Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.

Objective: To explore the predictive value of fractional lfow reserve (FFR) level for long-term prognosis in patients after coronary drug-eluting stent (DES) implantation, and to analyze the relevant factors affecting the level of post-operative FFR. Methods: A total of 135 patients who received DES implantation in our hospital from 2012-01 to 2013-07 with coronary intermediate lesion at (50-80) % were studied. The relevant factors for MACE occurrence were studied by multivariate logistic regression analysis, the post-stent FFR level for predicting the long term prognosis after DES implantation was ifnally analyzed by ROC curve. Results: All patients ifnished 1 year follow-up study including 104 male and 31 female with the mean age of (63 ± 9) years. The post-stent FFR level was lower in MACE group than that in Non-MACE group, (0.82 ± 0.07) vs (0.87 ± 0.06),P=0.004. Multivariate logistic regression analysis presented that the higher level of post-stent FFR was the protective factor for MACE occurrence (OR=0.212,P=0.039); the post-stent FFR level had certain predictive value for MACE occurrence at 1 year after DES implantation (AUC=0.706,P=0.006); Kaplan-Meier survival study showed that the patients with post-stent FFR<0.875 had the less MACE occurrence than those with FFR≥0.875,P=0.012. Multivariate logistic regression analysis also indicated that post-stent FFR≥0.875 was positively related to right coronary target vessel, higher pre-operative FFR level and larger stent diameter.Conclusion: Post-stent FFR level had certain predictive value for MACE occurrence in patients at 1 year after DES implantation, the patients with post-stent FFR≥0.875 had the lower MACE occurrence rate than those with FFR<0.875.

Objective To explore the association between the CpG methylation level of positive regulatory domain containing 16(PRDM16)gene promoter and obesity or body mass index(BMI). Methods A total of 116 patients(91 female adults and 25 male adults) with abdominal operation in a municipal hospital of Henan province were enrolled in this study and they were divided into two groups:normal weight group(n=50), overweight or obesity group ( n=66 ) . Fasting plasma glucose, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were measured in peripheral blood. DNA was extracted from white blood cells in peripheral blood and modified by bisulphite. Then the CpG methylation level of PRDM16 gene promoter was detected by mass spectrometry. Finally, all data were analyzed by IBM SPSS Statistics 21. 0 at the 5% level. The essential features and biochemical indexes of research objects between two groups were compared by two independent sample t-test, except chi-square test for gender. The correlation between CpG methylation level of PRDM16 gene and BMI was analyzed by multiple linear regression. Results There were no significant differences ( P>0. 05 ) in the methylation levels of PRDM16 gene's effective CpG sites(including CpG5. 6, CpG8, CpG9, CpG12, CpG13. 14. 15, CpG26. 27, CpG28 and CpG29) between two groups. The methylation level of CpG26. 27 had positive linear relation with BMI in overweight or obesity group with the standardized coefficients of 46. 928(P=0. 015), which means the higher the methylation level is, the higher the BMI would be. Conclusion The CpG26. 27 methylation level of PRDM16 gene promoter region may have relationship with the risk of obesity.

Objective:To analyze the risk factors of subdelirium syndrome in Intensive Care Units (ICU) patients, build a risk prediction model and verify the prediction performance of the model.Methods:From July 2021 to February 2022, 443 ICU patients who were admitted to the Affiliated Hospital of Zunyi Medical University were selected by convenient sampling. The patients were divided into subdelirium syndrome group ( n=151) and non-subdelirium syndrome group ( n=292) according to whether they had subdelirium syndrome. The binomial Logistic regression was used to screen out independent influencing factors to construct a risk prediction model of subdelirium syndrome in ICU. The prediction effect of the model was tested by the area under the curve ( AUC) of receiver operating characteristic curve. According to the same standard, 147 ICU patients admitted to the Affiliated Hospital of Zunyi Medical University from March to April 2022 were selected for external validation of the model. Results:The risk prediction model of subdelirium syndrome in ICU was Y=-4.126+1.569×Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score+1.261×pain score+1.643×total leukocyte+1.276×albumin +1.530 × operation or not. The internal validation of the model showed that the AUC was 0.878 [95% confidence interval (0.844, 0.912) ], the maximum Youden index was 0.614, the sensitivity was 74.8%, and the specificity was 86.6%. Hosmer-Lemeshow goodness of fit test showed that χ 2=2.743, P>0.05. The external validation of the model showed that the sensitivity was 92.6% and the specificity was 95.7%. Conclusions:This risk prediction model of subdelirium syndrome in ICU has good prediction performance, which can help medical and nursing staff identify high-risk patients with subdelirium syndrome in ICU as soon as possible.

Objective:To investigate the related risk factors related to patellar dislocation combined with osteochondral fracture (OCF).Methods:A case control study was conducted to analyze the clinical data of 278 patients with patellar dislocation admitted to Second Hospital of Lanzhou University from January 2016 to June 2020, including 98 males and 180 females; aged 12-41 years [(21.1±4.6)years]. The patients were divided into OCF group ( n=112) and non-OCF group ( n=166) according to the surgical records and occurrence of OCF or not under intraoperative arthroscopy. The data of the two groups were recorded, including basic characteristics (ie, sex, age, sides of injury, whether or not the epiphysis is closed), patella height, patellar inclination angle, tibial tubercle-trochlear groove (TT-TG), femoral trochlear shape, tibial lateral rotation angle and femoral anteversion angle. Univariate analysis was adopted to evaluate the correlation of the data with patellar dislocation combined with OCF. Multivariate Logistic regression analysis was used to determine the independent risk factors of patellar dislocation combined with OCF. Results:Univariate analysis showed that patellar dislocation combined with OCF was related to male, patellar inclination angle and femoral anteversion angle ( P<0.05 or 0.01), while not to age, epiphysis is closed or not, sides of injury, patella height, TT-TG, femoral trochlear shape and tibial lateral rotation angle (all P>0.05). Multivariate Logistic regression analysis showed that male ( OR=1.75, 95% CI 1.07-2.90, P<0.05) and increased femoral anteversion angle ( OR=3.12, 95% CI 1.89-5.17, P<0.05) were significantly correlated with patellar dislocation combined with OCF. Conclusion:Male and increased femoral anteversion angle are independent risk factors for patellar dislocation combined with OCF.

Background: and Purpose Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids. Methods: The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients’ characteristics and identified the factors that affect collateral circulation. Results: This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61–0.76) for HDL-C and 0.69 (95% CI, 0.62–0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71–0.84). Conclusions In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.

Objective:To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA).Methods:This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R, and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher ′s exact test was used for categorical variables, and independent sample t test or Wilcoxon rank sum test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results:After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%, χ2=7.600， P=0.006),complication rate (44.7% vs.26.3%, χ2=4.025， P=0.045), and secondary intervention rate (31.6% vs.13.2%, χ2=4.910， P=0.027) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%, χ2=0.109， P=0.741), complication rate (28.6% vs.35.7%, χ2=0.507， P=0.477) and secondary intervention rate (14.3% vs.21.4%, χ2=0.353， P=0.552) between the two groups. Conclusions:When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

Objective:To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA).Methods:This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R, and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher ′s exact test was used for categorical variables, and independent sample t test or Wilcoxon rank sum test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results:After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%, χ2=7.600， P=0.006),complication rate (44.7% vs.26.3%, χ2=4.025， P=0.045), and secondary intervention rate (31.6% vs.13.2%, χ2=4.910， P=0.027) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%, χ2=0.109， P=0.741), complication rate (28.6% vs.35.7%, χ2=0.507， P=0.477) and secondary intervention rate (14.3% vs.21.4%, χ2=0.353， P=0.552) between the two groups. Conclusions:When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

The traditional experimental teaching mode of forensic science and biological evidence is mostly confined to experimental operation, which is not capable of cultivating students' comprehensive quality and post competency. Therefore, it is urgent to seek an innovative teaching and training mode. At present, the experimental teaching of forensic science and biological evidence is dominated by teachers. There are some problems, such as insufficient training of students' scientific thinking and innovation ability, single teaching and evaluation model, and disconnection from the practical application. This paper proposes an experimental teaching design scheme of forensic science and biological evidence based on post competency training. The course is implanted in the framework of simulated cases, and the virtual simulation experiment platform and group discussion learning method are used to achieve a training model oriented by social needs and centered on students. In the preliminary study on the students who were trained in this mode of selected sections, we found that, compared with traditional teaching, the time for students to complete the prescribed experimental operation in this teaching mode was shortened by 4 minutes on average, and the average score of theoretical course test case analysis questions was increased by 1.5 points. In conclusion, the instructional design of the experiment teaching forensic science and biological evidence can effectively improve students' post-competency, and it deserves further exploration and application.

Objective We retrospectively analyzed the causes,diagnosis,clinical characteristics,treatment and prognosis of 17 patients with rhabdomyolysis.Methods Rhabdomyolysis cases diagnosed from January 2005 to March 2014 in our department were included.Results A total of 17 rhabdomyolysis patients (male 13,mean age (60.4 ± 15.7)years) were analyzed.Four cases had coronary heart disease combined with hypertension,hyperlipaemia,atrial fibrillation,10 cases had dilated cardiomyopathy combined with coronary heart disease,hyperlipaemia,atrial fibrillation,8 cases had atrial fibrillation combined with hypertension,coronary heart disease,hyperlipaemia,1 patient had pulmonary embolism combined with hyperlipaemia,1 patient had aortic dissection combined with hypertension,10 hypertension patients were combined with coronary heart disease,hyperlipaemia,atrial fibrillation,aortic dissection and 1 patient with ventricular tachycardia was combined with depression.Various degrees of liver and kidney dysfunction,reduced hemoglobin and myoglobinuria were found in all patients.Fever was found in 7 cases,relevant neurological signs in 5 cases.Digestive tract discomfort and muscle weakness or muscle pain symptoms were seen in all patients during hospitalization.All cases underwent renal replacement therapy and respirator was used in 14 patients to support breathing.Post therapy,10 cases improved but 7 cases died.All 17 patients had history of statin use.Conclusion Statin may be the major cause of rhabdomyolysis in these patients,and the mortality of rhabdomyolysis is high despite various therapy stratigies.