Myocardial infarction (MI) is a major cause of death and disability worldwide.The definition of myocardial infarction has been updated.Released in 2012,Third Universal Definition of Myocardial Infarction of ESC/ACCF/AHA/WHF Expert Consensus,made the clinical application value of troponin clear and suggested to monitor the dynamic changes of cTn in patients with suspected,emphasized the importance of clinical differential diagnosis.In consensus,it also noted that the application of high sensitive troponin can lead to false positives results,and pointeds out that in the assessment of cardiac injury associated with percutaneous or surgical coronary procedures,the rational cut-off value of cTn remains controversival.In addition to acute coronary syndrome,cTn elevations are common in many disease states,and with the improvement of detection sensitivity,low level increase of cTn,will be more.In acute and chronic heart failure,the cTn is elevated,and ACS may be the cause of worsening heart failure,So we should identify whether the cTn elevation is pure from the myocardial injury of heart failure or myocardial necrosis caused by ACS.Nowadays,the increased incidence of myocardial infarction has much to do with the wide application of cTn.Clinical applications of cardiac biomarkers and imaging techniques are flexible as the differences in the diagnostic techniques of myocardial infarction among countries and regions result.

Objective To study the correlation between the degree of anxious state in patients with hypertension and the serum homocysteine level.Methods This is a case-control study in Beijing Anzhen Hospital from January to May in 2013.164 cases of essential hypertension with continuing unstable blood pressure after being treated for nearly a week were include.They have been analysed with GAD-7 and PHQ-9 evaluation scale for anxiety and depression state.According to the anxiety status,patients were devided into three groups:Group Ⅰ (28 cases without anxiety),Group Ⅱ (81 cases with mild anxiety),group Ⅲ (55 cases with moderate-to-severe anxiety).Results (1) Correlation analysis showed,the GAD-7 anxiety scale score related with age,PHQ-9 Depression Scale and Hcy level (P ＜ 0.05),PHQ-9 Depression Scale score and Hcy levels were correlated (P ＜ 0.05).(2) Multiple stepwise regression showed that PHQ-9 Depression Scale entered the regression equation,while GAD-7 anxiety scale,age and the level of hcy were risk factors.Conclusion Hcy level is a risk factor for hypertension patients with depression,there is correlation with the severity of anxiety.Mental health should be paid attention to patients with essential hypertension.

Objective To explore the effect of quality control circle (QCC) on health education in stroke rehabilitation nursing. Methods Such activities were conducted in the VIP ward of neurological rehabilitation in our hospital as: theme selecting, activity planning, status mastering, cause analyzing, countermeasures formulating and implementing, etc., in accordance with QCC theory from January to April, 2014. Results The satisfaction of stroke patients to health education rose from 80.1% to 91.1% (P<0.001), and the dissatisfaction to guidance of activities of daily living and prevention of complications decreased significantly (P<0.05) after the implementation of QCC program. All the circle members benefited from the improvement of QCC technique, team work, professional knowledge, communication and coordination, activity confidence, duty and honor. Conclusion Carrying out the QCC activities can play a positive role on health education in stroke rehabilitation nursing.

Schizophrenia is one of the most serious mental diseases found in humans. Previous studies indicated that the single nucleotide polymorphism (SNP) rs1344706 in the gene ZNF804A encoding zinc finger protein 804A was associated with schizophrenia in Caucasian population but not in Chinese Han population. However, current results are conflicting in Asian population. In the present study, a meta-analysis was performed to revisit the association between rs1344706 and the risk of schizophrenia in Asian, Caucasian and other populations. Electronic search of PubMed database identified 25 case–control studies with available genotype frequencies of rs1344706 for the meta-analysis, involving a total of 15,788 cases and 22,654 controls. A pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the association. The current meta-analysis showed an association between rs1344706 and schizophrenia in Caucasian populations (P= 0.028, OR= 1.138, 95% CI: 1.014–1.278; P = 0.004 for heterogeneity) and Asian populations (P = 0.008, OR = 1.092, 95% CI: 1.023–1.165; P = 0.001 for heterogeneity), but not in other populations (P= 0.286, OR= 1.209, 95% CI: 0.853–1.714, P = 0.120 for heterogeneity). Egger’s test (P > 0.05) and Begg’s test (P>0.05) are both suggestive of the lack of publication bias for the included studies. Thus, the absence of association in other populations suggests a genetic heterogeneity in the susceptibility of schizophrenia and demonstrates the difficulties in replicating genome-wide association study findings regarding schizophrenia across different ethnic populations. To validate the association between rs1344706 and schizophrenia, further studies with larger participant populations worldwide are needed.

Objectives To evaluate the role of PCSK9 (proprotein convertase subtilisin kexin type 9) on the lipid accumulation and kidney injury of C57BL/6 mice. Methods The 24 h urine of 12 weeks old wide type C57BL/6 mice and PCSK9 knockout (KO) mice were collected through a metabolic cage, followed by perfusion and sacrifice. Urinary microalbumin?to?creatinine ratio (UACr), total cholesterol and triglyceride in kidney tissues were measured by ELISA. BODIPY 493/503 staining and standard transmission electron microscopy (TEM) of kidney tissues was performed for evaluating lipid accumulation and podocyte foot effacement in the kidney. Kidney tissues were also evaluated by PAS stain and TUNNEL stain. PCSK9, podocin and nephrin were quantified through real?time PCR, and the Bcl?2, Bax and cleaved caspase 3 were evaluated by Western blotting. Results Total cholesterol and triglyceride contents were higher in the kidneys of PCSK9 KO mice than controls (P<0.05). The level of lipid accumulation in glomeruli and tubules through BODIPY 493/503 stain, and the amount of lipid drop in TEM were more serious in PCSK9 KO mice. UACr and podocyte foot process effacement were increased, and the transcription of podocin and nephrin were decreased in the kidneys of PCSK9 KO mice (all P<0.05). The expression of Bcl?2 was decreased, and Bax and cleavedcaspase 3 were increased in the kidney samples of PCSK9 KO mice. Conclusion PCSK9 might be reversely involved in lipid homeostasis and accumulation, resulting in injury and apoptosis in the kidneys of C57BL/6 mice.

Objective:To investigate the expression of programmed death ligand 1 (PD-L1) in rectal cancer tissues and the correlation of PD-L1 expression with clinicopathological characteristics and overall survival of patients.Methods:The clinical data of 200 newly treated rectal cancer patients in Shanxi Provincial Cancer Hospital from January 2014 to December 2015 were retrospectively analyzed. The expression of PD-L1 in rectal cancer tissues was detected by immunohistochemistry. The correlations of PD-L1 expression with gender, age, tumor T stage, lymph node metastasis, tumor differentiation, histological type, tumor TNM stage, neutrophil-to-lymphocyte ratio (NLR) and overall survival of patients were analyzed.Results:The positive expression rate of PD-L1 was 24% (48/200). The positive expression rate of PD-L1 was high in patients with lymph node metastasis and high NLR (≥ 3.5) (both P < 0.05). The 5-year overall survival rate in PD-L1-positive group was 42%, and the PD-L1-negative group was 59%, and the difference between the two groups was statistically significant ( P < 0.05). The results of multivariate analysis showed that lymph node metastasis ( HR = 3.456, 95% CI 2.148-5.556, P < 0.01), NLR ≥ 3.5 ( HR = 1.871, 95% CI 1.169-2.996, P = 0.009), and PD-L1-positive expression ( HR = 2.187, 95% CI 1.373-3.484, P = 0.001) were independent adverse influencing factors for the overall survival of rectal cancer patients. Conclusion:PD-L1 is highly expressed in rectal cancer tissues, and the positive expression of PD-L1 is associated with poor overall survival of patients.

Objective To explore the correlations of serum vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinases-1(TIMP-1)with grading of myelofibrosis(MF)in patients with myeloproliferative neoplasms(MPN).Methods Ninety patients with Philadelphia chromosome negative(Ph-)MPN were selected as MPN group.According to the grading criteria for myelofibrosis by the World Health Organization(WHO)in 2016,MPN pa-tients were divided into pre-fibrosis or early fibrosis group with 54 cases and significant fibrosis group with 36 cases;another 50 healthy volunteers were selected as the control group.Levels of serum VEGF,MMP-9 and TIMP-1 were detected by enzyme-linked immunosorbent assay,and the ratio of TIMP-1 to MMP-9(TIMP-1/MMP-9)was calculated.Spearman rank correlation test was used to analyze the correlations of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 with MF grading.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of each indicator a-lone or their combination for diagnosing MPN or distinguishing MF grading.Results Compared with the control group,the serum levels of VEGF,MMP-9 and TIMP-1 in the MPN group increased significantly(P＜0.05).Values of area under the curve(AUC)of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for diagnosing MPN were 0,834,0.745,0.923 and 0.618 respectively;the AUC of the combined diagnosis of MPN by VEGF,MMP-9 and TIMP-1 was 0.960;when the optimal cut-off value was 0.627,the sensitivity was 85.56％,and the specificity was 92.00％.Compared with the pre-fibrosis or early fibrosis group,the serum levels of VEGF,TIMP-1 and TIMP-1/MMP-9 in the significant fibrosis group increased significantly(P＜0.05).Spearman correlation analysis showed that VEGF(r=0.378,P=0.001),TIMP-1(r=0.512,P＜0.001)and TIMP-1/MMP-9(r=0.353,P=0.001)were positively correlated with the MF grading of MPN patients(P＜0.05).ROC curve analysis showed that the values of AUC of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis were 0.723,0.523,0.802 and 0.708 respectively;the AUC of the combined detection of VEGF,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis was 0.838;when the optimal cut-off value was 0.530,the sensitivity was 72.22％,and the specificity was 85.19％.Conclusion Serum VEGF,TIMP-1 and TIMP-1/MMP-9 can reflect the MF progression of MPN patients,and the combined detection of these indica-tors can predict the MF degree of MPN patients.

Objective To evaluate the effect of parasternal intercostal plane block(PIB)on postopera-tive fatigue in elderly patients undergoing off-pump coronary artery bypass grafting(CABG).Methods A to-tal of 111 elderly patients undergoing elective off-pump CABG in Xuzhou Municipal Central Hospital from May 2021 to January 2023 were selected as the study subjects.The patients were divided into the control group(group C,n=55)and PIB group(group P,n=56)by adopting the random number table method.After induction of anesthesia,the patients in the group P received the ultrasound-guided bilateral PIB,and the group C received the equal volume of normal saline at the same site.The incidence rate of postoperative fatigue syn-drome(POFS)on postoperative 1,3,5,7 d and postoperative 8 weeks,NRS scores immediately after extuba-tion and at postoperative 12,24,48 h,postoperative opioid drugs consumption,ICU stay duration,hospitaliza-tion duration and adverse events occurrence were compared between the two groups.Results Compared with the group C,the incidence rates of POFS on postoperative 1,3,5,7 d and postoperative 8 weeks in the group P were significantly decreased,the NRS scores immediately after extubation and at postoperative 12,24 h in the group P were lower,the postoperative opioid drugs consumption were smaller,the ICU stay duration was shorter,and the differences were statistically significant(P＜0.05).The NRS score at postoperative 48 h and hospitalization duration had no statistical differences between the two groups(P＞0.05).No nerve block re-lated adverse events in the patients appeared during the study period.Conclusion The ultrasound guided PIB could effectively reduce the incidence rate of POFS in elderly patients undergoing off-pump CABG,promote the patients'prognosis and improve the recovery quality of the patients.

Objective To explore the correlations of serum vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinases-1(TIMP-1)with grading of myelofibrosis(MF)in patients with myeloproliferative neoplasms(MPN).Methods Ninety patients with Philadelphia chromosome negative(Ph-)MPN were selected as MPN group.According to the grading criteria for myelofibrosis by the World Health Organization(WHO)in 2016,MPN pa-tients were divided into pre-fibrosis or early fibrosis group with 54 cases and significant fibrosis group with 36 cases;another 50 healthy volunteers were selected as the control group.Levels of serum VEGF,MMP-9 and TIMP-1 were detected by enzyme-linked immunosorbent assay,and the ratio of TIMP-1 to MMP-9(TIMP-1/MMP-9)was calculated.Spearman rank correlation test was used to analyze the correlations of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 with MF grading.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of each indicator a-lone or their combination for diagnosing MPN or distinguishing MF grading.Results Compared with the control group,the serum levels of VEGF,MMP-9 and TIMP-1 in the MPN group increased significantly(P＜0.05).Values of area under the curve(AUC)of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for diagnosing MPN were 0,834,0.745,0.923 and 0.618 respectively;the AUC of the combined diagnosis of MPN by VEGF,MMP-9 and TIMP-1 was 0.960;when the optimal cut-off value was 0.627,the sensitivity was 85.56％,and the specificity was 92.00％.Compared with the pre-fibrosis or early fibrosis group,the serum levels of VEGF,TIMP-1 and TIMP-1/MMP-9 in the significant fibrosis group increased significantly(P＜0.05).Spearman correlation analysis showed that VEGF(r=0.378,P=0.001),TIMP-1(r=0.512,P＜0.001)and TIMP-1/MMP-9(r=0.353,P=0.001)were positively correlated with the MF grading of MPN patients(P＜0.05).ROC curve analysis showed that the values of AUC of VEGF,MMP-9,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis were 0.723,0.523,0.802 and 0.708 respectively;the AUC of the combined detection of VEGF,TIMP-1 and TIMP-1/MMP-9 for distinguishing patients with pre-fibrosis or early fibrosis from those with significant fibrosis was 0.838;when the optimal cut-off value was 0.530,the sensitivity was 72.22％,and the specificity was 85.19％.Conclusion Serum VEGF,TIMP-1 and TIMP-1/MMP-9 can reflect the MF progression of MPN patients,and the combined detection of these indica-tors can predict the MF degree of MPN patients.

The blood-brain barrier (BBB) constitutes a major obstacle to effective delivery of drugs to the brain. Recent technological advances have led to improvements in brain-targeted drug delivery. In this review, we summarize existing technologies for efficient drug delivery across the BBB. We discuss the mecha-nisms of current BBB-based drug delivery strategies and introduce prospects for application in brain-targeted delivery of traditional Chinese medicine. We highlight the use of physical techniques for brain-targeted drug delivery, including electroporation, ultrasound, magnetophoresis, microneedles, microwaves, and laser. The characteristics of these techniques and relevant studies employing these approaches are discussed. In general, microneedles, lasers, ultrasound, electroporation, magnetophoresis, and microwaves are effective for drug delivery across the BBB. Notably, the synergistic effects of multiple approaches are superior to the additive effects of each technique in isolation. Our review provides guidance for the practical application of brain-targeted drug delivery techniques in an efficient and safe manner.