Objective:To investigate the association of systemic immune-inflammation index(SII)and serum cysta-tin C(CysC)with the severity of acute pulmonary embolism(APE),and their predictive value for prognosis.Meth-ods:A total of 181 patients who were first diagnosed with APE in Cangzhou People's Hospital between January 2018 and January 2023 were retrospectively selected.The severity of APE was determined according to risk stratification criteria for pulmonary embolism,and the patients were divided into low-risk group(n=67),middle-risk group(n=81)and high-risk group(n=33).General clinical data and venous blood neutrophils,platelet and lymphocyte counts,CysC and other indicators were collected,and SII was calculated according to the formula.The relevant in-dicators were compared among three groups,and their correlation with the severity of APE was analyzed by Spearman correlation analysis.According to the prognosis,all APE patients were divided into favorable outcome group(n=129)and unfavorable outcome group(n=52).The general clinical data were compared and multivariate Cox regression analysis was used to study the influencing factors of unfavorable outcome in APE patients.The re-ceiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of SII,CysC and their com-bination for the prognosis of APE patients.Nomogram model for prognosis was constructed.Results:Compared with patients in low-risk group,those in the middle-risk group and the high-risk group had significantly higher levels of serum creatinine,CysC and uric acid(P＜0.05 or＜0.01).The SII in the high-risk group was significant-ly higher than those of middle-risk group and low-risk group(P＜0.001 all).Spearman correlation analysis showed that serum creatinine,CysC,uric acid and SII were significant positively correlated with the severity of APE(r=0.356,0.358,0.233,0.353,P＜0.01 all).Compared with patients in the favorable outcome group,those in the unfavorable outcome group had significantly higher levels of D-dimer,serum creatinine,CysC,uric acid and SII(P＜0.01 all).There was a statistically significant difference in the severity of APE between the two groups(P=0.001).Multivariate Cox regression analysis showed that CysC,SII,and middle or high risk of disease severity were independent risk factors for unfavorable outcome in APE patients(HR=1.001～14.453,P＜0.05 or＜0.01).ROC curve indicated that the AUC of SII,CysC and their combination in predicting unfavorable outcome of APE patients were 0.815(95％CI 0.749～0.881),0.747(95％CI 0.661～0.832)and 0.878(95％CI,0.821～0.936),respectively.The combined AUC of the two was significantly higher than those of SII and CysC alone(Z=-2.234,-3.500,P＜0.05 or＜0.01).Based on the above independent risk factors,the AUC values of the 1-year and 3-year unfavorable outcome nomogram models were 92.9 and 88.2,respectively.The calibration prediction curve and the ideal curve fitted well.The decision curve showed that the model had a good net benefit.Conclusion:SII and CysC are significant positively correlated with the severity of APE and they are independent risk factors for unfavor-able outcome of APE,and the combination of the two indicators has a good predictive value for the prognosis of APE.The nomogram constructed has good accuracy and practicability.

Objective:To explore the effect of recombinant human brain natriuretic peptide(rhBNP)on the efficacy,inflammatory factors and cardiac function in patients with dilated cardiomyopathy(DCM)and chronic heart failure(CHF).Methods:This randomized controlled study enrolled 130 patients with DCM and CHF admitted to Dongy-ing District People's Hospital of Dongying City between February 2017 and December 2018.Patients were divided into intervention group(n=65)and control group(n=65).Patients in control group received conventional treat-ment,while those in the intervention group was given additional rhBNP treatment,both groups were treated for 4 weeks.The total effective rate,cardiac function indicators,levels of inflammatory factors and blood lipids,as well as incidence of adverse reactions,were compared between the two groups.Results:The total effective rate(95.38％vs.76.92％,P＜0.001)of the intervention group was significantly higher than that of the control group.After treatment,compared to patients in the control group,those in the intervention group had significant higher left ventricular ejection fraction(LVEF)[(53.21±3.57)％vs.(45.39±2.56)％]and interleukin(IL)-10[(79.55±13.98)pg/ml vs.(69.32±13.86)pg/ml],and significant lower left ventricular end-systolic diameter(LVESd)[(35.25±3.19)mm vs.(40.34±3.09)mm],left ventricular end-diastolic diameter(LVEDd)[(43.29±4.87)mm vs.(50.18±4.21)mm],IL-18[(212.19±24.28)pg/ml vs.(257.98±39.72)pg/ml],and high sensitive C reactive protein(hsCRP)[(11.39±2.29)mg/L vs.(16.59±2.83)mg/L](P＜0.001 all).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.753).Conclusion:The use of the rhBNP based on routine therapy for the treatment of dilated cardiomyopathy and chronic heart failure could effectively improve cardiac function and reduce levels of inflammatory factors.Additionally,it has a high safety profile.

Objective:To explore the application effect of emergency risk management in emergency treatment of pa-tients with acute myocardial infarction(AMI)and its safety.Methods:This randomized controlled study enrolled 103 AMI patients admitted in Haian People's Hospital between April 2020 and January 2023.Patients were divided into intervention group(n=51)and control group(n=52).Patients in intervention group received emergency risk management measures,while those in control group received routine management measures.Rescue quality,heart function,scores of Connor-Davidson resilience scale(CD-RISC),coronary self-management scale(CSMS)and incidence of adverse events were compared between two groups.Results:Compared to patients in the control group,those in intervention group had significant higher rescue success rate(96.0％vs.46.0％),and significant lower emergency stop time[(23.01±2.77)h vs.(36.61±3.00)h]and length of stay[(8.74±2.68)d vs.(15.52±2.91)d](P＜0.001 all).Compared with patients in the control group,those in the intervention group had significant lower cardiac troponin I(cTnI)[(0.48±0.28)ng/L vs.(1.05±0.57)ng/L],heart rate(HR)[(68.13±1.88)beats/min vs.(84.87±1.59)beats/min],left ventricular end-diastolic diameter(LVEDd)[(40.98±0.58)mm vs.(52.09±0.55)mm]and left atrial volume index(LAVI)[(27.07±0.58)ml/m2 vs.(36.86±0.65)ml/m2],and significant higher left ventricular ejection fraction(LVEF)[(67.93±0.56)％vs.(56.91±0.59)％](P＜0.001all).Compared with patients in the control group,those in the intervention group had significant higher scores of CD-RISC[(98.10±1.61)points vs.(71.33±1.87)points]and CSMS[(131.58±1.76)points vs.(111.82±1.75)points](P＜0.001 all),and significant lower incidence of adverse events(4.0％vs.16.0％,P=0.046).Conclusion:Emergency risk management may improve the rescue quality and en-hance cardiac function,and help to improve the psychological resilience and self-management ability in patients with acute myocardial infarction.

Objective:To investigate the predictive value of color Doppler ultrasound combined with electrocardio-gram for right heart dys function in patients with pulmonary heart disease(PHD).Methods:A total of 100 PHD patients admitted in Dongcheng Branch of First Affiliated Hospital of Anhui Medical University between January 2020 and December 2023 were retrospectively analyzed.According to results of 6min walking test(6MWT),pa-tients were divided into good right heart function group(n=64,≥350m)and right heart dysfunction group(n=36,＜350m).The indexes of cardiac color ultrasound[isovolumic relaxation time(IVRT),isovolumetric contraction time(IVCT)and right ventricular Tei index],ECG[24h mean R-R interval standard deviation(SDNN),normal R-R interval standard deviation per 5min(SDANN)and the ratio of low frequency components to high frequency components(LF/HF)]were compared between two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of color Doppler ultrasound,ECG and their combination for right heart dys-function in PHD patients.Spearman correlation coefficient was used to analyze the association of color Doppler ul-trasound,ECG and their combination with right heart dysfunction in PHD patients.Results:Compared with those in good right heart function group,patients in right heart dysfunction group had significant higher IVRT[(120.64±14.08)ms vs.(97.87±10.93)ms],IVCT[(84.28±12.33)ms vs.(71.92±10.61)ms]and Tei index[(0.85±0.11)vs.(0.63±0.07)](P＜0.001 all),and significant lower SDNN[(75.52±12.58)ms vs.(85.58±11.75)ms],SDANN[(63.86±10.92)ms vs.(76.75±11.71)ms]and LF/HF[(1.33±0.19)vs.(1.84±0.27)](P＜0.001 all).ROC curve indicated that the AUC of color Doppler ultrasound combined ECG in diagnosing right heart dysfunction in PHD patients was 0.911(95％CI 0.838～0.959),which was significantly higher than those of color Doppler ultrasound[0.775(95％CI 0.681～0.853),Z=2.404,P=0.016]and ECG[0.688(95％CI 0.588～0.777),Z=3.968,P=0.001]alone.Spearman correlation analysis indicated that there was a significant positive correlation of color Doppler ultrasound(r=0.547),ECG(r=0.375)and their combination(r=0.810)with right heart dysfunction in PHD patients(P＜0.001 all),and the correlation between combined detection and right heart dysfunction in PHD patients was significantly higher.Conclusion:Color Doppler ultrasound combined with ECG possesses high diagnostic performance for right heart dysfunction in PHD patients.

Objective:To explore the value of dynamic changes in serum creatinine(SCr)and cardiac troponin I(cT-nI)levels in predicting the occurrence of heart failure in emcrgency patients with ST segment elevation myocardial in-farction(STEMI)after interventional treatment.Methods:A total of 186 patients with emergency STEMI admitted to Suzhou Ninth People's Hospital between January 2021 and January 2023 were enrolled and followed up for 1 year to record the incidence of heart failure.Receiver operating characteristic(ROC)curves were plotted to determine the optimal cut-off points of Scr,△SCr(absolute value of SCr on 7d after operation-baseline SCr),cTnI,and △cTnI(absolute value of cTnI on 7d after operation-baseline cTnI),and the value of each indicator in predicting heart failure.Results:After 1-year follow-up,the incidence of heart failure after percutaneous coronary intervention(PCI)was 27.78％(50/180).Compared with patients in no occurrence group,those in occurrence group had significant highcr △SCr[18.45(9.01,34.17)μmol/L vs.2.15(0.76,6.45)μmol/L],△cTnI[1.52(0.72,2.71)μg/L vs.0.56(0.15,1.43)μg/L](P＜0.001 all).ROC curve indicated that the optimal cut-off points of SCr,△SCr,cTnI and △cTnI were 113.235 μmol/L,8.595μmol/L,8.475 μg/L and 0.695μg/L,respectively.Multivariate Logistic regression analysis showed that baseline SCr≥113.235μmol/L,△SCr ≥8.595μmol/L,baseline cTnI ≥8.475 μg/L and △cTnI ≥0.695μg/L were independent risk factors for heart failure after PCI in emergency STEMI patients(OR=3.480～21.035,P＜0.01 all).Pearson correlation analysis indicated that baseline SCr was significantly positive associated with baseline cTnI(r=0.232,P=0.002).Conclu-sion:The dynamic changes of serum SCr and cTnI levels may predict the occurrence of heart failure in STEMI patients af-ter interventional treatment.

Objective:To investigate the association of serum levels of micro RNA-126(miR-126),C-peptide,secreted phospholipase A2(sPLA2)with carotid atherosclerotic plaque(CAP)and prognosis in patients with coronary heart disease(CHD).Methods:A total of 114 patients with carotid atherosclerotic coronary heart disease(CAS-CHD)admitted to-Baoding Third Central Hospital between February 2020 and February 2021 were enrolled.Patients were divided into stable plaque group(n=68)and unstable plaque group(n=46)according to carotid ultrasound findings.Serum levels of miR-126,C-peptide and sPLA2 were compared between two groups.Pearson correlation analysis was used to determine the as-sociation of miR-126,C-peptide and sPLA2 with plaque Crouse score.Binary Logistic regression analysis was used to in-vestigate the association of miR-126,C-peptide and sPLA2 with unfavorable outcome.The predictive performance of the combined detection of miR-126,C-peptide,and sPLA2 for unfavorable outcome in CAS-CHD patients was evalua-ted using the receiver operating characteristic(ROC)curve analysis.Results:Compared with patients in the stable plaque group,those in the unstable plaque group had significant higher miR-126[(0.99±0.30)vs.(0.81±0.24)],carotid inti-ma-media thickness(IMT)[(1.67±0.42)mm vs.(1.31±0.51)mm]and plaque Crouse score[(5.93±1.42)points vs.(4.30±1.32)points](P＜0.001 all).Pearson correlation analysis indicated that miR-126,C-peptide and sPLA2 were positively correlated with plaque Crouse score(r=0.267,0.309,0.351,P＜0.01 all).Binary Logistic regression a-nalysis showed that age[odds ratio(OR)=1.509,95％CI 1.055～2.157],miR-126(OR=60.595,95％CI 1.252～2932.237),C-peptide(OR=2.870,95％CI 1.249～6.595),sPLA2(OR=1.068,95％CI 1.016～1.124)and plaque Crouse score(OR=4.491,95％CI 1.824～11.059)were independently associated with unfavorable outcome(P＜0.05 or＜0.01).The area under the joint prediction curve(AUC)was 0.898(95％CI 0.825～0.948),which was significantly higher than miR-126(AUC=0.722,95％CI 0.628～0.804),C-peptide(AUC=0.818,95％CI 0.732～0.886)and sPLA2(AUC=0.806,95％CI 0.719～0.876)alone(Z=3.140,3.161,2.930,P＜0.01 all).Conclusion:Serum miR-126,C-peptide and sPLA2 levels were significantly correlated with the severity of carotid atherosclerosis in coronary heart disease.Combined detection of these three biomarkers may predict unfavorable outcome in these patients.

Objective:To investigate the clinical efficacy of levocarnitine combined with fructose 1,6-diphosphate(FDP)on patients with viral myocarditis(VMC)and its effect on serum levels of aspartate aminotransferase(AST),lactate dehydrogenase(LDH)and cardiac troponin I(cTnI).Methods:This randomized controlled study enrolled 126 patients with VMC admitted to Xingyuan Hospital of Yulin between May 2020 and August 2021.Pa-tients were divided into control group(n=63)and intervention group(n=63).Patients in the control group re-ceived routine treatment comparing to those in the intervention group receiving additional FDP combined with levoc-arnitine,both groups were treated for 4 weeks.Left ventricular ejection fraction(LVEF),levels of AST,LDH,cTnI,creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB)and therapeutic effective rate were com-pared between the two groups.Pearson correlation analysis was used to analyze the association of AST,LDH,cTnI levels with LVEF.Results:Compared with patients in control group after 4-week treatment,those in the inter-vention group had significant higher LVEF[(73.17±6.39)％vs.(63.30±6.04)％]and therapeutic effective rate(96.67％vs.80.00％)(P＜0.001 all),and significant lower levels of AST[(32.35±7.34)U/L vs.(48.22±8.40)U/L],LDH[(154.50±28.10)U/Lvs.(183.77±29.60)U/L],cTnI[(77.47±12.04)ng/ml vs.(96.12±15.33)ng/ml],CK[(181.47±8.93)U/L vs.(192.33±8.85)U/L],CK-MB[(24.25±2.19)U/L vs.(28.17±2.01)U/L](P＜0.001 all).Pearson correlation analysis indicated that AST,LDH and cTnI levels were significant negatively correlated with LVEF(r=-0.404,-0.231,-0.339,P＜0.05 or＜0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.543).Conclusion:FDP combined with levocarnitine could significantly improve cardiac function,reduce the levels of AST,LDH and cTnI,and effectively improve therapeutic effective rate with good safety in patients with viral myocarditis.

Objective:To explore the effect of ezetimibe combined with atorvastatin on the efficacy,blood lipids,ca-rotid ultrasound indicators in patients with coronary heart disease(CHD)and its safety.Methods:This randomized controlled study enrolled 98 CHD patients admitted to 945th Hospital of the PLA Joint Logistic Support Force be-tween June 2021 and June 2023.Patients were divided into intervention group and control group with 49 cases in each group.Patients in the control group was treated with atorvastatin-bascd routine medication comparing to those in intervention group receiving additional ezetimibe,both groups were treated for 90 d.Clinical efficacy,blood lipids,carotid ultrasound indicators,endothelial function indicators,and incidence of adverse reactions were compared between two groups.Results:Compared with patients in the control group,those in the intervention group had significant higher total effective rate(91.83％vs.73.47％,P=0.016).Compared with patients in the control group after treatment,those in intervention group had significant lower levels of low density lipoprotein cho-lesterol(LDL-C)[(2.74±0.61)mmol/L vs.(3.42±0.66)mmol/L],total cholesterol(TC)[(3.80±0.89)mmol/L vs.(4.69±1.02)mmol/L],triglyceride(TG)[(1.79±0.53)mmol/L vs.(2.35±0.62)mmol/L],re-sistance index(RI)[(52.02±6.32)％vs.(57.95±6.02)％],carotid intima-media thickness(IMT)[(0.91±0.17)mm vs.(1.08±0.24)mm],von Willebrand factor(vWF)[(19.03±3.76)mg/L vs.(23.41±4.42)mg/L],angiotensin Ⅱ(Ang Ⅱ)[(45.83±5.87)ng/L vs.(52.87±6.01)ng/L](P＜0.001 all);and significant high-er high density lipoprotein cholesterol(HDL-C)[(1.63±0.32)mmol/L vs.(1.35±0.27)mmol/L],peak systol-ic velocity(PSV)[(47.93±5.26)cm/s vs.(41.32±4.98)cm/s],end-diastolic velocity(EDV)[(36.14±5.10)cm/s vs.(30.73±4.48)cm/s],pulse index(PI)[(85.98±9.03)％vs.(78.42±8.82)％],vascular endothelial growth factor receptor 1(VEGFR1)[(289.14±32.98)ng/L vs.(258.34±29.32)ng/L](P＜0.001 all).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.538).Conclusion:Ezetimibe combined with atorvastatin possesses significant therapeutic effect on CHD patients,which could signifi-cantly reduce blood lipids,improve the carotid blood flow velocity and vascular endothelial function with good safety.

Objective:Based on the dataset in the Gene Expression Omnibus database(GEO),we screened out the co-expression modules most relevant to acute myocardial infarction(AMI)and identified ferroptosis-related bio-markers.Methods:We constructed a weighted gene co-expression network for the hypervariable genes in the GSE123342 dataset,screened out the gene modules most related to AMI and identified ferroptosis-related biomark-ers from the key modules,and then observed their expression levels in tissues as well as further analyzed their corre-lation with the immune microenvironment.Results:One key module most relevant to AMI patients was obtained.By intersecting with differential genes,a total of 532 differential genes that were up-regulated in AMI were ob-tained.Functional enrichment analysis showed that they were mainly enriched in biological processes such as granu-locyte migration,reactive oxygen species generation,leukocyte chemotaxis and activation,and defense response regulation.The pathways were mainly enriched in Toll-like signaling pathway,nuclear factor kappa B(NF-κB)signaling pathway,tumor necrosis factor(TNF)signaling pathway,hypoxia-inducible factor-1(HIF-1)signa-ling pathway and cytokine-cytokine receptor interaction pathways,etc.Finally,14 genes were found that were promising targets for AMI treatment:zinc finger antisense 1(ZFAS1),WD repeat domain,phosphoinositide inter-acting 1(WIPI1),Toll-like receptor 4(TLR4),quiescin sulfhydryl oxidase 1(QSOX1),phosphatase and tensin homolog(PTEN),phosphogluconate dehydrogenase(PGD),mitochondrial fusion protein 2(MFN2),double mi-nute 2 homolog(MDM2),mitogen-activated protein kinase 14(MAPK14),mitogen-activated protein kinase 1(MAPK1),gamma-aminobutyric acid receptor-associated protein-like 1(GABARAPL1),arachidonate 5-li-poxygenase(ALOX5),long-chain acyl-CoA synthetase 4(ACSL4),and long-chain acyl-CoA synthetase 1(ACSL1).Correlation analysis revealed that they all had obvious correlations with various immune cells.Conclusion:The 14 ferroptosis genes associated with AMI are expected to become potential immunotherapy targets.

Objective:To explore the effect of combined comprehensive geriatric assessment(CGA)and medical con-joined hierarchical diagnosis and treatment in patients with chronic pulmonary heart disease(CPHD).Methods:This randomized controlled study enrolled 173 CPHD patients treated in the First Affiliated Hospital of Xinjiang Medical University between January 2021 and June 2023,and patients were divided into intervention group(n=86)and control group(n=87).Patients in the control group received the routine diagnosis and treatment process man-agement,and those in the intervention group received the CGA combined with medical conjoined hierarchical diag-nosis and treatment.Both groups were intervened for 1 month,and the curative effect,referral situation,incidence of adverse cardiac events,falls,score of Adult Health Self-Management Scale Revised Version(AHSMSRS),stroke volume(SV),left ventricular ejection fraction(LVEF),forced expiratory volume in one second(FEV1),the ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC)and medical coping modes questionnaire(McMQ)score were compared between two group safter intervention.Results:Compared with pa-tients in control group,those in intervention group had significant higher curative effect(92.00％vs.80.00％),proportion of referral to the primary hospital(62.67％vs.26.67％),SV[(62.41±1.83)ml vs.(56.15±2.24)ml],LVEF[(58.48±0.83)％vs.(54.14±0.71)％],FEV1[(1.82±0.18)L vs.(1.41±0.06)L],FEV1/FVC[(78.19±1.96)％vs.(68.85±2.10)％],confronce score[(16.92±0.83)points vs.(14.93±0.83)points]of McMQ,significant lower avoidance score[(9.01±0.85)points vs.(11.91±0.83)points]of McMQ,significant higher dimensional scores of AHSMSRS(P＜0.001 all),and significant lower incidence of cardiac adverse events(9.33％vs.22.67％)and falls(8.00％vs.20.00％)(P＜0.05 both).Conclusion:The implementation of CGA combined with medical conjoined hierarchical diagnosis and treatment for CPHD patients may effectively improve the curative effect and hospital referral.It indirectly enhances the self-management ability and cardiopulmonary function,and helps to reduce the risk of cardiac adverse events and falls.