The prognostic significance of the hemoglobin-to-red blood cell distribution width (Hb/RDW) ratio in patients undergoing pacemaker implantation (PMI) remains uncertain. Our study aimed to explore the prospective relationship between the Hb/RDW ratio and the risk of major cardiovascular events (MCEs) in Chinese patients with PMI. A total of 595 patients with permanent PMI were enrolled. Patients were divided into the high-Hb/RDW (≥ 9.1 g/L per percent) and the low-Hb/RDW (< 9.1 g/L per percent) groups according to the levels of the Hb/RDW ratio using the receiver operating characteristic curve. The primary outcome was the composite MCEs including heart failure hospitalization, myocardial infarction, stroke, and all-cause death, presented as hazard ratios (HR) with 95

目的 探讨黄连素(BBR)通过KRUPPEL样因子4(KLF4)减轻缺血/再灌注(I/R)损伤所致的大鼠心肌细胞凋亡的作用机制.方法 将大鼠永久心肌细胞系H9C2细胞按随机数字表法分为4组,即对照组(正常培养4 h)、I/R组(诱导I/R模型)、BBR组(诱导模型期间给予50μmol/L BBR作用4 h)、KLF4小干扰RNA(siRNA)组(转染KLF4 siRNA后,诱导模型期间给予50μmol/L BBR作用4 h).采用细胞计数试剂盒-8检测细胞活力,原位末端转移酶标记法染色和流式细胞术检测细胞凋亡情况,蛋白质印迹法检测细胞凋亡因子[包括B淋巴细胞瘤-2基因(Bcl-2)、Bcl-2相关X蛋白(Bax)]、KLF4蛋白表达水平,实时定量逆转录-聚合酶链反应检测KLF4 mRNA表达水平.结果 BBR组、I/R组、对照组H9C2细胞活力、细胞凋亡因子蛋白表达水平、膜阳性面积百分比、细胞凋亡率以及KLF4蛋白、mRNA表达水平比较,差异均有统计学意义(均P<0.05);其中BBR组细胞活力、Bcl-2蛋白表达水平以及KLF4蛋白、mRNA表达水平均明显高于I/R组(均P<0.05),Bax蛋白表达水平、膜阳性面积百分比、细胞凋亡率均明显低于I/R组(均P<0.05).KLF4 siRNA组细胞活力明显低于BBR组(P<0.05),膜阳性面积百分比和细胞凋亡率均明显高于BBR组(均P<0.05).结论 BBR可以通过KLF4依赖的方式保护心肌细胞免受I/R损伤所致的细胞凋亡.

目的:探讨经胸右心声学造影(cTTE)、经颅多普勒发泡试验(cTCD)及食道心超(TEE)等检查对卵圆孔未闭(PFO)的诊断价值.方法:回顾性分析比较140例温州医科大学附属第一医院成功行PFO封堵术患者(A组)与右心导管检查未见PFO患者(B组)的临床资料,包括临床基线资料、cTTE、cTCD及TEE.比较两组间在cTTE、cTCD分流量大小、TEE卵圆孔大小差异及cTTE气泡出现的时间差异,并绘制这些指标诊断PFO的ROC曲线.结果:cTTE下A组与B组比中-大量分流占比更大.在静息状态、瓦氏动作后和总评分情况下A组中-大量分流占比均显著大于B组(67.35％vs.42.86％,P=0.04;100.00％vs.71.42％,P<0.001;81.63％vs.51.43％,P=0.004).cTCD下A组与B组相比中-大量分流占比更大(75.90％vs.19.35％,P<0.001).TEE下A组与B组相比PFO裂隙更大(2.18±0.78 vs.1.19±0.78,P<0.001).用cTTE、cTCD、TEE等指标做PFO诊断的ROC曲线,结果提示cTCD、TEE两个指标ROC曲线下面积较大,具有较好的敏感度和特异度(P<0.05).在cTTE气泡出现的时间方面,A组气泡出现时间小于等于5个心动周期的患者比例显著大于B组(73.47％vs.42.86％,P=0.007).结论:cTCD、TEE检查对于PFO有较好的预测价值,综合价值优于cTTE检查.

Abstract Background Prognostic nutritional index (PNI) score is a useful indicator to evaluate the nutritional status of patients. However, the nutritional significance of the PNI score and its ability to predict clinical prognosis in patients with surgical valve replacement (SVR) are unknown. The goal of this study was to analyze the association between PNI on admission and adverse events in patients following SVR.Methods This study included 485 patients who underwent successful SVR. Baseline PNI score was calculated before SVR on admission. The patients were divided into high and low PNI groups according to the cut-off value of PNI using the receiver operating characteristic (ROC) curve. Primary outcomes were composite adverse events, defined as worsening heart failure, myocardial infarction, major bleeding, uncontrolled infection, second surgery, post-operative arrhythmia or all-cause death during the follow-up. The association of PNI score and primary outcomes was presented as hazard ratios (HR) with 95% confidence intervals (CI) calculated by adverse events in the crude and multivariate-adjusted Cox Proportional Hazards models.Results Overall, adverse events were observed in 61(13%) patients. ROC curves revealed an area under curve of 0.676 for PNI with a cut-off of 46. The cumulative event rate by Kaplan–Meier analysis was higher in low PNI group (P < 0.001). Adjusted multivariate analysis showed that low PNI was associated with adverse outcomes (HR: 2.303, 95% CI: 1.338-3.964, P = 0.003). Conclusion Low PNI on admission in patients with SVR was associated with higher incidence of clinical adverse events. Using the PNI score to identify individuals with poor nutritional status might be an important method for clinical prognosis prediction, and improving nutritional status during follow-up might help to reduce the risks of adverse outcomes in these patients.

Background: Emerging evidence indicates that the chemokine C-C motif ligand 20 (CCL20) promotes atherosclerosis via a chemo-attraction process. Statins improve atherosclerosis by inhibiting chemokine expression. Although the regulatory mecha-nisms of CCL20 have been investigated in other cells, they have not been clarified in macrophages. Moreover, the statin-induced regulation of CCL20 has not been studied previously. Therefore, this study explored the regulatory mechanism of CCL20 in oxidized low-density lipoprotein (oxLDL)-induced macrophages and the effect of statins on CCL20.Methods: CCL20 expression was tested after applying atorvastatin to interfere with oxLDL-induced macrophages, inhibiting nuclear factor-kappa B (NF -KB) activity in oxLDL-induced macrophages and the atorvastatin intervention model, and after transfecting a CCL20 overexpression plasmid into RAW 264.7 cells, after which NF -KB activity was also tested.Results: The results showed that atorvastatin downregulates CCL20 in oxLDL-induced macrophages, the NF -KB pathway par-ticipates in CCL20 regulation, and CCL20 overexpression in macrophages activates NF -KB.Conclusions: The results suggest that the NF -KB pathway is involved in regulating CCL20 expression in macrophages. Moreover, atorvastatin may regulate CCL20 to exert anti-inflammatory functions, indicating that the NF-KB/CCL20 signaling pathway rep-resents a potential antiatherosclerosis target.

Background The aim of our study was to evaluate changes in nutritional status as measured by the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) scores, and their abilities to predict clinical prognosis in patients with pacemaker implantation (PMI). Methods A total of 595 patients who underwent permanent PMI from January 2011 to December 2020 were included. PNI and GNRI scores were separately calculated at the beginning day of PMI operation and at the end of 12-month follow-up, and their net changes (Δ) were calculated by PNI or GNRI scores at follow-up minus the corresponding scores on admission. The cohort patients were divided into low risk of malnutritional status (ΔPNI or ΔGNRI scores ≥ 0) and high risk of malnutritional status (ΔPNI or ΔGNRI scores < 0) groups. Primary outcome measure was a composite major adverse cardiovascular event (MCE), defined as heart failure hospitalization (HFH), myocardial infarction (MI), stroke, or death from any cause, presented as hazard ratios (HR) with 95% confidence intervals (CI) calculated by MCE in the crude or multivariate-adjusted Cox Proportional Hazards models. Receiver operating characteristic (ROC) curve analysis was used to compare the differential ability to predict incident MCEs betweenΔPNI andΔGNRI scores. Results In total, 16% of patients developed the MCE during the follow-up. The cumulative event rates determined by Kaplan–Meier analysis were significantly higher in the high risk of malnutritional patients compared to the low risk of malnutritional patients (P < 0.05). Adjusted multivariate analysis showed that decreased PNI scores (HR: 2.228, 95% CI: 1.482–3.350) and decreased GNRI scores (HR: 2.178, 95% CI: 1.439–3.295) were independently associated with favorable outcomes. ROC curve analysis revealed an area under curve (AUC) of 0.586 forΔPNI scores and AUC of 0.592 for ΔGNRI scores, but their predictive abilities were not statistically different. Conclusion Either positive change of PNI or GNRI scores were associated with reduced risk of MCEs in patients with PMI, and they have similar ability to predict clinical cardiometabolic risk. Additional enhancing nutritional status during follow-up may help to prevent unfavorable prognosis in clinical practices.

We aimed to examine whether prognostic nutritional index (PNI) could serve as an auxiliary predictor for major cardiovascular events (MCEs) in patients undergoing invasive coronary angiography (ICA). A total of 485 participants were enrolled, divided into low-PNI (≥47.40) and high-PNI (<47.40) groups. ICA determined the stenotic vessels of coronary artery disease. The primary outcome was incidental MCEs, a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or rehospitalization of in-stent restenosis. There were 47 (9.69%) MCEs during the 3.78-years follow-up. The cumulative incidence of MCEs was significantly higher in the low-PNI patients compared with the high-PNI patients (17.07% vs. 7.18%, p = 0.001). Malnutrition risk (low PNI) was significantly and independently associated with a higher risk of MCEs (hazard ratios: 2.593, 95% confidence intervals [CI]: 1.418–4.742). Combined use of the number of stenotic vessels with malnutrition risk showed a higher capacity to predict the MCEs than the presence of stenotic vessels alone (areas under the receiver operator characteristic curve: 0.696 [95% CI, 0.618–0.775] vs. 0.550 [95% CI, 0.466–0.633], p = 0.013). In conclusion, lower PNI levels may predict a higher risk of cardiovascular events in patients undergoing ICA, which supports the necessity of the risk assessment of nutrition status and guide the clinical treatment on strengthening nutritional support before ICA is performed, as well as nutritional intervention after ICA.

Purpose : To compare diagnostic accuracy of cTTE, cTCD and TEE in patients undergoing patent foramen ovale closure (PFO) so as to provide evidence for clinical decision-making. Methods : The clinical data of 140 patients with cerebral infarction or migraine who successfully underwent PFO closure or whose right cardiac catheterization results showed no PFO in our hospital were analyzed retrospectively, including clinical baseline, data of cTTE, cTCD and TEE. Results : Patients who successfully underwent PFO closure or whose right cardiac catheterization results showed no PFO were divided into group A and group B, respectively. The differences of the shunt in cTTE and cTCD, the diameter of PFO in TEE and the appearance of bubbles in cTTE were compared. The results showed that the proportion of medium-large shunt in group A was significantly higher than group B in resting cTCD, post-Valsalva cTCD and total cTCD respectively (67.35% VS 42.86%，P=0.004；100% VS 71.42%，P=0.0003；81.63% VS 51.43%，P=0.002). The proportion of medium-large shunt in group A was higher than group B in cTCD (75.90% VS 19.35%，P＜0.001). The diameters of PFO of group A were larger than group B in TEE (2.18±0.78 VS 1.19±0.78，P＜0.001). Take the successful PFO closure as the state variable. The ROC curves of cTTE, cTCD and TEE were made, and the results showed that cTCD and TEE had better sensitivity and specificity. The proportion of appearance of bubbles within 5 cardiac cycles in cTTE in group A was significantly higher than group B (73.47% VS 42.86%，P=0.005). Conclusions : For the patients with PFO to be occluded, the success rate of operation could be improved by selecting patients with larger shunt, larger diameter of foramen ovale and shorter interval in the appearance of bubbles. Otherwise, there was perhaps no PFO. cTCD and TEE had better diagnostic value for PFO closure than that of cTTE.

患者男,30岁.既往体健.10h前使用铁锤锤击物体时铁锤破裂,飞出的铁片撞击胸口后出现胸痛,胸部出血不止,无畏寒发热、呼吸困难、头晕头痛等症状.患者为求进一步检查,来我院急诊就诊.体格检查:急性病容,体温37.1℃,血压165/85mmHg,胸口可见破溃,心率100次/min,律齐,心前区听诊未闻及杂音.胸部CT提示:心内见短条状致密影,其周见放射伪影(图1).二维超声心动图提示:于室间隔基底段右室面探及一大小约0.8cm×0.7cm的光团样强回声,凸出室间隔右室面约0.35cm,距主动脉右冠窦约1.3cm,距三尖瓣隔叶根部约2.7cm,距肺动脉瓣根部约2.3cm(图2,3).彩色多普勒示室水平未见分流,心包腔内未探及超过正常范围的液性暗区.超声诊断:室间隔右室面异常回声,结合病史,异物首先考虑.鉴于患者病情危重,患者入院当日予行急诊开胸手术,术中探查示右室表面见一0.3cm破口,室间隔见一0.3 cm破口,内有一0.4cm×0.6cm大小铁片,术中予以取出.术后患者恢复可,无诉特殊不适.