INTRODUCTION:This study aims to investigate the impact of different double-stent methods on the structure and mechanics of coronary bifurcation lesions, providing reference indicators for clinicians in selecting an appropriate interventional procedure. METHODS:Three-dimensional reconstruction of coronary Computed Tomography Angiography (CTA) image data of a patient with coronary bifurcation disease was performed. Two types of double-stent (Cullotte and Crush) procedures were simulated, and their effects were evaluated using Finite element analysis. Intravascular Ultrasound (IVUS) validation and retrospective clinical analysis were performed to support computational findings. RESULTS:The stress distribution following the Cullotte stent was concentrated in the SB, whereas the stress after the Crush procedure was localized at the overlap with the proximal main vessel three-layer stent. Compared with the Crush procedure, the Culotte approach resulted in a lower percentage of double-stent malapposition, better dilation of vascular stenosis, and less narrowing of the SB stent, suggesting a more favorable clinical outcome. IVUS validation and retrospective clinical analysis were performed to support computational findings. DISCUSSION:Culotte stenting resulted in better stent-vessel conformity and more favorable stress distribution. The findings support FEA as a valuable tool in procedural planning. CONCLUSION:The findings suggest that the Culotte technique may offer mechanical advantages over the Crush technique, potentially improving long-term clinical outcomes. These results emphasize the role of computational modeling in optimizing interventional strategies.

Background Insomnia, as one of the most prevalent sleep disorders, is frequently linked to heart failure (HF). However, the precise relationship and potential risk of HF events associated with insomnia and subtypes of symptoms necessitate further investigation. This meta-analysis aims to provide a comprehensive and current evaluation of the associations between insomnia symptoms and HF risk, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early-morning awakening, and non-restorative sleep (NRS). Methods A comprehensive literature search was conducted in PubMed, Web of Science, Embase, ProQuest and the Cochrane Library to identify prospective cohort studies from inception to October 31, 2024. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated to assess the correlation between insomnia and the risk of HF. Funnel plots and Egger's tests were employed to assess publication bias. Results A total of 177,008 patients from seven eligible prospective cohort studies were included. The pooled minimally adjusted HR for HF was 1.26 (p = 0.001), indicating that insomnia was associated with an increased risk of HF. Among the individual insomnia symptoms, only DIS showed a positive association with the risk of HF (p = 0.005). DMS and NRS had no significant effect on the risk of HF (p > 0.05). In the subgroup analysis including age, sex, and body mass index, there were no significant differences between groups. Conclusion This meta-analysis confirms the link between insomnia and an increased risk of HF, particularly highlighting the importance of DIS as a potential predictor for HF.

Background:At present, there is controversy about whether hematocrit (HCT) is a risk factor for coronary heart disease (CHD). We try to explore the effect of low or high HCT on CHD, and analyze its mechanism from the perspective of hemodynamics. Methods:According to the exclusion criteria, a total of 3,200 patients who underwent coronary angiography or coronary computed tomography angiography (CTA) for typical post-exercise chest pain/dyspnea; atypical chest pain; or noncardiac chest pain or asymptomatic at Beijing Anzhen Hospital Affiliated to Capital Medical University from October 2019 to October 2021 were selected as research subjects. A coronary artery stenosis of 50% was used as the criterion for determining CHD. A total of 1,660 patients with coronary artery stenosis greater than 50% were selected as the CHD group and 1,540 adults with coronary artery stenosis less than 50% were selected as the non-CHD group. The clinical data, including HCT, were subjected to non-parametric tests and chi-square tests. The relationship between HCT and CHD was statistically analyzed using logistic regression. Wall shear stress (WSS) is obtained through fluent software combined with Navier-Stokes (NS) equation calculation. Results:Multivariate logistic regression analysis showed that HCT was an independent risk factor for CHD [risk ratio (RR) 1.108, 95% confidence interval (CI): 1.084-1.133, P<0.001]. The area under the receiver operating characteristic (ROC) curve for the ability of HCT to predict CHD events was 0.726. The cut-off value was 44.13, with specificity of 0.701 and sensitivity of 0.702. The results of a computational fluid dynamics simulation demonstrated that the magnitude of HCT is positively correlated with the WSS. When HCT exceeds 50%, the WSS of the stenosis site reaches 42 Pa, which may lead to endothelial denudation and further damage to the blood vessel, resulting in plaque rupture. Conclusions:HCT is one of the risk factors for CHD. Combining HCT with traditional risk factors may be helpful for non-invasive diagnosis of CHD. In addition, the level of HCT may also help to judge the future prognosis of patients with coronary artery stenosis greater than 50% without revascularization, providing a new potential target for future clinical treatment of CHD.

BACKGROUND:Heart failure (HF) guidelines recommend routine testing for iron deficiency (ID) and, for those with ID, intravenous iron if the left ventricular ejection fraction is <50%. Guideline adherence to these recommendations by cardiologists in China is unknown. METHODS AND RESULTS:An independent academic web-based survey was designed and distributed via social networks to cardiologists across China. Overall, 1342 cardiologists (median age 34 years, IQR 30-39, 51% women) from all provinces of China completed this survey. More than half were unaware of the need to screen for ID in HF and did not do so routinely in their clinical practice. Approximately 80% were not familiar with the diagnostic criteria for ID in HF guidelines, and only 0.8% recognised transferrin saturation <20% as an independent marker of ID. Regarding iron repletion, only 14% preferred intravenous to oral iron for correcting ID compared with 68% favouring oral iron. Three-quarters were unfamiliar with methods for calculating intravenous iron dose. Furthermore, over 80% were unaware that current guidelines only recommend ferric carboxymaltose or ferric derisomaltose for correcting ID. The main barriers to using intravenous iron were lack of knowledge and experience. Despite such poor awareness and practice, most cardiologists were interested in learning more about managing ID in HF. CONCLUSIONS:In this nationwide survey of cardiologists in China, we identified large gaps in both knowledge and management of ID. This survey will help guide the development of educational programmes to improve care for patients with HF and ID in China.

Background::The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.Methods::This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.Results::Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n = 278] vs. 43.7% [ n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. Conclusion::This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

Background:Although contemporary guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) and heart failure with mildly-reduced ejection fraction (HFmrEF) has been shown to significantly improve prognosis, patients with these conditions still face considerable residual risk, and their quality of life (QoL) remains severely compromised. ShengXian-QuYu (SXQY) Decoction is a widely prescribed complementary and alternative medicine (CAM) therapy for HF in clinical practice. However, there is currently no robust evidence supporting its efficacy in HFrEF and HFmrEF, and its potential adverse effects have yet to be fully elucidated. Methods:Patients with chronic HF, New York Heart Association (NYHA) class II-IV symptoms, elevated plasma natriuretic peptide levels, and a left ventricular ejection fraction (LVEF) of ≤50 % were enrolled in the ShengXian-QuYu Decoction in the Treatment of Heart Failure with Reduced and mildly reduced Ejection Fraction (SHINE-HF) trial. Patients eligibility entered a run-in period, followed by randomization in a 1:1 ratio to double-blind treatment with either 30 ml of SXQY or 30 ml of placebo, administered twice daily. The primary endpoint was the change from baseline in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) at week 12. Key secondary endpoints included the change from baseline in the Traditional Chinese Medicine Syndrome Score Scale (TCMSSS) and the 6-min walk test (6MWT) distance at week 12. Additionally, a safety analysis will be conducted. Conclusion:SHINE-HF will determine the effects of SXQY on patient-reported outcomes (PROs) and symptom burden in patients with HFrEF and HFmrEF. This will shed light on the potential of SXQY as a novel treatment option in improving QoL of patients with HFrEF and HFmrEF.

Background:Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) has been demonstrated to significantly reduce morbidity and mortality. However, many patients, especially those with advanced HFrEF, are unable to tolerate optimal GDMT due to hypotension. Cardiac contractility modulation (CCM) is a novel therapeutic approach that enhances myocardial contractility and reverses cardiac remodeling, thereby improving cardiac function and quality of life in patients with HFrEF. However, whether CCM can bridge the hemodynamic vulnerability phase to facilitate GDMT optimization and improve patient prognosis remains unclear. Case presentation:A 56-year-old man with dilated cardiomyopathy and HFrEF (NYHA functional class III) had recurrent hospitalizations for HF over the past 4 years. Due to hypotension (systolic blood pressure ≤90 mmHg), the patient was unable to tolerate full-dose GDMT, with sacubitril-valsartan limited to 25 mg twice daily, metoprolol succinate to 23.75 mg once daily, and spironolactone to 20 mg once daily. After a comprehensive evaluation, a CCM device was implanted as the most effective and evidence-based option. Postoperatively, the patient's blood pressure gradually improved, allowing initiation of the four major therapeutic drug classes, which were uptitrated to the maximum tolerated doses. With regular follow-up for 12 months, the patient showed dramatic improvements in exercise capacity and quality of life. More surprisingly, there was significant improvement in cardiac structural and functional remodeling. Echocardiography revealed that left atrioventricular dimensions returned to normal, left ventricular ejection fraction (LVEF) increased from 15% to 48%, and left ventricular global longitudinal strain (GLS) improved from -3.3% to -16.2%. NT-proBNP levels also decreased from 6,553 pg/ml to within the normal range. Conclusion:This case suggests that CCM may serve as a promising strategy to address the issue of poor GDMT tolerance due to hypotension, thereby facilitating GDMT optimization and improving cardiac remodeling patients with HFrEF.

Background Anaemia is a common comorbidity in patients with chronic kidney disease (CKD) and heart failure (HF). Roxadustat has been approved for the treatment of anaemia in patients with CKD. However, its efficacy and safety in treating anaemia in patients with both CKD and HF remain unclear. We conducted a retrospective study with propensity score matching (PSM) to evaluate the efficacy and safety of roxadustat in this population. Methods This retrospective study enrolled patients diagnosed with HF comorbid with CKD and anaemia. The patients were divided into two groups: a roxadustat group and a control group. One-to-one PSM was used to balance baseline characteristics between the groups. The primary endpoint was the change in haemoglobin (Hb) at week 8. Secondary endpoints included Hb response, changes in haematocrit, iron parameters, echocardiographic parameters, B-type natriuretic peptides and lipid levels. Exploratory endpoints were mortality and rehospitalization rates over 30 days-2 years. Safety endpoints included the incidence of hyperkalaemia, liver damage and thrombotic events. Results A total of 1055 patients were screened. After PSM, 206 patients were included. Baseline characteristics were comparable between the matched cohorts. At week 8, the roxadustat group experienced a greater increase in Hb than the control group, with a difference of 0.8 g/dl (95% confidence interval 0.3-1.3; P = .003). The roxadustat group also demonstrated a higher Hb response (60.2% versus 28.2%; P < .001) and a greater increase in haematocrit (4.7 +/- 0.9% versus 2.8 +/- 0.6%; P = .008) than the control group. No significant differences were observed for other secondary endpoints. Thrombotic events were similar between the two groups and there were no differences in the risks of mortality or rehospitalization. Conclusions Roxadustat was effective in correcting and maintaining Hb levels in patients with anaemia, HF and CKD. It did not increase thrombotic and other adverse events, mortality or rehospitalization risks, making it a promising treatment option for anaemia in this population.

Background: Heart failure (HF) is a prevalent global health issue with increasing incidence due to aging populations and advancements in treatment. The Cardiometabolic Index (CMI), a new marker combining waist-to-height ratio and the triglycerides-to-HDL cholesterol ratio, has shown promise in predicting cardiovascular risks. However, the relationship between CMI and HF remains unclear, warranting further investigation. This study aims to examine the association between CMI and HF to better understand and potentially identify HF risks. Methods: This study included 101,316 participants, of whom 22,042 met the selection criteria to investigate the correlation between the CMI and heart failure. The CMI is calculated as the product of the waist-to-height ratio (WHtR) and the triglycerides-to-HDL cholesterol ratio (TG/HDL-C). Data collection involved personal interviews to gather heart failure information, with HF diagnosis based on specific questionnaire responses. Clinical and biochemical data encompassed a wide range of variables, including demographic details, health status, and biochemical markers. Statistical analyses leveraged complex survey design from the National Health and Nutrition Examination Survey (NHANES), using weighted regression and chi-square tests to compare groups and multivariate logistic regression to examine the CMI-HF relationship across adjusted models. An analysis of the threshold effect elucidated the nonlinear dynamics present between CMI and HF, incorporating subgroup analyses to investigate the interactions among variables and the Receiver Operating Characteristic (ROC) curve was employed to evaluate the diagnostic utility of CMI in comparison to Body Mass Index (BMI) for the detection of HF. Results: In this study, based on specific inclusion and exclusion criteria, 706 individuals were diagnosed with HF, representing 3.2% of the total population. The findings indicated a significant association between elevated CMI levels and an increased risk of HF (OR = 1.13; 95% CI, 1.07–1.17, p < 0.001), with each unit increment in CMI level being associated with a 13% increase in HF risk. Subgroup analyses revealed the stability of the CMI-HF relationship across various subgroups, identifying race, history of heart disease, and hypertension status as key modulators of the strength and direction of the CMI-HF association. Moreover, smooth curve fitting and threshold effect analysis demonstrated a non-linear relationship between CMI and HF, with an inflection point at a CMI level of 6.49. Below this threshold, the incidence of HF increased with rising CMI levels. Additionally, the diagnostic capabilities of CMI and Body Mass Index (BMI) in identifying HF were compared, with the area under the curve (AUC) values for CMI surpassing those for BMI, indicating a superior ability of CMI in identifying HF. Conclusion: Our research indicates that the level of CMI bears a substantial positive correlation with the incidence risk of HF, with the relationship between CMI and HF being non-linear. Additionally, the CMI is a better predictor of HF than the BMI.

Heart failure (HF) is a major global healthcare problem leading to substantial deterioration of prognosis. The current clinical guidelines in HF have begun to emphasize the importance of traditional Chinese medicine (TCM). TCM has been utilized in clinical practice for over 2000 years and is capable of treating a variety of HF pathogenic issues. This review summarizes the classification, pathophysiology, and treatment of HF from three perspectives: Western medicine, TCM, and integrated traditional Chinese and Western medicine (ITCWM). Emphasizing the most recent evidence, this review consolidates knowledge on ITCWM treatments for HF pertaining to different TCM syndromes, including TCM decoctions, oral patent Chinese medicine, TCM injections, as well as therapies like acupuncture and moxibustion. Additionally, this review explores TCM approaches to HF prevention, such as tai chi, Baduanjin exercise, and Sanfu acupoint herbal patching. The findings of this study suggest that ITCWM holds promise for the treatment and rehabilitation of HF. However, further research is warranted to elucidate the underlying mechanisms.

Stress Hyperglycemia Ratio (SHR) reflects the acute blood glucose variation in critically ill conditions. However, its prognostic value in chronic kidney disease (CKD) remains understudied. This study aimed to investigate the association between SHR and one-year mortality in CKD patients hospitalized in the Intensive Care Unit (ICU). Patients with diagnosis of CKD in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were enrolled. Incidence of all-cause mortality within one-year follow-up was used as the primary endpoint. 1825 CKD patients were included in the study. A “U-shaped” relationship between SHR and one-year mortality as identified using multivariate restricted cubic spline (RCS) analysis. Then study population were categorized into three groups: Group 1 (SHR < 0.70), Group 2 (0.70 ≤ SHR ≤ 0.95) and Group 3 (SHR > 0.95). Group 2 showed significantly better one-year outcomes compared to the other two groups (p = 0.0031). This survival benefit persisted across subgroup analyses stratified by age, sex, CKD stage, anemia and various clinical conditions. SHR proved to be a meaningful biomarker for predicting one-year mortality in ICU-admitted CKD patients, with a “U-shaped” correlation. The identification of the optimal SHR range (0.70–0.95) provided clinicians with a valuable tool for detecting high-risk populations.

Spatially charting molecular cell types at single-cell resolution across the three-dimensional (3D) volume of the brain is critical for illustrating the molecular basis of the brain anatomy and functions. Single-cell RNA sequencing (scRNA-seq) has profiled molecular cell types in the mouse brain, but cannot capture their spatial organization. Here, we employed an in situ sequencing technique, STARmap PLUS, to map 1.09 million high-quality cells across the whole adult mouse brain and the spinal cord, profiling 1,022 genes at subcellular resolution with a voxel size of 194 X 194 X 345 nm3 in 3D. We developed computational pipelines to segment, cluster, and annotate 230 molecular cell types by single-cell gene expression and 106 molecular tissue regions by spatial niche gene expression. Joint analyses of molecular cell types and molecular tissue regions enabled a systematic molecular spatial cell type nomenclature and allowed the identification of tissue architectures previously undefined in established brain anatomy. To create a transcriptome-wide spatial atlas, we further integrated the STARmap PLUS measurements with a published scRNA-seq atlas, imputing 11,844 genes at the single-cell level. Finally, we delineated the tropisms of a brain-wide transgene delivery tool, AAV-PHP.eB5,6, across the molecular cell types and tissue regions of the whole mouse brain. Together, this annotated dataset provides a comprehensive, high-resolution, single-cell resource that integrates a spatial molecular atlas, cell taxonomy, brain anatomy, and genetic manipulation accessibility of the mammalian central nervous system (CNS).

Cardiac hypertrophy characterized by abnormal cardiomyocyte viscosity is a typical sign of heart failure (HF) with vital importance for early diagnosis. However, current biochemical and imaging diagnostic methods are unable to detect this subclinical manifestation. In this work, we developed a series of NIR-I fluorescence probes for detecting myocardial viscosity based on the pyridazinone scaffold. The probes showed weak fluorescence due to free intramolecular rotation under low-viscosity conditions, while they displayed strong fluorescence with limited intramolecular rotation in response to a high-viscosity environment. Among them, CarVis2 exhibited higher stability and photobleaching resistance than commercial dyes. Its specific response to viscosity was not influenced by the pH and biological species. Furthermore, CarVis2 showed rapid and accurate responses to the viscosity of isoproterenol (ISO)-treated H9C2 cardiomyocytes with good biocompatibility. More importantly, CarVis2 demonstrated excellent sensitivity in monitoring myocardial viscosity variation in HF mice in vivo, potentially enabling earlier noninvasive identification of myocardial abnormalities compared to traditional clinical imaging and biomarkers. These findings revealed that CarVis2 can serve as a powerful tool to monitor myocardial viscosity, providing the potential to advance insights into a pathophysiological mechanism and offering a new reference strategy for early visual diagnosis of HF.

Introduction ST-segment elevation myocardial infarction (STEMI) with high thrombus burden is associated with a poor prognosis. Manual aspiration thrombectomy reduces coronary vessel distal embolisation, improves microvascular perfusion and reduces cardiovascular deaths, but it promotes more strokes and transient ischaemic attacks in the subgroup with high thrombus burden. Intrathrombus thrombolysis (ie, the local delivery of thrombolytics into the coronary thrombus) is a recently proposed treatment approach that theoretically reduces thrombus volume and the risk of microvascular dysfunction. However, the safety and efficacy of intrathrombus thrombolysis lack sufficient clinical evidence.Methods and analysis The intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion trial is a multicentre, prospective, open-label, randomised controlled trial with the blinded assessment of outcomes. A total of 2500 STEMI patients with high thrombus burden who undergo primary percutaneous coronary intervention will be randomised 1:1 to intrathrombus thrombolysis with a pierced balloon or upfront routine manual aspiration thrombectomy. The primary outcome will be the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, heart failure readmission, stent thrombosis and target-vessel revascularisation up to 180 days.Ethics and dissemination The trial was approved by Ethics Committees of China-Japan Friendship Hospital (2022-KY-013) and all other participating study centres. The results of this trial will be published in peer-reviewed journals.Trial registration number NCT05554588.

Here are the pre-processed datasets of RIBOmap included in "Spatially Resolved Single-cell Translatomics at Molecular Resolution" from Zeng et al. Please refer to the README file for more detailed information. Abstract The precise control of mRNA translation is a crucial step in post-transcriptional gene regulation of cellular physiology. However, it remains a major challenge to systematically study mRNA translation at the transcriptomic scale with spatial and single-cell resolution. Here, we report the development of RIBOmap, a three-dimensional (3D) in situ profiling method to detect mRNA translation of thousands of genes simultaneously in intact cells and tissues. By applying RIBOmap to 981 genes in HeLa cells, we revealed a remarkable dependency of translation on cell-cycle stages and subcellular localization. Furthermore, we profiled single-cell translatomes of 5,413 genes in adult mouse brain tissues yielding a spatial cell atlas of 119,173 cells. The pairwise spatial mapping of single-cell translatome and transcriptome in two adjacent mouse brain slices revealed cell-type and brain-region-dependent translational regulation and suggested a translation remodeling during oligodendrocyte lineage maturation. The spatial translatome profiling detected widespread patterns of localized translation in neuronal and glial cells in intact brain tissue networks. Together, RIBOmap presents the first spatially resolved single-cell translatomics technology, accelerating our understanding of protein synthesis in the context of subcellular architecture, cell types, and tissue anatomy.

患者男性,78岁,主因"间断呼吸困难1年,加重伴下肢水肿2个月"于2023年3月29日入院.患者1年前出现劳力性呼吸困难,伴胸闷,近2个月症状逐渐加重,出现中度可凹性双下肢水肿,夜间无法平卧入睡.既往高血压病史20余年,口服沙库巴曲缬沙坦(200mg,Qd)控制血压;糖尿病20余年.入院生命体征及心肌标志物结果(见表1),心电图(见图1).超声心动图:左心室射血分数(left ven-tricular ejection fraction,LVEF)27％,左室壁运动普遍减低,左室舒张功能减低,右室壁运动减低(见表1).胸部CT示:间质性肺水肿,左心增大,双侧胸腔积液.冠状动脉造影:左主干未见狭窄,前降支未见狭窄,回旋支近段狭窄25％,右冠近段狭窄25％,TIMI血流均为3级.

OBJECTIVE:Chronic kidney disease (CKD) patients with coronary artery disease (CAD) in the intensive care unit (ICU) have higher in-hospital mortality and poorer prognosis than patients with either single condition. The objective of this study is to develop a novel model that can predict the in-hospital mortality of that kind of patient in the ICU using machine learning methods.METHODS:Data of CKD patients with CAD were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Boruta algorithm was conducted for the feature selection process. Eight machine learning algorithms, such as logistic regression (LR), random forest (RF), Decision Tree, K-nearest neighbors (KNN), Gradient Boosting Decision Tree Machine (GBDT), Support Vector Machine (SVM), Neural Network (NN), and Extreme Gradient Boosting (XGBoost), were conducted to construct the predictive model for in-hospital mortality and performance was evaluated by average precision (AP) and area under the receiver operating characteristic curve (AUC). Shapley Additive Explanations (SHAP) algorithm was applied to explain the model visually. Moreover, data from the Telehealth Intensive Care Unit Collaborative Research Database (eICU-CRD) were acquired as an external validation set.RESULTS:3590 and 1657 CKD patients with CAD were acquired from MIMIC-IV and eICU-CRD databases, respectively. A total of 78 variables were selected for the machine learning model development process. Comparatively, GBDT had the highest predictive performance according to the results of AUC (0.946) and AP (0.778). The SHAP method reveals the top 20 factors based on the importance ranking. In addition, GBDT had good predictive value and a certain degree of clinical value in the external validation according to the AUC (0.865), AP (0.672), decision curve analysis, and calibration curve.CONCLUSION:Machine learning algorithms, especially GBDT, can be reliable tools for accurately predicting the in-hospital mortality risk for CKD patients with CAD in the ICU. This contributed to providing optimal resource allocation and reducing in-hospital mortality by tailoring precise management and implementation of early interventions.

BackgroundChronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHA2DS2-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD.MethodsThis was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHA2DS2-VASc score for each eligible patient was determined. Patients were stratified into two groups according to CHA2DS2-VASc score: <6 (low) and ≥6 (high). The primary endpoint was all-cause mortality.ResultsA total of 313 eligible patients were included in the study, with a mean CHA2DS2-VASC score of 4.55 ± 1.68. A total of 220 and 93 patients were assigned to the low and high CHA2DS2-VASc score groups, respectively. The most common reason for hospitalization was unstable angina (39.3%), followed by non-ST-elevation myocardial infarction (35.8%) and ST-elevation myocardial infarction (24.9%). A total of 67.7% of the patients (212/313) received coronary reperfusion therapy during hospitalization. The median follow-up time was 23.0 months (interquartile range: 12–38 months). A total of 94 patients (30.0%) died during follow-up. The high score group had a higher mortality rate than the low score group (46.2 vs. 23.2%, respectively; p < 0.001). The cumulative incidence of all-cause death was higher in the high score group than in the low score group (Log-rank test, p < 0.001). Multivariate Cox regression analysis indicated that CHA2DS2-VASc scores were positively associated with all-cause mortality (hazard ratio: 2.02, 95% confidence interval: 1.26–3.27, p < 0.001).ConclusionThe CHA2DS2-VASc score is an independent predictive factor for all-cause mortality in CKD patients who are hospitalized with ACS. This simple and practical scoring system may be useful for the early identification of patients with a high risk of death.

Background: Breast cancer (BRCA) is one of the most common cancers in women worldwide and a leading cause of death from malignancy. This study was designed to identify a novel biomarker for prognosticating the survival of BRCA patients. Methods: The prognostic potential of eukaryotic translation initiation factor 4 gamma 1 (EIF4G1) was assessed using RNA sequencing (RNA-seq) data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) as training cohort and validation set, respectively. The functional enrichment analysis of differentially expressed genes (DEGs) was performed. The relationship between EIF4G1 and tumor microenvironment (TME) was analyzed. Immunotherapy responses were explored by the immunophenoscores (IPS) and tumor immune dysfunction and exclusion (TIDE) score. The Connectivity Map (CMap) was used to discover potentially effective therapeutic molecules against BRCA. Immunohistochemistry (IHC) was applied to compare the protein levels of EIF4G1 in normal and cancer tissues and to verify the prognostic value of EIF4G1. Results: BRCA patients with increased expression of EIF4G1 had a shorter overall survival (OS) in all cohorts and results from IHC. EIF4G1-related genes were mainly involved in DNA replication, BRCA metastasis, and the MAPK signaling pathway. Infiltration levels of CD4+-activated memory T cells, macrophages M0, macrophages M1, and neutrophils were higher in the EIF4G1 high-expression group than those in the EIF4G1 low-expression group. EIF4G1 was positively correlated with T cell exhaustion. Lower IPS was revealed in high EIF4G1 expression patients. Five potential groups of drugs against BRCA were identified. Conclusion: EIF4G1 might regulate the TME and affect BRCA metastasis, and it is a potential prognostic biomarker and therapeutic target for BRCA.

Abstract Objective We aimed to investigate the effect of the triglyceride glucose (TyG) index on the association between diabetes and cardiovascular disease (CVD). Methods Data from 6,114 individuals were extracted and analyzed from the China Health and Retirement Longitudinal Survey (CHARLS) from 2011 to 2018. Logistic regression analyses were conducted to assess the relationship between diabetes and CVD across the various TyG index groups. The statistical method of subgroup analysis was used to determine the correlation between diabetes and CVD for each TyG index group by sex, history of hypertension and dyslipidemia, smoking, and drinking. Results Diabetes was positively associated with CVD risk after adjustment in 2011(odds ratio (OR) 1.475, 95% CI 1.243–1.752, P < 0.001). There was a gradient increase in the OR for new-onset CVD in 2018 due to diabetes at baseline across the value of the TyG index based on a fully adjusted model (P for trend < 0.05). The ORs of diabetes at baseline for CVD in 2018 were 1.657 (95% CI 0.928–2.983, P = 0.098), 1.834(95% CI 1.064–3.188, P = 0.037) and 2.234(95% CI 1.349–3.673, P = 0.006) for T1, T2 and T3 of the TyG index respectively. The gradient of increasing risk of CVD still existed among those with hypertension and nondrinkers in the subgroup analysis. Conclusion Elevated TyG index strengthens the correlation between diabetes mellitus and CVD in middle-aged and elderly Chinese adults.