Objective:To investigate the expression and significance of serum osteoprotegerin and related inflammatory factors in patients with coronary heart disease.Methods:According to case-control study method, 236 subjects with chest pain admitted to Nanyang Second General Hospital Affiliated to Xinxiang Medical University from March 2018 to July 2019 were collected.According to the results of coronary angiography, they were divided into 132 cases of coronary heart disease group and control group(non-coronary Patients with heart disease) 104 cases.Questionnaire survey to collect general data of patients; 5 mL of fasting peripheral venous blood was collected in the morning, and serum was collected by centrifugation.Enzyme-linked immunosorbent assay was used to detect osteoprotegerin and monoclonal antibody to receptor activator of nuclear factor kappa B(RANK) ligand, interleukin 6 (IL-6), C-reactive protein, insulin-like growth factor 1 (IGF-1), monocyte chemoattractant protein 1 (MCP-1), matrix metalloproteinase 9 (MMP-9) levels.Results:The levels of serum osteoprotegerin, IL-6, C-reactive protein, IGF-1, MCP-1, and MMP-9 in patients with coronary heart disease were (1.85±0.49) μg/L, (65.93±5.18) ng/L, (15.74±2.52) mg/L, (725.19±13.36) μg/L, (302.16±15.92) μg/L and (58.31±7.94) μg/L, respectively, which were significantly higher than those in control group (1.42±0.44) μg/L, (47.56±3.51) ng/L, (1.91±0.67) mg/L, (228.61±12.05) μg/L, (246.39±10.28) μg/L and (37.09±4.76) μg/L.Soluble RANK ligand (332.69± 14.91) ng/L was significantly lower than the control group (380.85±19.56) ng/L.The difference was statistically significant (t value were 4.739, 21.065, 29.721, 27.637, 18.911, 16.463 and 17.085, respectively, all P<0.05). The levels of serum osteoprotegerin, IL-6, C-reactive protein, and IGF-1 were statistically significant among different lesion groups (all P<0.05). The levels of osteoprotegerin, IL-6, C-reactive protein and IGF-1 in three vessel disease group ((2.05±0.51) μg/L, (80.96±25.70) ng/L, (19.79±2.03) mg/L, (849.07±18.95) μg/L) were significantly higher than the double-vessel disease group ((1.83±0.45) μg/L, (62.74±20.61) ng/L, (13.82±1.75) mg/L, (714.84±19.06) μg/L) and single-vessel disease group ((1.61±0.42) μg/L, (53.09±18.37) ng/L, (9.67±1.40) mg/L, (507.51±17.83) μg/L), and the double-vessel disease group was significantly higher than the single-vessel disease group, the difference was statistically significant (all P<0.05). Multivariate unconditional Logistic regression analysis showed that serum osteoprotegerin and IGF-1 are the influencing factors of coronary heart disease.ROC curve analysis showed that the AUC of serum osteoprotegerin was 0.827.At the best cut-off point of 1.54 μg/L, the diagnostic sensitivity was 84.09% (111/132) and the specificity was 73.48% (97/132) ; the AUC of serum IGF-1 was 0.883, which was at the best cut-off point.At 395.78 μg/L, the diagnostic sensitivity was 71.21% (94/132) and the specificity was 96.21% (127/132). Conclusion:Serum osteoprotegerin and related inflammatory factor IGF-1 are influential factors in the occurrence of coronary heart disease, and are positively correlated with the severity of coronary artery disease, and have a good diagnostic value for the occurrence of coronary heart disease.

Objective:To observe the incidence of syncope in patients with acute and critical cardiovascular diseases and to explore the risk factors of death.Methods:925 cases of acute heart failure, acute myocardial infarction, pulmonary embolism, arrhythmia and aortic dissection rupture who participated in Prospective, Multi-CenterRegistered Research Project for Chinese Syncope Patients from March 2018 to March 2020, admitted to the department of emergency of Nanyang Second General Hospital were selected as the research objects. The incidence and mortality of syncope were recorded, and the patients were divided into syncope group and non-syncope group according to whether they were accompanied by syncope or not. The incidence of syncope in male and female patients with different cardiovascular critical diseases, the age and mortality of cardiovascular critical patients with syncope or not were analyzed and compared. Multivariate Logistic regression analysis was used to analyze the risk factors of death, and receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of risk factors on the prognosis of patients.Results:The incidence of syncope in 5 kinds of cardiovascular critical patients from high to low was: acute myocardial infarction 3.03% (28/925), arrhythmia 2.70% (25/925), pulmonary embolism 1.51% (14/925), aortic dissection rupture 1.41% (13/925), acute heart failure 0.65% (6/925), with statistically significant differences ( χ2 = 10.765, P = 0.010). There was no significant difference in the incidence of syncope between male and female patients with pulmonary embolism, aortic dissection rupture, acute myocardial infarction, arrhythmia and acute heart failure. The age of patients with aortic dissection rupture, acute myocardial infarction and arrhythmia in syncope group were significantly higher than those in non-syncope group [aortic dissection rupture (years old): 66.29±15.64 vs. 57.63±14.23, acute myocardial infarction (years old): 69.55±15.13 vs. 62.10±15.75, arrhythmia (years old): 70.48±14.93 vs. 60.29±16.31, all P < 0.05]. The mortality of patients with pulmonary embolism, aortic dissection rupture, acute myocardial infarction, arrhythmia, acute heart failure in syncope group were significantly higher than those in non-syncope group [pulmonary embolism: 5.81% (5/86) vs. 0.95% (8/839), aortic dissection rupture: 4.65% (4/86) vs. 0.60% (5/839), acute myocardial infarction: 4.65% (4/86) vs. 1.19% (10/839), arrhythmia: 2.33% (2/86) vs. 0.95% (8/839), acute heart failure: 2.33% (2/86) vs. 0.60% (5/839), all P < 0.05]. Multivariate Logistic regression analysis showed that age [odds ratio ( OR) = 2.158, 95% confidence interval (95% CI) was 0.921-4.785, P = 0.000], pulmonary embolism ( OR = 15.391, 95% CI was 8.904-27.314, P = 0.001), aortic dissection rupture ( OR = 13.079, 95% CI was 6.237-25.509, P = 0.000), acute myocardial infarction ( OR = 18.826, 95% CI was 10.420-32.921, P = 0.000), syncope ( OR = 4.940, 95% CI was 1.764-9.287, P = 0.000) were risk factors for the prognosis of patients with acute and critical cardiovascular diseases. ROC curve analysis showed that syncope had a certain predictive value for 28-day prognosis of patients [the area under the ROC curve (AUC) = 0.760, P = 0.000], when the cut-off value was 4.12, the sensitivity was 88.51%, the specificity was 78.05%, the positive predictive value was 81.31%, and the negative predictive value was 84.27%. Conclusions:Syncope is an independent risk factor of death in patients with acute and critical cardiovascular diseases. For patients with syncope as the chief complaint, we should quickly identify the types of acute and critical diseases and assess the risk of sudden death.

Objective:To evaluate the effectiveness of syncope unit in improving the diagnosis efficiency and treatment prognosis of patients with suspected syncope.Methods:The standardized syncope unit was established in the Affiliated Nanyang Second General Hospital of Xinxiang Medical College in 2018. Patients with suspected syncope attending from November 2018 to April 2019 (before the establishment of syncope unit) and from May to October 2019 (after the establishment of syncope unit) were enrolled in the study. There were 109 cases attending before the establishment of syncope unit (control group) and 126 cases attending after establishment (syncope unit group). The positive rate of examination, the treatment and its cost before and after the establishment of syncope unit were compared. After one year, the follow-up rate, recurrence rate, rehospitalization rate, treatment satisfaction and quality of life of patients were documented and compared between two periods.Results:The positive rates of tilt table test [61.90%), Holter monitoring [64.29%(81/126)], exercise stress test [7.14%(9/126)] invasive electrophysiology [40.48%(51/126)], cardiac imaging [9.52%(12/126)] and 24-h blood pressure monitoring [55.56%(70/126)] in syncope unit group were significantly higher than those in control group [44.95%(49/109), 36.70%(40/109), 5.50%(6/109), 10.09%(11/109), 2.75%(3/109) and 40.37%(44/109); χ2=19.28, 23.11, 6.93, 28.18, 15.85 and 11.61,respectively; all P<0.01]. The diagnostic rate of etiology in syncope unit group was significantly higher than that in control group [87.30%(110/126) vs. 77.06%(84/109), χ2=21.70, P<0.01].The time from onset to cardiac assessment and hospitalization time in syncope unit group were significantly shorter than those in control group[(3.68±1.93)h vs. (7.31±2.64)h;(6.17±1.52)d vs. (10.83±2.09)d]. The hospitalization rate [3.17%(4/126) vs. 8.26%(8/109)], hospital mortality [0.79%(1/126) vs. 2.75%(3/109)] and treatment cost [(4.91±1.14) thousands Yuan vs. (7.05±2.53) thousands Yuan] in syncope unit group were significantly lower than those in control group ( t=14.49, P<0.01; t=8.62, P=0.02;χ2=15.83, P<0.01;χ2=10.03, P=0.01; t=6.17, P=0.03).The outpatient follow-up rate [82.54%(104/126)] and treatment satisfaction rate [91.35%(95/104)] in syncope unit group were significantly higher than those in control group [61.47%(67/109) and 64.18%(43/67)]; and the recurrence rate [14.42%(15/104)] and rehospitalization rate [7.69%(8/104)] in syncope unit group were significantly lower than those in control group [40.30%(27/67) and 23.88%(16/67)](χ2=17.30, 20.37, 18.56, 15.08,all P<0.01). The scores of psychological status, physiological status, environmental status, social relations and overall quality of life in contral group were significantly lower than those in syncope unit group (43.62±12.84 vs. 59.13±13.95,43.10±11.31 vs. 5.86±12.09,52.35±12.76 vs. 63.58±13.05,54.87±12.08 vs. 67.91±14.23,58.42±11.87 vs. 69.28±13.51; t=7.74, P=0.03; t=7.50, P=0.03; t=8.66, P=0.02; t=9.77, P=0.01; t=8.46, P=0.02, respectively). Conclusion:The establishment of standardized syncope unit is helpful to improve the diagnosis efficiency and the prognosis of patients with suspected syncope, and also reduce the cost of diagnosis and treatment.

Objective:To investigate the influencing factors of restenosis after drug-eluting stent(DES) implantation in diabetic patients, and to establish a Nomogram graph prediction model.Methods:From January 2016 to January 2019, 78 patients with diabetes mellitus who underwent coronary DES implantation successfully in the Second People's Hospital of Nanyang were retrospectively analyzed, and the patients were followed up for 8-12 months.According to the follow-up results, the patients were divided into non-stenosis group(61 cases) and restenosis group(17 cases). Age, sex, smoking history, history of hypertension, BMI, UA, glycated hemoglobin, TG, VLDL, TC, HDL, FBG, CRP, creatinine, TB, DB, platelet count, LVEF, number of lesion vessels, location of lesion vessels, SYNTAX score and drug use were analyzed by univariate analysis.Multivariate analysis was further conducted by logistic regression.According to the results of logistic regression, the Nomogram graph was established by using R software(R 3.3.2), and the scoring prediction model was constructed.Results:Univariate analysis showed that smoking history, hypertension history, UA, HbA1c, TG, VLDL, number of lesion vessels and SYNTAX score were related to restenosis after coronary DES implantation( P<0.05). Multivariate analysis showed that the number of lesion vessels( OR=3.681, 95% CI: 1.229~11.027, P=0.020), UA( OR=12.004, 95% CI: 1.406~102.525, P=0.023), SYNTAX score( OR=11.032, 95% CI: 1.559~78.071, P=0.016) and glycosylated hemoglobin( OR=18.711, 95% CI: 1.418~246.85, P=0.026) were independent risk factors for restenosis after coronary DES implantation.Nomogram scoring model showed that the total score of each influencing factor ranged from 141 to 282, and the corresponding risk rate ranged from 0.1 to 0.9.The higher the total score, the greater the risk of restenosis after coronary DES implantation.The C-index of Nomogram for predicting restenosis after coronary DES implantation was 0.876. Conclusion:Number of lesion vessels, UA, SYNTAX score and glycosylated hemoglobin are independent risk factors for restenosis after coronary DES implantation.Nomogram chart can be used for visual evaluation and provide objective basis for clinical practice.

Objective:To compare the effects of atorvastatin and rosuvastatin on lipid metabolism, atherosclerosis and vascular endothelial function in patients with coronary heart disease.Methods:From June 2017 to October 2018, 300 patients with coronary heart disease admitted to the Second People's Hospital of Nanyang were divided into atorvastatin group (156 cases) and rosuvastatin group (144 cases) according to the random digital table method.The two groups were given basic treatment, and the atorvastatin group was given atorvastatin calcium tablets, 40 mg/time, once a night, while the rosuvastatin group was given rosuvastatin calcium tablets, 10 mg/time, once a night.All patients were treated continuously for 6 months.The blood lipid index, atherosclerosis degree related index and brachial artery diameter change percentage were measured before and after treatment.Results:After 6 months of treatment, the total cholesterol [(3.02±0.84)mmol/L], triglyceride [(1.25±0.41)mmol/L] and LDL[(1.70±0.52)mmol/L] in the rosuvastatin group were significantly lower than those in the atorvastatin group [(3.55±0.92)mmol/L, (1.69±0.63)mmol/L, (2.05±0.68)mmol/L], the differences were statistically significant( t=7.681, 5.115, 6.207, all P<0.05). The HDL [(1.72±0.37)mmol/L] in the rosuvastatin group was significantly higher than that of the atorvastatin group [(1.40±0.32)mmol/L], the difference was statistically significant( t=5.308, P<0.05). After 6 months of treatment, the scores of carotid plaque score[(4.08±0.59)points] and coronary stenosis degree score[(23.86±3.29)points] in the rosuvastatin group were significantly lower than those before treatment [(4.60±0.75)points, (33.74±4.07)points] and at the same time in the atorvastatin group [(4.39±0.64)points, (27.90±3.61)points], the differences were statistically significant( t=4.276, 17.504, 4.735, 8.415, all P<0.05). After 6 months of treatment, the change percentages of brachial artery diameter in the atorvastatin group and the rosuvastatin group were (8.23±2.59)%, (8.75±2.71)%, respectively, which were significantly higher than those before treatment[(6.48±1.92)%, (6.51±1.86)%], the differences were statistically significant( t=10.780, 11.534, all P<0.05). The change percentage of brachial artery diameter in the rosuvastatin group was significantly higher than that in the atorvastatin group, the difference was statistically significant ( t=5.530, P<0.05). Conclusion:Rosuvastatin is superior to atorvastatin in reducing blood lipid, improving atherosclerosis and vascular endothelial relaxation function in patients with coronary heart disease, and can be widely used.

Objective:To analyze the risk factors of deep venous thrombosis (DVT) in patients with tibial plateau fracture during preoperative period.Methods:From July 2017 to October 2019, a total of 264 patients undergoing surgeries of tibial plateau fractures were enrolled. Duplex ultrasonography (DUS) during hospitalization was used to screen for DVT of the bilateral lower extremities. Patients were divided into DVT group and non-DVT group according to results of DUS. Data on demographics, comorbidities, injury-related data, fracture type, laboratory biomarkers were collected and compared between groups with and without DVT.Results:The incidence of preoperative DVT was 39.0% (103/264) among 264 patients with traumatic tibial plateau fractures, and distal thrombosis predominated in DVT group. There were 103 cases in DVT group. 55 were males and 48 were females. The average age was 54.00±11.12. According to the Schatzker classification of tibial plateau fractures, 7 cases belonged to type I, 37 to type II, 2 to type III, 11 to type IV, 29 to type V, and 17 to type VI. There were 161 cases in non-DVT group. 89 were males and 72 were females. The average age was 48.57±13.25. According to the Schatzker classification of tibial plateau fractures, 23 cases belonged to type I, 76 to type II, 2 to type III, 10 to type IV, 33 to type V, and 17 to type VI. Univariate analysis showed that age ( t=3.451, P=0.001), the type of tibial plateau fracture ( χ2=8.314, P=0.004), D-dimer ( χ2=18.552, P<0.001), APTT ( t=2.869, P=0.004), ALB ( t=2.292, P=0.023) and Hb ( t=1.983, P=0.048) were statistically different than those in non-DVT group. Multivariate analysis showed age ( OR=1.033, 95% CI: 1.009, 1.058; P=0.007), the type of tibial plateau fracture ( OR=1.829, 95% CI: 1.014, 3.299; P=0.045) and D-dimer ( OR=1.914, 95% CI: 1.057, 3.464; P=0.032) were independent risk factors. Conclusion:The incidence of DVT in patients with tibial plateau fractures during preoperative period is high, and distal thrombosis is the main part of venous thrombosis of lower extremity. The type of tibial plateau fracture, age and the level of D-dimer are independent risk factors of preoperative DVT in patients with tibial plateau fractures.

Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.