Heart failure and stroke are the important causes of death worldwide, and both are closely related. This article reviews the prevention and reperfusion therapy of ischemic stroke in patients with heart failure.

Objective: To investigate the expressions of CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells in peripheral blood of patients with acute coronary syndrome (ACS) and their significance. Methods: A case-control study was conducted. Ninety-four patients receiving coronary angiography (CAG) admitted to Tianjin Chest Hospital from March 5th to April 27th in 2018 were enrolled. They were divided into non-coronary heart disease (CHD) group (n = 12), unstable angina pectoris (UAP) group (n = 27), acute non-ST elevation myocardial infarction (NSTEMI) group (n = 27) and acute ST elevation myocardial infarction (STEMI) group (n = 28) according to the patients' symptoms, electrocardiogram, troponin test and angiographic results. General data, blood routine parameters, and biochemical indicators were collected. The ratios of CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells were determined by flow cytometry. Multivariate Logistic regression was used to evaluate whether CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells were associated with STEMI. Results: Ninety-four patients were included initially. After excluding the patients who died during the intervention, 93 patients were enrolled in the data analysis finally, with 12 patients in the non-CHD group, 27 patients in the UAP group, and the same as the NSTEMI group and the STEMI group. Compared with the non-CHD group, white blood cell count (WBC) was decreased (×10⁹/L: 6.03±1.30 vs. 6.60±1.30, P > 0.05), and lymphocyte ratio was increased (0.273±0.059 vs. 0.269±0.070, P > 0.05) in patients of the UAP group; however, in the NSTEMI group and STEMI group, WBC was increased (×10⁹/L: 8.29±2.28, 9.86±2.76 vs. 6.60±1.30, both P < 0.05), and lymphocyte ratio was decreased (0.236±0.076, 0.173±0.094 vs. 0.269±0.070, P > 0.05 and P < 0.05), especially in the STEMI group [WBC (×10⁹/L): 9.86±2.76 vs. 6.60±1.30, lymphocyte ratio: 0.173±0.094 vs. 0.269±0.070, both P < 0.05]. There was no significant difference in biochemical indicators among all of the groups. Flow cytometry results showed that the ratios of CD4⁺CD45RO⁺T cells in the UAP group and NSTEMI group were higher than those in the non-CHD group (0.323±0.074, 0.319±0.078 vs. 0.314±0.058, both P > 0.05); however, the ratio of CD4⁺CD45RO⁺T cells in the STEMI group showed a decreased tendency (0.270±0.057 vs. 0.314±0.058, P > 0.05), and it was significantly lower than that in the UAP group and the NSTEMI group (0.270±0.057 vs. 0.323±0.074, 0.319±0.078, both P < 0.05). There was no significant difference in the ratio of CD4⁺CD45RA⁺T cells among all of the groups. Multivariate Logistic regression analysis showed that CD4⁺CD45RA⁺T cells ratio was not significantly correlated with the occurrence of STEMI [odds ratio (OR) = 0.976, 95% confidence interval (95%CI) was 0.907-1.050, P = 0.518], but CD4⁺CD45RO⁺T cells ratio was significantly correlated with the occurrence of STEMI (OR = 0.888, 95%CI was 0.821-0.961, P = 0.003). Conclusions There was no significant difference in the ratio of CD4⁺CD45RA⁺T cells among UAP, NSTEMI and STEMI patients, and CD4⁺CD45RO⁺T cells ratio in the STEMI group was significantly lower than that in the UAP group and NSTEMI group. CD4⁺CD45RO⁺T cells ratio may be risk factor of STEMI.

Objective To assess the long-term effects of pacing in patients with hypertrophic obstructive eardiomyopathy(HOCM),and explore the most specific echocardiographic indexes.MethodsA total of 37 consecutive HOCM patients implanted dual-chamber pacemakers were enrolled and followed up.Thirty-seven cases were followed up for 1 year,26 cases were followed up for 2 years,and 10 cases were followed up for 3 years.After 1,2 and 3 years pacemaker implantation,pacing frequency,pacing threshold,impedance,atrioventricular delay and cumulative percent atrial and ventricular pacing were respectively tested,and left atrial dimension (LAD),left ventricular end-diastolic dimension (LVEDd),left ventricular posterior wall thickness (LVPW),interventricular septum thickness (IVS),left ventricular outflow tract diameter(LVOTd),left ventricular outflow tract pressure gradient (LVOTPG),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure (PASP) were measured and mitral valve systolic anterior motion(SAM) was observed.Pacing parameters and echocardiography indexes were dynamically compared before and after pacemaker implantation.ResultsPacing frequency was adjusted 60～70 bpm,atrioventricular delay was adjusted 90～ 180 ms,in order to achieve more than 95％ ventricular pacing,pacing threshold,pacing impedance were normal.The difference of various pacing parameters were no statistically significant within 3 years ( P ＞ 0.05).Compared with before pacing,after 1,2 and 3 years pacemaker implantation,IVS and LVOTPG declined significantly (P ＜ 0.01 ),LVOTd widened significantly ( P ＜0.01),SAM phenomenon improved obviously ( P ＜0.01 ),but the difference of LAD,LVEDd,LVPW,LVEF,PASP were no statistically significant ( P ＞ 0.05 ).Conclusions The heart structure reconstruction of patients with HOCM can been chronically improved by dual-chamber pacing treatment.IVS,LVOTd and LVOTPG can be used as the sensitive and specific indexes to evaluate pacing treatment.

Objective:To study the relationship and the role of leptin in children with biliary atresia and hepatic fibrosis to provide a treatment basis for these patients.Methods:The clinical data of children with biliary atresia or congenital biliary dilatation (CBD) who underwent surgical treatment at the Department of General Surgery of Tianjin Children's Hospital from August 2019 to August 2021 were retrospectively analyzed. Of 31 children included in this study, there were 14 males and 17 females, with age of 60 (30, 63) d. Children with biliary atresia served as the study group ( n=26) and children with CBD served as the control group ( n=5). Leptin protein, α-smooth muscleactin (α-SMA) and phosphorylation of extracellular-regulated protein kinase 1/2 (p-ERK1/2) in liver tissues were detectd by immunohistochemistry (IHC). The expression level of leptin mRNA in liver tissues were detected by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). Results:The average optical density values of leptin protein, α-SMA protein and p-ERK1/2 protein in the liver tissues of children in the study group were significantly higher than the control group ( P<0.05). The expression levels of leptin, α-SMA and p-ERK1/2 in liver tissues of children with biliary atresia significantly increased with increase in fibrosis degree ( P<0.05). The expression level of leptin in liver tissues of children with biliary atresia was positively correlated with the liver fibrosis grade ( rs=0.876), α-SMA ( r=0.723) and p-ERK1/2 ( r=0.725) ( P<0.01). The results of qRT-PCR showed that the content of leptin mRNA in liver tissues of children with biliary atresia was significantly higher than that of children with CBD ( P<0.05). Conclusion:Expressions of leptin increased with aggravation of degrees of hepatic fibrosis in biliary atresia. Leptin may be involved in activation of HSCs through the ERK1/2 signaling pathway in the process of hepatic fibrosis due to biliary atresia.