Background:Hypocalcaemic cardiomyopathy is a rare but potentially reversible cause of heart failure (HF), yet it remains under-recognized in clinical practice. Evidence supporting a direct causal relationship is limited, particularly with regard to relapse and long-term follow-up. Case summary:A 71-year-old woman with post-thyroidectomy hypoparathyroidism presented with new-onset HF characterized by progressive exertional dyspnoea, orthopnoea, and paroxysmal nocturnal dyspnoea. Echocardiography revealed left ventricular and left atrial dilatation with a reduced left ventricular ejection fraction (34%) and severe functional mitral regurgitation. Electrocardiography showed sinus rhythm with prolonged corrected QT interval and T-wave inversion. Coronary angiography excluded significant coronary disease, and no alternative causes of HF were identified. Laboratory testing demonstrated severe hypocalcaemia (1.18 mmol/L) and suppressed parathyroid hormone levels. Despite guideline-directed HF therapy, symptoms failed to improve. Intravenous and oral calcium supplementation, together with calcitriol, led to rapid symptomatic and functional recovery. Two months later, discontinuation of calcium supplementation resulted in recurrent hypocalcaemia and relapse of HF, despite ongoing guideline-directed HF therapy, and again resolved after calcium repletion. During 30 months of follow-up, adherence to supplementation maintained calcium homeostasis and was associated with preserved cardiac function, with no further HF recurrence. Discussion:This case illustrates reversible and recurrent hypocalcaemic cardiomyopathy and highlights the importance of calcium homeostasis. The reproducible dechallenge-rechallenge pattern observed on two occasions provides clinically relevant evidence supporting a causal relationship between hypocalcaemia and myocardial dysfunction. Long-term biochemical monitoring and sustained adherence to calcium and vitamin D supplementation are important to prevent recurrence in patients with hypoparathyroidism.

Sepsis is a serious consequence of acute pancreatitis (AP) that requires immediate detection and treatment. Triglyceride-glucose (TyG) index demonstrated predictive ability for a number of diseases. In an effort to enhance clinical care and early warning systems, this study examined the association between the TyG index and sepsis risk with the aim of improving clinical care and early warning systems. Patients who were first admitted and satisfied the diagnostic criteria for acute pancreatitis (ICD-9: 5770; ICD-10: K85) were chosen from the MIMIC-IV database, excluding those lacking essential demographic or laboratory data. Using the Sepsis-3.0 criteria. Depending on whether they had sepsis or not, patients were divided into sepsis group and non-sepsis group. Utilizing the formula ln[(triglycerides mg/dl) × (glucose mg/dl)/2], the TyG index was calculated. The Boruta algorithm and Xgboost model were used for feature selection in order to pinpoint the important variables affecting results. Logistic regression with univariate and multivariate factors were used to assess the association between the TyG index and the start of sepsis after admission. Twenty-eight thousand AP patients were screened in all, among which 661 patients were ultimately included in the study. Of these, 228 patients (34.5

BACKGROUND:Early prediction of left ventricular reverse remodeling (LVRR) can guide the subsequent treatment in dilated cardiomyopathy (DCM) patients. We aimed to investigate the value of left atrium (LA) strain for predicting LVRR in DCM patients. METHODS:Clinical and imaging data of DCM patients were gather between January 2018 and January 2023. The participators were divided into LVRR group and non-LVRR group according to the ultrasound follow-up results. CMR images were process to yield LA fast long-axis strain parameters. Univariate and multivariate logistic regression analysis was used to screen the predictors and establish the prediction model. RESULTS:The study included 116 participants. LVRR occurred in 69 participants within 1 year. Compared with the non-LVRR group, the LVRR group has smaller left ventricular end-diastolic volume index (LVEDVi), late gadolinium enhancement extent (LGE%) and higher left atrial passive eject fraction (LAPEF), left atrial reservoir strain (LARS) and left atrial conduit strain (LACS). In multivariable logistic regression analysis, LVEDVi (HR: 0.990; 95 % CI: 0.981, 0.999; P = 0.037), LACS (HR: 1.434; 95 % CI: 1.025, 2.007; P = 0.035) and LGE% (HR: 0.713; 95 % CI: 0.584, 0.870; P = 0.001) were independent predictors of LVRR. The model based on NYHA, LVEDVi, LGE% and LACS had a better performance in predicting LVRR (AUC = 0.807; 95 % CI: 0.723; 0.874). CONCLUSIONS:LVEDVi, LACS and LGE% were independent predictors of LVRR within 1 year in DCM patients. The combination of NYHA, LVEDVi, LACS and LGE% has a better predictive performance.

Cardiac involvement is the primary driver of death in systemic light chain (AL) amyloidosis. However, the early prediction of cardiac death risk in AL amyloidosis remains insufficient. We aimed to develop a novel prediction model and prognostic scoring system that enables early identification of these high-risk individuals. This study enrolled 235 patients with confirmed AL cardiac amyloidosis from three hospitals. Patients from the first hospital were randomly assigned to the training and internal validation sets in an 8:2 ratio, while the external validation set comprised patients from the other two hospitals. Participants were categorized into a cardiac death group and a non-cardiac death group (including survivors and those who died from other causes). Five different machine learning models were used to train model, and model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. All five models showed excellent performance on the training and internal validation sets. In external validation, both the Logistic Regression (LR) and Random Forest models achieved an area under the ROC curve of 0.873 and 0.877, respectively, and exhibited superior calibration and decision curve analysis. Considering the comprehensive performance and clinical applicability, the LR model was selected as the final prediction model. The visualization results are ultimately presented in a nomogram. Further analyses were performed on the newly identified predictors. This prediction model enables early identification and risk assessment of cardiac death in patients with AL amyloidosis, exhibiting considerable predictive ability.

Although previous observational studies have shown an association between venous thromboembolism (VTE) and atrial fibrillation (AF), the underlying causal relationship between them remains uncertain. This two-sample bidirectional Mendelian randomization (MR) analysis was performed to investigate the causal relationship between VTE and AF. The VTE dataset were obtained from FinnGen, including 9,176 cases and 209,616 controls. Meanwhile a genome-wide association study (GWAS) of 60,620 individuals with AF and 970,216 control subjects identified genetic variations associated with AF. The principal MR analytic approach used in this study is the inverse-variance weighting (IVW) method. Furthermore, we performed complementary MR analyses, including the MR-Egger, Weighted median (WM), and Weighted Mode. MR pleiotropy residual sum was applied to identify pleiotropy. The MR analysis showed suggestive causal associations between VTE and the risk of AF (p = 0.0245, OR [95

Background:The efficacy of chronic heart failure (CHF) checklist management in reducing adverse outcomes of heart failure patients is still uncertain. This study explores whether CHF checklist management is more useful than usual care in reducing adverse health outcomes in the medium- and long-term among CHF patients.Methods:In our prospective study, 132 patients with CHF were randomly assigned to CHF management group and usual care group by random number method. Patients in CHF management group were conducted through CHF checklist by cardiologists and general practitioner. Patients assigned to usual care were treated by non-stationary medical group without checklist. All groups were followed up for 18 months.Results:There was no significant difference in overall mortality rate between management group and control group during 18 months (12.3% [8/65] vs. 11.7% [7/60], P = 0. 912]). The re-hospitalization rate of heart failure in management group (18.5% [12/65]) was significantly lower than that in usual care group (38.3% [23/60]) after 18 months of follow-up (P = 0.013). Median NT-proBNP level (632.3 ng/l vs. 1678 ng/l, p = 0.004) was lower in management group than that in usual care group. Cardiac ultrasonography was performed at 18 months between the management and usual care group. LVEDD (55.88±7.11 mm vs. 60.92±8.06 mm) and LVESD (43.25±8.42mm vs. 48.41± 9.02mm) were decreased (P<0.01). LVEF was increased (45.36±10.64% vs. 39.96 ±10.15%, P<0.01). The utilization rate of ACEI/ARB/ARNI, β-blocker were high in management group.Conclusion:CHF checklist management by cardiologists and general practitioners can significantly reduce the re-hospitalization and improve cardiac function. CHF management through heart failure checklist may improve prognosis in patients with CHF in the medium- and long-term.

Objective:To study the clinical characteristics, diagnosis, complications and prognosis of neonatal varicella.Methods:From September 2008 to December 2019, the clinical data of hospitalized neonates with varicella in our hospital were retrospectively analyzed.Results:A total of 33 cases of neonatal varicella were reviewed, including 18 males and 15 females, 32 full-term infants and 1 premature infant. The gestational age (GA) was (38.8±1.2)w and birth weight (BW) was (3 670±247)g. The onset of the disease occurred at 14.0 (8.0,19.0)d and was diagnosed at 18.0 (11.5,23.0)d. The hospital stay duration was (8.1±3.7)(2~20)d. All mothers denied varicella history or varicella vaccination. Among the 33 infants, 29 had a history of varicella/zoster exposure. All 33 infants had typical rash and 25 had fever, body temperature (38.3±0.6) ℃ and duration (2.4±1.4) d. 13 cases were congenital varicella, 20 cases were acquired varicella. 24 cases abnormality of cardiac enzymes, 11 cases skin infection, 8 cases liver damage, 4 cases pneumonia, 6 cases granulocytopenia/agranulocytosis, 9 cases anemia, 4 cases sepsis and 1 case viral encephalitis were diagnosed. 20 infants received intravenous antiviral therapy (acyclovir), 17 were treated with antibiotics, 15 were given intravenous immunoglobulin (IVIG), 8 received both antiviral therapy and IVIG and 6 were treated with recombinant human granulocyte stimulating factor. 31 infants were cured and discharged. 2 infants were discharged after improvement of rashes. All infants reported complete recovery on telephone follow-up.Conclusions:Most neonatal varicella cases have a definite exposure history. Besides rashes, complications including pneumonia, liver damage, myocardial injury, granulocytopenia/agranulocytosis, viral encephalitis are common. Intravenous antiviral therapy with acyclovir and combined treatment of IVIG and symptomatic support can often achieve a good prognosis.

A microtiter plate assay is described for detecting cells bearing Fc receptors for IgE (Fcϵ receptors) and for assaying IgE-binding molecules. Cells are bound specifically to IgE-coated wells of microtiter plates, and the bound cells are enumerated in a quantitative colorimetric assay. IgE-binding molecules and monoclonal antibodies are assayed as inhibitors of the IgE-dependent cell binding. Major advantages of the plate assay compared to rosetting assays are its ability to accomodate many test samples for replicates and titrattions and the ease with which results are read out. The versatility of the assay is discussed with respect to detecting other immunoglobulin Fc receptor-bearing cells.

BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated cardiomyopathy (DCM). The study aimed to investigate the all-cause mortality up to 15 years (mean 7.9 ± 5.7 years) in such patients, and the independent prognostic factors influencing their long-term mortality. METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003. The mean age of patients was 59.5 ± 10.4 years, and approximately 57% were male. They were followed up by telephone or outpatient visit at least every three months until 2019 or all-cause death occurred. Predictors of mortality were identified using multivariate logistic regression analysis. RESULTSDuring the 15 years of follow-up, five patients were lost to follow-up, and the complete data records of 161 patients were included in the analysis. Patients were treated with angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin-receptor blocker (ARB), β-blockers, mineralocorticoid receptor antagonist (MRA), diuretics and digitalis from 2002 to 2004, and maintained at the maximum tolerated doses between 2004 and 2019. Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg, respectively. All-cause mortality in the first five years was 55.9%. The independent risk factors for the 5-year mortality were age ≥ 70 years old (OR = 5.45, P = 0.006), systolic blood pressure (SBP) > 120 mmHg (OR = 3.63, P = 0.004), 6-minute walk distance (6MWD) < 450 m (OR = 3.84, P = 0.001). 15-year all-cause mortality was 65.8%. The independent risk factors for 15-year mortality were age ≥ 70 years old (OR = 16.07, P = 0.009), LVEF ≤ 35% (OR = 5.69, P = 0.003), and SBP > 120 mmHg (OR = 9.56, P < 0.001). CONCLUSIONSThis study was the first to demonstrate the 15-year survival rate of 34% in DCM patients. The DCM patients’ first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management. The mortality then plateaued in the following 10 years. Age ≥ 70 years, LVEF ≤ 35%, and SBP > 120 mmHg were independent predictors of 15-year all-cause mortality.

Resumo Fundamento: A fração de ejeção (FE) tem sido utilizada em análises fenotípicas e na tomada de decisões sobre o tratamento de insuficiência cardíaca (IC). Assim, a FE tornou-se parte fundamental da prática clínica diária. Objetivo: Este estudo tem como objetivo investigar características, preditores e desfechos associados a alterações da FE em pacientes com diferentes tipos de IC grave. Métodos: Foram incluídos neste estudo 626 pacientes com IC grave e classe III–IV da New York Heart Association (NYHA). Os pacientes foram classificados em três grupos de acordo com as alterações da FE, ou seja, FE aumentada (FE-A), definida como aumento da FE ≥10%, FE diminuída (FE-D), definida como diminuição da FE ≥10%, e FE estável (FE-E), definida como alteração da FE <10%. Valores p inferiores a 0,05 foram considerados significativos. Resultados: Dos 377 pacientes com IC grave, 23,3% apresentaram FE-A, 59,5% apresentaram FE-E e 17,2% apresentaram FE-D. Os resultados mostraram ainda 68,2% de insuficiência cardíaca com fração de ejeção reduzida (ICFEr) no grupo FE-A e 64,6% de insuficiência cardíaca com fração de ejeção preservada (ICFEp) no grupo FE-D. Os preditores de FE-A identificados foram faixa etária mais jovem, ausência de diabetes e fração de ejeção do ventrículo esquerdo (FEVE) menor. Já os preditores de FE-D encontrados foram ausência de fibrilação atrial, baixos níveis de ácido úrico e maior FEVE. Em um seguimento mediano de 40 meses, 44,8% dos pacientes foram vítimas de morte por todas as causas. Conclusão: Na IC grave, a ICFEr apresentou maior percentual no grupo FE-A e a ICFEp foi mais comum no grupo FE-D.

Objective:To investigate the causes of anemia in newborns delivered by human immunodeficiency virus (HIV) infected mothers.Methods:This was a retrospective study. Forty-two newborns delivered by HIV infected mothers during January 2010 and May 2019 in Beijing Ditan Hospital Affiliated to Capital Medical University were selected. According to the hemoglobin levels of newborns on the days of their birth, newborn cases were divided into two groups, anemia group and non-anemia group. The clinical data including gestational ages, birth weight, maternal anemia status during pregnancy, using of antiviral drugs during pregnancy, percentages of HIV RNA positivity in early pregnancy/pre-treatment and before delivery, maternal percentage of different CD4 + T lymphocyte counts in early pregnancy/pre-treatment and before delivery between two groups were compared. The efficacies of relative indicators for prediction of anemia in newborns were evaluated by the area under receiver operating characteristic curve (AUROC). Differences between groups were compared by chi-square test. Results:Among 42 cases of newborns, 14 cases were in anemia group and 28 cases in non-anemia group. There were no statistical differences in gestational ages, birth weight, maternal anemia status during pregnancy and positive percentage of HIV RNA before delivery between two groups ( χ2=2.211, 1.025, 1.362 and 3.783, respectively, P=0.283, 0.763, 0.181 and 0.092, respectively). In anemia group, 11 mothers took zidovudine during pregnancy, which was 12(42.86%) in non-anemia group. The difference was statistically significant ( χ2=4.359, P=0.037). Eight cases of mothers with HIV RNA positive in early pregnancy/pre-treatment in the anemia group, which was 11(39.29%) in the non-anemia group. The difference was statistically significant ( χ2=6.490, P=0.011). The number of CD4 + T lymphocyte count ≤500/μL was 13 in early pregnancy/pre-treatment in anemia group, which was 20(71.43%) in the non-anemia group. The difference was statistically significant ( χ2=16.396, P<0.01). The number of CD4 + T lymphocyte ≤0.28 was 13 in early pregnancy/pre-treatment in the anemia group, which was 19(67.86%) in the non-anemia group ( χ2=19.908, P<0.01). The number of CD4 + T lymphocyte count ≤500/μL was 14 before delivery, which was 15(53.37%) in the non-anemia group ( χ2=9.536, P=0.008). The number of CD4 + T lymphocyte ≤0.28 before delivery was 14 in anemia group, which was 15(53.37%) in the non-anemia group ( χ2=9.750, P=0.006). According to the receiver operating characteristic curve results, the AUROC, optimal cut-off value, sensitivity and specificity of CD4 + T lymphocyte count before delivery in predicting neonatal anemia were 0.708, 476.0/μL, 100.0% and 50.0%, respectively. The AUROC, optimal cut-off value, sensitivity and specificity of maternal CD4 + T lymphocyte percentage before delivery in predicting neonatal anemia were 0.719, 0.275, 100.0% and 53.6%, respectively. Conclusion:Low CD4 + T lymphocyte level in HIV-infected mothers before delivery, HIV positive in early pregnancy/pre-treatment and using of zidovudine during pregnancy may be associated with neonatal anemia.

BACKGROUND:Ejection fraction (EF) has been used in phenotype analyses and to make treatment decisions regarding heart failure (HF). Thus, EF has become a fundamental part of daily clinical practice. OBJECTIVE:This study aims to investigate the characteristics, predictors, and outcomes associated with EF changes in patients with different types of severe HF. METHODS:A total of 626 severe HF patients with New York Heart Association (NYHA) class III-IV were enrolled in this study. The patients were classified into three groups according to EF changes, namely, increased EF (EF-I), defined as an EF increase ≥10%, decreased EF (EF-D), defined as an EF decrease ≥10%, and stable EF (EF-S), defined as an EF change <10%. A p-value lower than 0.05 was considered significant. RESULTS:Out of 377 severe HF patients, 23.3% presented EF-I, 59.5% presented EF-S, and 17.2% presented EF-D. The results further showed 68.2% of heart failure with reduced ejection fraction (HFrEF) in the EF-I group and 64.6% of heart failure with preserved ejection fraction (HFpEF) in the EF-D group. The predictors of EF-I included younger age, absence of diabetes, and lower left ventricular ejection fraction (LVEF). The predictors of EF-D were absence of atrial fibrillation, lower uric acid level, and higher LVEF. Within a median follow-up of 40 months, 44.8% of patients suffered from all-cause death. CONCLUSION:In severe HF, HFrEF presented the highest percentage in the EF-I group, and HFpEF was most common in the EF-D group.

目的探讨奈韦拉平与齐多夫定对人类免疫缺陷病毒(HIV)暴露婴儿母婴阻断结局、肝功能、血常规及生长发育的影响.方法选取2014年1月至2019年1月首都医科大学附属北京地坛医院收治的HIV感染患者分娩新生儿70例,最终纳入研究63例,根据出生后6h内母婴阻断用药情况分为奈韦拉平组(37例)和齐多夫定组(26例).比较2组婴儿性别、出生体质量和分娩方式等基本资料,HIV母婴阻断效果和HIV抗体转阴率,出生6周和出生3个月的生长发育情况、肝功能和血常规.结果2组新生儿性别、出生体质量、低出生体质量儿比例和分娩方式比较差异均无统计学意义(均P>0.05).2组婴儿出生6周、3个月HIV-RNA均阴性,HIV母婴阻断效果均为100％,出生24个月2组婴儿HIV抗体均转阴,阻断成功率均为100％.出生6周,奈韦拉平组总蛋白水平低于齐多夫定组[(52.62 ±0.48)g/L比(55.01 ±0.57)g/L],白细胞计数高于齐多夫定组[(8.34 ± 0.42)x 109/L 比(6.99 ±0.19)x 109/L](均P<0.05),2组婴儿出生6周和出生3个月的体质量、头围、身长以及其他肝功能、血常规指标水平比较差异均无统计学意义(均P>0.05).结论奈韦拉平与齐多夫定对HIV暴露婴儿母婴阻断结局和生长发育均无影响,奈韦拉平对肝功能中总蛋白生成有影响,齐多夫定对造血功能有一过性抑制作用,二者均能对HIV进行完全阻断.

目的:分析不同性别重症心力衰竭(心衰)患者的临床特点及预后影响因素.方法:入选我院2011年1月至2016年12月因心衰住院的NYHA心功能分级Ⅲ～Ⅳ级患者848例,记录患者的一般临床资料及用药情况,实验室指标和超声心动图参数.通过电话或门诊进行随访,记录发生全因死亡时间.比较不同性别重症心衰患者临床特点,Cox回归分析全因死亡影响因素.结果:(1)基线资料:中位随访时间41(1 d,93个月)个月,失访56例,纳入分析792例.其中女性290例,男性502例.NYHA心功能分级Ⅲ级400例,Ⅳ级392例;射血分数降低的心衰(HFrEF)361例(45.6％),射血分数中间值的心衰(HFmrEF)145例(18.3％),射血分数保留的心衰(HFpEF)286例(36.1％).(2)在重症心衰患者中,男性以HFrEF为主,NYHA心功能分级Ⅳ级多见;女性以HFpEF为主,NYHA心功能分级Ⅲ级多见,两者基础疾病以冠心病最多见.与男性患者相比,女性患者瓣膜病比例高,年龄大,多伴有糖尿病、心房颤动病史,左心室射血分数(LVEF)高,肌酐清除率(Ccr)低(P均<0.05).NYHA心功能分级Ⅳ级患者N末端B型利钠肽原(NT-proBNP)水平显著高于NYHA心功能分级Ⅲ级患者(P均<0.05).(3)不同类型重症心衰患者亚组比较显示,各类型心衰基础疾病均以冠心病为主,占55％左右.HFpEF女性患者多,年龄最大,心房颤动比例最高,NT-proBNP值最低;HFrEF男性患者为主,心房颤动比例最低,NT-proBNP最高.三种类型心衰全因死亡率相似.(4)患者全因死亡共345例(43.6％),其中男性215例(42.9％),女性130例(44.8％),预后相似.年龄、NYHA心功能分级Ⅳ级、冠心病病史、血红蛋白、血尿酸、血钠、NT-proBNP≥3300 ng/L、服用血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)类药物、男性是重症心衰患者全因死亡的独立影响因素.结论:重症心衰患者男性以HFrEF及NYHA心功能分级Ⅳ级为主,年龄低,而女性以高龄、HFpEF为主,NYHA心功能Ⅲ级多,两者预后相似.年龄、NYHA心功能分级Ⅳ级、冠心病病史、血红蛋白、血尿酸、血钠、NT-proBNP≥3300 ng/L、服用ACEI/ARB类药物、男性是重症心衰患者全因死亡的独立影响因素.

Objective:To investigate the characteristics of lymphocyte subsets in children with severe influenza A, and to evaluate their diagnostic value for children with severe influenza A.Methods:A retrospective study was conducted on 129 hospitalized children with influenza A within 48 hours in Beijing Ditan Hospital, Capital Medical University from October 2018 to December 2019. A 1∶2 match was made according to age and sex. Only those with fever and upper respiratory symptoms were classified as mild group (43 cases); those with persistent high fever > 3 days, and those with pneumonia, dyspnea and altered consciousness were classified as severe group (86 cases). Blood routine examination and lymphocyte subsets of the two groups were detected and compared. The diagnostic efficacy of each parameter of lymphocyte subsets in severe influenza A were analyzed by receiver operating characteristic curve (ROC), while the area under the curve (AUC) of each parameter were compared in pairs by Medcalc software.Results:Lymphocyte count [1 554 (928, 2 605) cells/μl vs. 2 723 (1 792, 4 108) cells/μl] and T cell count [728 (419, 1 491) cells/μl vs. 1 558 (1 123, 2 259) cells/μl], CD4+ T cell count [418 (237, 699) cells/μl vs. 1 558 (1 123, 2 259) cells/μl] decreased, all with significant differences (Z =-3.959, -2.833, -4.399; P < 0.001, 0.005, < 0.001). The sensitivity and specificity of CD4+ T cell count were 60.4% and 95.5%, the area under the curve (AUC) was 0.825 (95%CI: 0.715-0.905). The AUC of CD4+ T cell count compared with that of CD8+ T cell count, NK cell count and B cell count were all with significantly difference (Z = 1.961, 2.227, 2.602; P = 0.0498, 0.026, 0.0093), but without significantly difference compared with lymphocyte count and T cell count (Z = 1.016, 1.372; P = 0.310, 0.17).Conclusions:The cellular immune function of children with severe influenza A is impaired at early stage of the disease. CD4+ T cell count within 48 hours of the disease has good diagnostic efficacy for severe influenza A.

Objective: This study aimed to find echocardiographic parameters that can predict short- and long-term adverse cardiovascular events in patients with AMI. Methods: A total of 126 patients with AMI admitted to our hospital from July to December 2012 were enrolled in this study. All patients underwent echocardiographic examination within 12 hours after admission and received regular follow-ups until December 2018. The primary endpoint was a composite of the major adverse cardiovascular events (MACEs). Results: In the first year of this study, a primary endpoint occurred in 35 patients and the predictor derived from the echocardiography of 1-year primary endpoint was LVEF<40% (OR: 9.000, 95% CI 3.242-24.987, p<0.0001) and the area under the curve (AUC) for the predictor was 0.676 (95% CI 0.561-0.790, p=0.002). For the total 5 years, 57 patients underwent primary endpoint. The results of the 5-year primary endpoint were: E/E'>15 (OR: 4.094, 95% CI 1.726-9.710, P=0.001), the wall motion score index was (WMSI)>1.5 (OR: 12.791, 95% CI 1.511-108.312, P=0.019), and the AUC was 0.691 (95% CI 0.595-0.787 P<0.0001). Conclusion: LVEF is correlated with a short-term outcome (1-year), and WMSI and E/E' can predict a long-term outcome (5-year) in patients with acute myocardial infarction.

目的 探讨老年重症射血分数保留心力衰竭(HFpEF)患者临床特点并对其预后因素进行分析.方法 入选2011-2016年北京朝阳医院住院的纽约心脏协会(NYHA)心功能分级Ⅲ～Ⅳ级重症HFpEF患者308例,记录患者一般资料、生化指标、超声心电图等参数.按年龄分为＜75岁组和≥75岁组.采用Kaplan-Meier生存曲线及Cox回归对患者预后及其影响因素进行分析.结果(1)共纳入分析286例,NYHA Ⅲ级171例,Ⅳ级115例,平均年龄71.3岁,死亡131例.≥75岁组142例,死亡80例,＜75岁组144例,死亡51例.(2)≥75岁组女性多见;伴随高血压、糖尿病、卒中等疾病多;糖化血红蛋白、老年营养风险指数(GNRI)＜92比例高于＜75岁组;白蛋白、血红蛋白、肌酐清除率、左室舒张末期内径(LVEDD)及地高辛和β受体阻滞剂使用率明显低于＜75岁组.≥75岁组死亡率明显高于＜75岁组,P＜0.001.(3)Cox多因素回归分析显示≥75岁组NT-proBNP、未服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)、左室肥厚是其预后的独立危险因素.结论 老年重症HFpEF患者一般状况差,伴随疾病多,死亡率高,预后差.NT-proBNP、未服用ACEI/ARB类药物、左室肥厚是其预后的独立危险因素.

The hallmark of atherogenesis is characterized as endothelial dysfunction and subsequent macrophage activation. Although our previous study has demonstrated that endothelin-1 (ET-1) plays an important role in atherogenesis, the underlying mechanism remains deeply investigation. Enhanced atherosclerotic plaques were observed in endothelium-specific ET-1 overexpression ApoE(-/-) mice (eET-1/ApoE(-/-)) concomitant with increased secretion of pro-inflammatory adhesion molecules and cytokines. The conditional media used for culturing human umbilical vein endothelial cells (HUVECs) with AdET-1 infection and subjected to OX-LDL stimulation, was collected and utilized for bone marrow-derived macrophages (BMDMs) culturing. RT-PCR analysis showed increased genes expression related to classical M1 macrophages but decreased alternative activated M2 macrophages genes expression in macrophage culturing with the conditional media. Furthermore, consistent regulations of macrophage polarization were observed using isolated exosomes from the conditional media. More importantly, we noticed that miR-33 was enriched in the exosomes derived by HUVECs with AdET-1 infection, while bioinformatics analysis further indicated that miR-33 directly targeted NR4A and miR-33/NR4A axis was required for the effect of endothelial-specific ET-1 overexpression on pro-inflammatory macrophage activation. By contrast, such effects could be reversed by ET-1 knockdown. Taken together, our study indicated that the exosomes derived by HUVECs with AdET-1 infection can transfer miR-33 to macrophages and subsequently promote pro-inflammatory macrophage activation by directly targeting to NR4A. These evidences clearly revealed that miR-33/NR4A axis was the important mechanism underlying the effect of ET-1 on macrophage activation and indicated that ET-1 may act as a promising target for atherosclerosis management.

背景 对于慢性心力衰竭患者给予积极治疗和良好的管理可避免心力衰竭加重.目前国内外没有统一、公众认可的心力衰竭管理模式.本课题拟应用心力衰竭清单方式对慢性心力衰竭患者进行统一的管理,旨在为我国探索社区管理模式提供参考.目的 应用心力衰竭清单对慢性心力衰竭患者进行社区管理,并评价此方法的效果,希望通过此研究探索一种简单易行的慢性心力衰竭社区管理模式并可进行推广.方法 选取2016-06-30至2017-06-30于首都医科大学附属北京朝阳医院心脏中心住院且明确诊断为慢性心力衰竭的患者200例.采用随机数字法将其分为管理组100例和对照组100例,管理组由全科团队采用心力衰竭清单对患者进行全方位管理,随访1次/月;对照组不应用心力衰竭清单,由全科团队进行常规门诊管理,随访1次/月,仅记录相关资料但不特别干预.查阅患者电子病例系统收集基线资料.随访6个月后,比较两组患者N末端脑钠肽前体(NT-proBNP)及心功能指标左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、慢性心力衰竭标准化药物使用率及心力衰竭再住院率和死亡率.结果 共176例患者完成随访,其中管理组89例,对照组87例.管理后,管理组NT-proBNP、心功能分级、LVEDD、LVESD均低于对照组,LVEF高于对照组(P<0.05).管理组管理后血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)使用率高于管理前,螺内酯使用率低于管理前(P<0.05).管理后两组β-受体阻滞剂、螺内酯使用率比较,差异无统计学意义(P>0.05);管理组ACEI/ARB使用率高于对照组(P<0.05).管理组心力衰竭再住院率〔11.2％(10/89)〕低于对照组〔29.9％(26/87)〕(χ2=9.404,P=0.002).两组死亡率比较,差异无统计学意义〔9.0％(8/89)与11.5％(10/87),χ2=0.301,P=0.583〕.结论 全科医生应用心力衰竭清单管理慢性心力衰竭患者能明显提高管理效果,提示心力衰竭清单是一种简单易行的慢性心力衰竭社区管理模式.

Objective To determine the possible association of anti-β1-adrenergic receptors (anti-β1-AR), anti-β2-AR and anti-α1-AR with carvedilol treatment in patients with heart failure (HF). Methods A total of 267 HF patients were prospectively enrolled. Blood samples were measured by an enzyme-linked immunosorbent assay. All of the patients received carvedilol for their HF. Each patient was followed up for six months and their cardiac function was measured. Results The final analysis encompassed 137 patients comprising 65 patients with three autoantibodies (positive group) and 72 patients without all three autoantibodies but with one or two autoantibodies (negative group). The frequency and geometric mean titer of anti-β1-AR, anti-β2-AR, and anti-α1-AR were significantly lower in the group without all three autoantibodies after six months of carvedilol treatment (all P < 0.01; from 100% to 57%, 50%, and 49%, respectively; and from 1: 118, 1: 138, and 1: 130 to 1: 72, 1: 61, and 1: 67, respectively). Furthermore, 28 patients in the positive group demonstrated complete ablation of autoantibodies. In addition, left ventricular remodelling and function was significantly improved by the use of carvedilol combined with the standard treatment regime for six months in the positive group (P < 0.01) when compared to the negative group (P < 0.05). Conclusions Carvedilol treatment significantly decreases frequency and geometric mean titer in patients with all three autoantibodies, even up to complete ablation, and significantly improved cardiac function and remodelling. The effect of carvedilol is probably correlated to the presence of all three autoantibodies.