Cardiovascular diseases, particularly acute myocardial infarction (AMI), have posed a significant global health burden due to the high morbidity and mortality rates. Current treatment methods are compromised by a narrow therapeutic window, risk of ischemia-reperfusion injury, rapid systemic drug clearance, and inadequate targeting efficiency. To address these limitations, we developed an innovative multifunctional biomimetic nano-therapeutic system (PDMC/CHP@S/V), which comprised a triblock copolymer synthesized through controlled polymerization of dopamine methacrylamide (DMA), 2-methacryloyloxyethyl phosphorylcholine (MPC), and methacrylate-functionalized cyclodextrin. Adamantane-conjugated cardiac homing peptide was anchored onto the nanoparticles surface via host-guest interactions, enabling precise infarct-targeting drug delivery. The cell membrane-like MPC shell markedly reduced macrophage-mediated phagocytosis, prolonging circulation time, while the catechol groups in DMA provided robust antioxidant effects by scavenging reactive oxygen species (ROS). The in vitro experiments showed that the nanosystem effectively reduced ROS level, alleviated cell apoptosis, and restored mitochondrial membrane potential in hypoxic cardiomyocytes. Furthermore, the in vivo tests indicated that PDMC/CHP@S/V significantly improved cardiac function, as evidenced by a remarkable reduction of myocardial fibrosis and attenuated ventricular remodeling in AMI mice model. Collectively, the spatiotemporal collaborative delivery design of PDMC/CHP@S/V nanoparticles addressed limitations of conventional therapies, providing an efficient, stable, and safe strategy for achieving targeted AMI treatment.

BACKGROUND:Previous studies showed that remnant cholesterol(RC) partially explained the residual risk of cardiovascular disease. We tried to test the hypothesis that remnant cholesterol is a risk factor for all-cause mortality and cardiovascular(CV) mortality in oldest-old(>80 years old) patients with acute coronary syndrome(ACS). METHODS:699 oldest-old patients with ACS and undergoing coronary angiography(CAG) were included in our study. RC was calculated by fasting total cholesterol(TC) minus low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDLC). With a maximum follow-up period of 10 years, 37 patients were lost to follow-up, and 662 were finally available for statistical analysis. Pearson's correlation test was used to assess the associations between RC and clinical parameter. Multivariable Cox regression analysis was used to identify the association between RC and all-cause mortality. Nelson-Aalen cumulative hazard curves and Fine-Gray plots were used to assess the association between RC and clinical outcomes, including all-cause mortality, major adverse cardiovascular events (MACEs), cardiovascular (CV) mortality, and non-CV mortality. Receiver operating characteristic(ROC) curve was used to compare the discrimination capacity of RC, TC, HDL-C and LDL-C to predict all-cause mortality. RESULTS:Among the 662 oldest-old patients enrolled, 92.90% accepted statin therapy. The average age was 81.87 ± 2.14 years old. Nelson-Aalen cumulative hazard curves showed that the cumulative hazard of all-cause mortality and MACEs in the high RC tertile was higher than that in the middle or low RC tertiles. In the fully-adjusted Cox regression model, the Hazard ratio(HR) [95% confidence interval (CI)] of all-cause mortality was 1.17 (1.01, 1.44) for each standard deviation(SD) increase in RC. Compared to RC tertile 1, RC tertile 3 was associated with a 94% increased risk of all-cause mortality (HR:1.94; 95%CI: 1.22-3.10). The increased risk of all-cause death from tertile 1 to tertile 3 was statistically significant. Fine-Gray test showed that regarding CV mortality, marginally statistically significant differences in cumulative incidence were observed among the three RC tertile groups (P = 0.054). For non-CV mortality, statistically significant differences were detected across three groups (P = 0.026). The subgroup analysis confirmed the significant association between RC and all-cause mortality. ROC curve showed that RC had a better discrimination capacity at predicting all-cause mortality (AUC (95% CI): 0.621(0.575-0.666)), and improved the prognostic value of the Gensini score combined with left ventricular ejection fraction(LVEF). CONCLUSION:Remnant cholesterol was associated with all-cause mortality in oldest-old patients with ACS in a long-term follow-up.

Currently, precise stent manipulation and placement in percutaneous coronary intervention remain compromised. Intravascular imaging techniques are often limited by either spatial resolution or depth of penetration. A hybrid intravascular ultrasound (IVUS)-optical coherence tomography (OCT) system would be a better choice for interventional cardiologists. To validate the image quality and safety of the novel IVUS-OCT system for guiding coronary intervention in Chinese patients, a total of 114 cases were included. The proportion of clear imaging length was 96.21% ± 10.16%. Device success rate was 99.1%, technical success rate was 98.2%, and excellent image rate was 96.5%. No catheter-related adverse events occurred, and the incidence of device defects was 0.9%. This study preliminarily verified the image quality and safety of the novel Hybrid IVUS and OCT imaging system. (The StUdy to Evaluate the Performance and safEty of the Novasight HybRid System Using Objective PeRformance Criteria [SUPERIOR]; NCT04617899).

Myocardial infarction accompanied by diabetes mellitus is accepted as the most serious type of coronary heart disease, and among the current treatment strategies, the precise delivery of protective drugs for inhibiting cardiomyocyte apoptosis is still a challenge. In this study, we developed a biodegradable nanoparticles-based delivery system with excellent macrophage escape, cardiac targeting, and drug release properties to achieve targeted therapy of myocardial infarction. Specifically, a copolymer of p(DMA–MPC–CD) combining self-adhesion, hydration lubrication, and targeting peptide binding site was successfully prepared by free radical copolymerization, and it was self-assembled on the surface of melatonin-loaded dendritic mesoporous silica nanoparticles (bMSNs) following the integration of adamantane-modified cardiac homing peptide (CHP) based on supramolecular host–guest interaction. Importantly, a hydration layer formed around the zwitterionic phosphorylcholine groups of the multifunctional nanoparticles, which was confirmed by the enhancement in hydration lubrication and reduction in coefficient of friction, prevented the nanoparticles from phagocytosis by the macrophages. The in vivo bioluminescence imaging test indicated that the nanoparticles were endowed with satisfied cardiac targeting capability, and the in vivo mice study demonstrated that the intravenous injection of drug-loaded nanoparticles (namely bMSNs–Mel@PDMC–CHP) effectively reduced cardiomyocyte apoptosis, alleviated myocardial interstitial fibrosis, and enhanced cardiac function.

Objective To explore the possibility of rhabdomyolysis and related organ damage in new recruits training in high temperature and high humidity environment by comparing the effects of different training environments on the laboratory indicators and electrocardiogram. Methods A total of 250 new recruits from a unit in Beijing and another 250 ones from a unit in Hainan were recruited and assigned into conventional environment group and high temperature and high humidity environment group, respectively. All of them were male, with an average age of 21.36±2.59 years. Before and in 4 weeks after training in the same subjects, their general information, blood and urine indicators, and electrocardiogram were collected. All data were statistically analyzed. Results The incidences of inflammatory reaction, myocardial injury, muscle injury, liver injury, and kidney injury were 45.76%, 3.39%, 12.71%, 25.42%, and 12.71%, respectively, in the high temperature and high humidity environment group, which were all significantly higher than those in the conventional environment group (P < 0.05). The former group had an incidence rate of 6.78%, 5.93%, 8.47%, 6.78%, and 2.54%, respectively, in sinus bradycardia, atrial premature beats, unspecific ST-T changes, left ventricular hypertension and short PR interval, and all of the rates were higher than those of the conventional environment group (P < 0.05). Conclusion The incidences of inflammatory reaction, myocardial injury, muscle injury, liver injury, kidney injury, and ECG abnormalities are more common in new recruits after military training in high temperature and high humidity environment.

Abstract Aims This study sought to assess the effect of treatment of sacubitril/valsartan (S/V) on improving cardiac function and reversing cardiac remodelling in patients with acute coronary syndrome (ACS) complicated with heart failure with reduced ejection fraction after percutaneous coronary intervention (PCI). Methods and results We enrolled 275 ACS patients with reduced left ventricular ejection fraction after PCI. The patients were divided into the routine and S/V groups according to the treatment drugs. The symptoms, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) concentrations, echocardiographic parameters [left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end‐diastolic volume index (LVEDVI), and left ventricular end‐systolic volume index (LVESVI)], major adverse cardiac events (MACEs), and adverse reactions were recorded at baseline and 6 months after treatment when a clinical follow‐up was performed. The S/V group was further divided into prespecified subgroups including unstable angina (UA) group, non‐ST‐elevation myocardial infarction (NSTEMI) group, and ST‐elevation myocardial infarction (STEMI) group according to the type of ACS. We analysed the changes in LVEF, LVMI, LVEDVI, LVESVI, and NT‐proBNP in both groups and evaluated the correlation between the changes in the above variables (ΔLVEF, ΔLVMI, ΔLVEDVI, ΔLVESVI, and ΔNT‐proBNP). Cox regression model was used to assess the independent risk factors of MACE. Prespecified subgroup analyses were also conducted. Compared with baseline, LVEF increased significantly (P < 0.05), NT‐proBNP, LVMI, and LVESVI decreased significantly in both groups after 6 months (P < 0.05), and LVEDVI decreased significantly in the S/V group (P = 0.001). In the S/V group, ΔLVEF (t = −2.745, P = 0.006), ΔNT‐proBNP (P = 0.009), ΔLVEDVI (t = 4.203, P = 0.001), and ΔLVESVI (t = 3.907, P = 0.001) were significantly improved than those in the routine group. In the S/V group, ΔLVEF was negatively correlated with ΔNT‐proBNP (r = −0.244, P = 0.004), ΔLVMI (r = −0.190, P = 0.028), ΔLVEDVI (r = −0.173, P = 0.045), and ΔLVESVI (r = −0.261, P = 0.002). In Cox regression model analysis, ΔLVEF {hazard ratio [HR] = 0.87 [95% confidence interval (CI) 0.80–0.95], P = 0.003}, ΔLVEDVI [HR = 1.04 (95% CI 1.01–1.06), P = 0.013], and ΔLVESVI [HR = 1.04 (95% CI 1.01–1.08), P = 0.026] were independent risk factors for MACE. Subgroup analysis showed that ΔLVEF (t = 6.290, P = 0.001), ΔLVEDVI (t = 2.581, P = 0.011), and ΔNT‐proBNP (P = 0.019) in the NSTEMI group were significantly improved than those in the UA group, ΔLVEDVI in the NSTEMI group was significantly better than that in the STEMI group (t = −3.365, P = 0.001), and ΔLVEF in the STEMI group was significantly better than that in the UA group (t = −3.928, P = 0.001). There was a significant difference in the survival probability without MACE among the three groups in the analysis of the Kaplan–Meier curve (P = 0.042). The incidence of MACE in the UA group was significantly higher than that in the NSTEMI group (32.4% vs. 6.3%, P = 0.004). Conclusions The cardiac function is improved and cardiac remodelling is reversed significantly after treatment of S/V in ACS patients with reduced left ventricular ejection fraction after PCI, and the improvement is more obvious than the routine group. There is a significant negative correlation between the change in LVEF and the changes in NT‐proBNP, LVMI, LVEDVI, and LVESVI. The increase of LVEF and the decrease of LVEDVI and LVESVI are protective factors to improve the prognosis. Patients with myocardial infarction and reduced left ventricular ejection fraction might benefit more from the initiation of S/V as first‐line heart failure treatment after PCI.

Background and objectiveNutritional status assessment in acute coronary syndrome (ACS) patients has been neglected for a long time. The geriatric nutritional risk index (GNRI) is a sensitive indicator for assessing the nutritional status of the elderly. This study aims to explore the association between GNRI and all-cause mortality in the oldest-old patients with ACS.MethodsThe patients who met the inclusion criteria were consecutively enrolled from January 2006 to December 2012. Clinical data were collected on admission, and all subjects were followed after being discharged. The nutritional status was evaluated using GNRI. The relationship between GNRI and all-cause mortality was assessed by using different analyses.ResultsA total of 662 patients with a mean age of 81.87 ± 2.14 years old were included in our study, and followed (median: 63 months, IQR 51–71). Patients whose GNRI ≤ 98 were reported as at risk of malnutrition (31.11%, n = 206). In multivariable analysis, we found that for each SD increase in GNRI, the risk of all-cause mortality lowered by 23%, and the HR for GNRI ≤ 98 was 1.39 (95% CI 1.04–1.86). After stratifying patients into three groups by tertiles of GNRI, we found that the HRs for tertile 2 and tertile 3 were 1.49 (95% CI 1.02–2.19) and 1.74 (95% CI 1.22–2.50), respectively. The trend test revealed a dose–response relationship between GNRI and all-cause mortality in the oldest-old with ACS. Lastly, in subgroup analyses, we found a reliable association between GNRI and all-cause mortality.ConclusionMalnutrition is common in the oldest-old patients with ACS, and GNRI could predict their long-term all-cause mortality in a dose-dependent manner. GNRI may be a prospective index for risk-stratification and secondary-prevention in the oldest-old patients with ACS.

目的 探讨行经皮冠状动脉介入(PCI)治疗的未绝经女性冠心病患者的临床特点.方法 回顾性分析2014年1月至2018年12月于解放军总医院第一医学中心行首次PCI治疗的74例未绝经和109例绝经女性冠心病患者的临床资料.比较两组患者一般情况、冠状动脉病变特征及术后1年内主要不良心血管事件(MACE)的发生情况,并通过多因素logistic回归分析探究术后MACE发生的独立危险因素.结果 未绝经组患者的高血压病患病率、吸烟率、低密度脂蛋白胆固醇水平、甘油三酯水平及总胆固醇水平均低于绝经组[41.9％(31/74)vs 72.5％(79/109)、0 vs 13.8％(15/109)、(2.40±0.86)mmol/L vs(2.71±0.95)mmol/L、(1.40±0.74)mmol/L vs(1.69±0.97)mmol/L、(3.88±1.02)mmol/L vs(4.39±1.05)mmol/L,P均＜0.05],而自身免疫病患病率、左心室射血分数均高于绝经组[14.9％(11/74)vs 1.8％(2/109)、(62.4±4.9)％vs(60.0±5.4)％,P均＜0.05].未绝经组患者左前降支和左主干病变的发生率均高于绝经组[83.8％(62/74)vs 67.9％(74/109)、14.9％(11/74)vs 4.6％(5/109),P均＜0.05].未绝经组PCI术后 1 年内MACE的发生率高于绝经组[12.2％(9/74)vs 3.7％(4/109),P＜0.05].多因素logistic回归分析显示,未绝经是女性冠心病患者PCI术后1年内发生MACE的独立危险因素(OR=3.635,95％CI 1.075～12.283,P=0.038).结论 未绝经女性冠心病患者左前降支和左主干受累较多见,且经PCI治疗后1年内MACE的发生率较高.

Background Acute coronary syndrome (ACS) and diabetes mellitus (DM) are the leading health risks for the elderly. Triglyceride-glucose (TyG) index is a novel and reliable indicator of insulin resistance (IR). This study aims to explore the relationship between the TyG index and all-cause mortality in oldest-old patients with ACS and DM. Methods Seven hundred twenty hospitalized patients with ACS aged ≥ 80 years were enrolled, and 699 patients signed informed consent for the study. During the follow-up period, 37 were lost to follow-up, and the follow-up rate was 94.7%. 231 ACS patients with DM were selected for the study’s analyses. Kaplan–Meier curve, Cox regression model and receiver operating characteristic (ROC) curve were used to analyze the association between the TyG index and all-cause mortality. Results The mean age of participants was 81.58 ± 1.93 years, and 32.47% were women. Compared to TyG tertile 1, the Hazard Ratio (HR) [95% confidence interval (CI)] of all-cause mortality was 2.04 (1.09, 3.81) for TyG tertile 3 in the fully adjusted model. For the TyG index per standard deviation (SD) increment, the HR (95% CI) of all-cause mortality was 1.44 (1.13, 1.83). Further, the association between the TyG index and all-cause mortality was dose–response ( P for trend = 0.026). ROC curve analyses indicated that the TyG index outperformed FBG and TG in the prediction of mortality risk and improved the prognostic value of the Gensini score combined with LVEF. Conclusion The TyG index predicts the risk of all-cause mortality in the oldest-old ACS patients with DM.

Objective To investigate the effect of ezetimibe combined with statin on the clinical prognosis of elderly patients with in-stent restenosis after percutaneous coronary intervention（PCI）.Methods A total of 456 elderly patients with in-stent restenosis who were confirmed by coronary angiography after PCI in the First Medical Center of Chinese PLA General Hospital from January 2017 to March 2020 were enrolled in this study.According to their treatment regimens before admission, they were divided into combined treatment group（180 cases） and statin monotherapy group（276 cases）.Baseline data, previous PCI,and treatment of current admission were recorded.After discharge, all patients were followed up every 6 months to analyze the difference of long-term prognosis between the two groups.Results There were no significant differences in the number of stents inserted, number of diseased vessels, location of target vessels, types of in-stent restenosis, severity of in-stent restenosis and treatment methods between the two groups（P＞0.05）.The follow-up time was 20-59 months.The rate of readmission and recurrence of PCI at last follow-up were significantly lower in the combined treatment group than the statin monotherapy group（20.0% vs 45.7%,5.0% vs 19.6%,P＜0.01）.No statistical differences were seen in coronary artery bypass grafting and all-cause mortality between the two groups（P＞0.05）.Kaplan-Meier curve analysis showed that the two groups had a statistically significant difference in event-free survival(P log rank ＜0.01).Conclusion Ezetimibe combined with statin can significantly reduce the readmission rate and re-PCI rate of elderly patients with in-stent restenosis.No matter what level of LDL-C is in elderly patients with in-stent restenosis, combined treatment may bring benefits.

Abstract Background With the advancement of the world population aging, more attention should be paid to the prognosis of elderly patients with acute coronary syndrome (ACS). Triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to traditional risk factors of cardiovascular disease (CVD). However, the effect of TyG index on the prognosis of long-term adverse events in elderly ACS patients has not been reported. This study evaluated the prognostic power of TyG index in predicting adverse events in elderly ACS patients. Methods In this study, 662 ACS patients > 80 years old who were hospitalized from January 2006 to December 2012 were enrolled consecutively and the general clinical data and baseline blood biochemical indicators were collected. The follow-up time after discharge was 40–120 months (median, 63 months; interquartile range, 51‒74 months). In addition, the following formula was used to calculate the TyG index: Ln [fasting TG (mg/dL) × FBG (mg/dL)/2], and patients were divided into three groups according to the tertile of the TyG index. Results The mean age of the subjects was 81.87 ± 2.14 years, the proportion of females was 28.10%, and the mean TyG index was 8.76 ± 0.72. The TyG index was closely associated with the traditional risk factors of CVD. In the fully-adjusted Cox regression model, the Hazard ratio (95% CI) of all-cause mortality (in tertile 3) was 1.64 (1.06, 2.54) and major adverse cardiac event (MACE) (in tertile 3) was 1.36 (1.05, 1.95) for each SD increase in the TyG index. The subgroup analyses also confirmed the significant association of the TyG index and long-term prognosis. Conclusion The TyG index is an independent predictor of long-term all-cause mortality and MACE in elderly ACS patients.

目的 研究老年急性冠状动脉综合征(ACS)合并射血分数减低的心力衰竭(HFrEF)患者PCI术后早期用沙库巴曲缬沙坦(V/S)的临床疗效.方法 连续入选解放军总医院收治的ACS合并HFrEF行PCI患者134例,按诊断分为不稳定性心绞痛(UAP)组71例、ST段抬高型心肌梗死(STEMI)组31例和非ST段抬高型心肌梗死(NSTEMI)组32例,3组均常规治疗联合口服V/S,随访＞6个月.比较3组治疗1及6个月心功能及心脏重构指标,记录主要不良心脏事件(MACE)及不良反应发生情况.结果 与治疗前和治疗1个月比较,3组治疗6个月后LVEF、左心室短轴缩短率(LVFS)、左心室质量指数(LVMI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)有明显改善(P＜0.05).3组治疗6个月后LVEF、LVFS、LVEDVI、LVESVI比较,有统计学差异(P＜0.05,P＜0.01);NSTEMI 组和 STEMI 组患者 LVEF、LVFS、LVEDVI、LVESVI 改善显著优于 UAP组(P＜0.05),NSTEMI组LVMI改善显著优于UAP组(P＜0.05).随访期间UAP组、STEMI组和NSTEMI组患者MACE及不良反应发生率比较,无统计学差异(11.27％vs6.25％vs 6.45％,7.04％vs 6.25％vs 9.68％,P＞0.05).结论 老年ACS合并HFrEF患者PCI术后早期应用V/S,可显著改善心功能并逆转心脏重构.

目的 探讨褪黑素通过介导线粒体自噬对糖尿病(DM)心肌梗死(MI)后心肌损伤的保护作用及相关机制.方法 将32只C57BL/6J雄性小鼠按照随机数表法随机分为4组,每组8只:(1)假手术组(sham组);(2)糖尿病组(DM组);(3)糖尿病急性心肌梗死组(DMI组);(4)糖尿病急性心肌梗死+褪黑素组(DMI+Mel组).4周后行超声心动图检测小鼠心脏功能.取心脏行切片染色,检测小鼠心肌间质纤维化程度和心肌细胞凋亡水平.培养H9c2细胞,分为以下4组:(1)对照组(CON组);(2)高糖高脂组(HG/HF组);(3)高糖高脂缺氧组(HG/HF+hypoxia组);(4)HG/HF+hypoxia+Mel组.行相应处理后,采用蛋白质印迹法检测B细胞淋巴瘤-2蛋白(Bcl-2)、含半胱氨酸的天冬氨酸蛋白水解酶-3蛋白(Caspase-3)、Bcl-2关联X蛋白(Bax)和微管相关蛋白1轻链3-β(LC3)、死骨片蛋白1(P62)、帕金蛋白(Parkin)等线粒体自噬相关蛋白的表达,采用荧光素酶法检测细胞内三磷酸腺苷(ATP)浓度.采用SPSS 25.0统计软件进行数据分析.根据数据类型,分别采用方差分析和Dunnett法进行组间比较.结果 与sham组相比,DMI组和DMI+Mel组小鼠的左心室射血分数(LVEF)和左室短轴缩短率(LVFS)显著降低;左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、心肌细胞横截面积、间质纤维化程度和细胞凋亡率显著升高,差异均有统计学意义(P<0.05).与DMI组相比,DMI+Mel组小鼠的心功能明显改善;LVESD、LVEDD、心肌细胞横截面积、间质纤维化程度和细胞凋亡率显著降低,差异均有统计学意义(P<0.05).与CON组相比,HG/HF组和HG/HF+hypoxia组细胞Bax、Caspase-3、P62表达显著升高,Bcl-2、LC3-Ⅱ/LC3-Ⅰ及Parkin水平显著降低,细胞内ATP含量显著降低,差异均有统计学意义(P<0.05).与HG/HF组和HG/HF+hypoxia组相比,HG/HF+hypoxia+Mel组细胞Bax、Caspase-3、P62表达显著降低,Bcl-2、LC3-Ⅱ/LC3-Ⅰ、Parkin水平显著升高,细胞内ATP含量显著升高,差异均有统计学意义(P<0.05).结论 褪黑素可通过增强线粒体自噬减轻糖尿病心肌梗死后心肌细胞的损伤,从而改善心脏功能.

Background:The management of a large thrombus burden in patients with acute myocardial infarction and diabetes is still a worldwide problem. Case presentation:A 74-year-old Chinese woman presented with ST-segment elevation myocardial infarction (STEMI) complicated with diabetes mellitus and hypertension. Angiography revealed massive thrombus formation in the mid-segment of the right coronary artery leading to vascular occlusion. The sheared balloon was placed far from the occlusion segment and urokinase (100,000 u) was administered for intracoronary artery retrograde thrombolysis, and thrombolysis in myocardial infarction (TIMI) grade 3 blood flow was restored within 7 min. At last, one stent was accurately implanted into the culprit's vessel. No-reflow, coronary slow flow, and reperfusion arrhythmia were not observed during this process. Conclusion:Intracoronary artery retrograde thrombolysis (ICART) can be effectively and safely used in patients with STEMI along with diabetes mellitus and hypertension, even if the myocardial infarction exceeds 12 h (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).

目的 探讨血栓弹力图检查指导下的双联抗血小板治疗对经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)患者临床预后的影响.方法 选取2017年1月至2020年1月中国人民解放军总医院第一医学中心心血管内科收治的经冠状动脉造影确诊为PCI术后ISR的患者275例.完善血栓弹力图(TEG)检查,根据二磷酸腺苷(ADP)途径诱导的血小板抑制率(ADP抑制率)和ADP途径曲线最大振幅(MA)是否达标,将患者分为对照组(n=184)、氯吡格雷组(n=57)和替格瑞洛组(n=34),给予阿司匹林联合氯吡格雷或替格瑞洛治疗.出院后每6个月随访一次,分析3组患者长期预后的差异.采用SPSS 25.0软件进行统计分析.采用logistic回归法分析影响ISR患者预后的危险因素.结果 随访时间15～52[26(18,34)]个月.对照组患者ADP抑制率显著高于氯吡格雷组和替格瑞洛组[(85.63±13.57)％和(37.60±8.19)％,(22.74±9.76)％;P<0.05];替格瑞洛组MA-ADP显著高于对照组及氯吡格雷组[(52.16±4.82)和(17.01±9.08),(38.69±4.68)mm;P<0.05].替格瑞洛组换药后ADP抑制率显著升高[(22.74±9.76)％和(81.04±15.01)％],MA-ADP显著降低[(52.16±4.82)和(17.06±9.26)mm],差异均有统计学意义(均P<0.05).氯吡格雷组的主要不良心血管事件(MACE)发生率和全因死亡率显著高于对照组和替格瑞洛组(均P<0.05).ADP抑制率是ISR患者治疗术后再次入院、行冠状动脉造影检查、再次PCI、心源性死亡及MACE的保护性因素.随着ADP抑制率的升高,MACE发生率显著降低(OR=0.56,95％CI 0.42～0.76;P<0.001).结论 ADP抑制率是ISR患者治疗术后MACE事件发生的保护因素,在TEG指导下采用有效的DAPT方案可以显著降低ISR患者MACE发生率,改善患者预后.

Adenoid cystic carcinoma (ACC) is a malignant tumor that originates from exocrine gland epithelial cells. We profiled the transcriptomes of 49,948 cells from paracarcinoma and carcinoma tissues of three patients using single-cell RNA sequencing. Three main types of the epithelial cells were identified into myoepithelial-like cells, intercalated duct-like cells, and duct-like cells by marker genes. And part of intercalated duct-like cells with special copy number variations which altered with MYB family gene and EN1 transcriptomes were identified as premalignant cells. Developmental pseudo-time analysis showed that the premalignant cells eventually transformed into malignant cells. Furthermore, MYB and MYBL1 were found to belong to two different gene modules and were expressed in a mutually exclusive manner. The two gene modules drove ACC progression into different directions. Our findings provide novel evidence to explain the high recurrence rate of ACC and its characteristic biological behavior.

目的 探讨行急诊经皮冠状动脉介入治疗(PCI)的冠状动脉左主干急性闭塞患者发生院内死亡的危险因素.方法 回顾性分析2011年1月至2021年1月于中国人民解放军总医院第一医学中心经急诊绿色通道行冠状动脉造影检查确诊为左主干急性闭塞引起心肌梗死的患者的临床资料.根据患者住院期间是否死亡分为死亡组和存活组,比较2组患者临床和影像学资料,分析不同观察指标对患者住院期间死亡率的影响,并筛选危险因素.采用SPSS 19.0软件进行数据分析.根据数据类型,组间比较分别采用t检验、秩和检验及χ2检验.多变量分析采用logistic回归.结果 22例左主干急性闭塞患者均为右优势型.死亡组患者无右冠提供侧支循环及术后血流心肌梗死溶栓治疗(TIMI)0～2级发生情况显著高于存活组,差异均有统计学意义[6例(85.71％)和1例(6.67％),5例(71.43％)和4例(26.67％);均P<0.05];其他指标比较,差异均无统计学意义.电话随访存活患者,其中20 d后死于再次心肌梗死患者1例(4.54％),3个月后再次住院行右冠状动脉介入治疗患者1例(4.54％),分别于术后第4个月、第4年因左主干支架内再狭窄行介入治疗患者2例(9.09％),于术后第6年死于肺癌患者1例(4.54％),未出现严重的心血管不良事件患者10例(45.45％).logistic单因素回归分析结果显示,入院时心源性休克、无右冠提供侧支循环、术后血流TIMI 0～2级是患者住院期间死亡的危险因素(P<0.05);多因素回归分析结果显示,无右冠侧支循环是左主干急性闭塞患者住院期间死亡的重要预测因素(P<0.05).结论 入院时发生心源性休克,无右冠提供侧支循环、术后血流TIMI 0～2级是接受急诊PCI治疗的左主干急性闭塞患者住院期间死亡的重要预测因素,右冠提供侧支循环是患者发生院内死亡的保护因素.

Aging represents an independent risk factor affecting the poor prognosis of patients with acute myocardial infarction (AMI). This present research aimed to explore the molecular mechanism of myocardial injury in elderly AMI by animals and cells experiment. Our previous clinical study found the serum Cystatin C (Cys-C) increased in the elderly AMI population, while the mechanism underlying high Cys-C induced myocardial injury of AMI remains unclear. In the in-vitro study, we confirmed that Wnt/β-catenin could significantly reduce the expression of cytoplasmic Cys-C through transnuclear action, and highly attenuate the occurrence of mitochondrial oxidative stress injury induced via Cys-C/reactive oxygen species (ROS). Furthermore, the addition of exogenous Wnt3a and inhibition of Cys-C expression could effectively inhibit mitochondrial oxidative stress injury and relieve the acute myocardial hypoxia injury. These results indicate that Cys-C exerted damaging effects on the hypoxic aging cardiomyocyte through the ROS/mitochondrial signaling pathway. Inhibition of this pathway effectively reduced the apoptosis of aging cardiomyocytes. In the in-vivo study, we also explored the function of the Wnt/Cys-C pathway on the ischemic infarction heart. We confirmed that Wnt/β-catenin served as the upstream protective protein of this pathway, and the promotion of this pathway improved the cardiac structure and function of the elderly AMI mice effectively.