NF-κB通路,下调VEGF表达,抑制HUVEC的增殖、迁移和血管生成.

To understand the clinical characteristics of omicron in COVID-19 Rehabilitation Clinic after the current shift of dynamic zeroing policy, we consecutively collected the patients' data who visited in COVID-19 Rehabilitation Clinic of a Grade-A tertiary hospital in Hangzhou, Zhejiang Province, from January 3 to January 10, 2023, analyzed related data and then compared the pneumonia between elderly and non-elderly groups. The results showed that 95.68% of the patients in COVID-19 Rehabilitation Clinic had symptoms, 70.10% had a dry cough, 12.36% had abnormal complete blood count or C-reactive protein, 19.35% had electrolyte disorder, and 2% had abnormal troponin or creatine kinase-MB. 40.45% of patients had abnormal lung CT findings, among them 86.49% of elderly patients had abnormal lung CT findings, and the utilization rate of glucocorticoids in COVID-19 Rehabilitation Clinic was only 5.98%, although people are all susceptible to getting the COVID-19 infection, the elderly are more prone to getting pneumonia, and the glucocorticoids utilization rate is relatively insufficient. It is needed to be stressed that Chinese medical staff should pay more attention to the elderly patients who are vulnerable to getting pneumonia during this period.

Wellens综合征是一种左前降支严重狭窄的急性冠脉综合征;心电图表现为胸前导联T波呈正负双向或近似对称性深倒置,且不伴有QRS波的改变.本文报道浙江中医药大学附属第一医院1例Wellens综合征快速进展为急性ST段抬高型心肌梗死患者的诊治经过,阐述早期诊断和及时进行冠脉血运重建的重要性,为临床诊治提供参考.

BACKGROUND:Isolated single coronary artery is a rare congenital anomaly. R-I subtype single coronary artery is even rarer. In this subtype, a very large right coronary artery extends in the coronary sulcus to the anterior base of the heart where it produces the left anterior descending coronary artery. Currently, only a few case reports are available in the literature for this anomaly.CASE SUMMARY:Here, we report the case of a 62-year-old woman who presented to the cardiology clinic with decreased exercise tolerance and poor blood pressure control. The patient underwent coronary angiography (CAG) and emission computed tomography (ECT). CAG images revealed a single gigantic right coronary artery (R-I type) arising from the right coronary sinus with branches supplying the left coronary territory. The ECT results confirmed myocardial ischemia at the location of the absent left coronary artery. The ECT findings confirmed that ischemia was consistent with the vascular loss location in CAG images. In such anomalies, there is a compensatory widening of the coronary artery lumen. Medical treatment was administered, and the patient was discharged.CONCLUSION:Isolated single coronary arteries are associated with ischemia and potentially fatal acute coronary events. Hence, controlling risk factors is critical.

冠状动脉栓塞是指来自心脏或者循环中的栓子脱落随血流进入冠状动脉,阻塞冠状动脉血流而导致急性心肌缺血坏死.冠状动脉栓塞本质上属于继发性疾病,常见病因有心房颤动、瓣膜性心脏病、感染性心内膜炎、医源性栓塞等.及时诊断,及时干预能极大程度挽救濒死心肌,降低死亡率.根据冠状动脉栓塞的病因和栓塞部位不同,选择个体化最佳治疗方案至关重要,包括经皮冠状动脉介入治疗、静脉溶栓和外科手术.后续积极治疗原发病预防再次栓塞.

经皮冠状动脉(下称冠脉)介入(PCI)治疗是发生冠脉阻塞性疾病时血运重建的首选,旨在恢复冠脉血流,缓解心肌缺血.但PCI手术相关的并发症不可避免,由侧支闭塞、远端栓塞、夹层、血栓、无复流或慢复流引起的围术期心肌损伤和梗死较常见,且与未来不良心血管事件发生率增加相关.临床上PCI相关并发症的发生不能被低估,明确其发生的危险因素和机制,才能更有效进行干预.本文对PCI围术期心肌损伤和梗死的研究进展作一综述.

目的 研究心房颤动(AF)与肺动脉高压(PH)的相关性.方法 收集从2016年11月至2019年10月连续人院的AF患者292例.根据临床分类将292例AF患者分为两组:阵发性AF组167例(发作后7d内自行或干预终止的AF);持续性AF组125例(持续时间超过7 d的AF);另设同期住院的窦性心律患者137例.根据肺动脉压分成两组,PH组248例,非PH组181例.收集所有患者临床资料及肺动脉压,分析与PH相关的影响因素.结果 阵发性AF、持续性AF、窦性心律患者的肺动脉压分别为(33.95±9.89)mmHg,(42.21±11.19)mmHg、(27.39±5.32)mmHg,三组患者肺动脉压差异有统计学意义(F=86.013,P＜0.01).阵发性AF、持续性AF患者的肺动脉压比窦性心律组高,持续性AF组最高.Spearman相关性分析显示,PH与心律失常分类成正相关(r=0.557,P＜0.01).通过多因素Logistic回归分析显示,年龄、起搏器置入术后、阵发性AF、持续性 AF 均为 PH 的影响因素[OR(95％CI)=1.051(1.027～1.076)、3.684(1.020～13.302)、4.035(2.378～6.844)、15.327(7.200～32.628),P＜0.05].结论 AF 和 PH 有相关,AF 持续时间长的患者,肺动脉压升高明显,AF可能与PH的发生有关.

心房颤动(房颤)是临床上最常见的心律失常之一,其死亡率和发病率在很大程度上与血栓栓塞并发症相关.肺栓塞是心血管疾病死亡最常见的原因之一,是以各种栓子阻塞肺动脉或其分支为其发病原因的一组疾病或临床综合征的总称,而其中肺血栓栓塞症为肺栓塞最常见的类型.房颤和肺血栓栓塞有类似的高危因素,并且有越来越多的证据表明在房颤合并肺血栓栓塞的患者中,房颤可以通过右心房血栓形成、脱落导致肺血栓栓塞,反之房颤也可能是肺血栓栓塞产生的后果.目前,抗凝及预防血栓栓塞形成,仍是肺血栓栓塞合并房颤患者治疗中的重要策略.