Objective To explore the association between estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and the SYNTAX score in old patients with coronary heart disease. Methods Two hundred and fifty-six consecutive old patients with coronary heart disease were included in this study. The patients were angiographically diagnosed with coronary heart disease between January 2013 and April 2014 at the Department of Cardiology.eGFR was caculated by using BIS2 equation based on creatinine and cystatin C.SYNTAX score was caculated by SYNTAX score algorithm. Multiple linear regression and ordinal logsitic regreesion was used to analyze the association between eGFR and SYNTAX score. Results In patients with normal of renal function [eGFR≥90 ml/(min·1.73 m2), 110 patients], mild renal insufficiency [60 ml/(min · 1.73 m2) ≤ eGFR<90 ml/(min · 1.73 m2), 98 patients], midrange and severe renal insufficiency[eGFR<60 ml/(min · 1.73 m2), 48 patients], with the decrease in renal function of patients, SYNTAX score increased: (15.42 ± 9.65), (25.24 ± 8.34), (33.73 ± 10.15) scores, P<0.01. eGFR was an independent predictor of SYNTAX score (r=-0.059, P<0.01).eGFR was negatively correlated with SYNTAX score (r=-0.457, P<0.01). Conclusions eGFR is an independent predictor of SYNTAX score and negatively correlated with SYNTAX score in old patients with coronary heart disease. This might be helpful to explain the increased risk of coronary heart disease events and mortality in old patients with renal dysfunction.

BACKGROUND:Matrix extracel ular phosphoglycoprotein phosphorylated extracel ular matrix glycoprotein (MEPE) gene plays an important role in bone mineralization and absorption as wel as the balance of osteoblasts and osteoclasts. Studies on the function and regulatory mechanism of MEPE can provide new ideas for the treatment of osteoporosis. OBJECTIVE:To analyze the regulatory effects of transcription factor Runx2 on MEPE promoter in mouse preosteoblasts, thereby preliminarily studying the Runx2 effects in the process of bone formation and development. METHODS:First of al , the Runx2 eukaryotic expression vector was built according to the gene sequence of Runx2 in Genebank;then the dual luciferase reporter assay was employed to analyze the effects of Runx2 on transcription activity of MEPE promoters with different lengths in order to determine the promoter region in which Runx2 has significant effect. Afterwards, the effects of Runx2 on transcipition activity of MEPE gene promoter which induced by three MAPK signaling pathway inhibitors were investigated. Final y, real-time PCR was used to analyze the expression activity of MEPE gene promoter regulated by Runx2. RESULTS AND CONCLUSION:We successful y constructed the Runx2 eukaryotic expression vector. Dual luciferase reporter assay showed that Runx2 could increase the transcription activity of MEPE gene promoter in preosteoblasts, and the fragment area in which Runx2 exhibited the more significant up-regulatory effectiveness was (-300 to+66)366 bp. Runx2 could increase the transcription activity of MEPE gene promoter by activating the MAPK single pathway. The real-time PCR verified that Runx2 increased the expression activity of MEPE gene promoter. These findings indicate that Runx2 can regulate the express of MEPE gene promoter by the MAPK single pathway, in order to build the basis for exploring the process of bone formation and development.

Objective To evaluate the left ventricular systolic dyssynchrony in patients with left ventricular apical ballooning syndrome (LVABS) quantitatively by real-time three-dimensional echocardiography(RT-3DE) and its correlation with left ventricular ejection fraction(LVEF).Methods 7patients with LVABS were enrolled in this study.The images of left ventricle in full volume mode were obtained by RT-3DE in the different time (just after admission,4 weeks and 8 weeks).Post-processing software of 4D LV Volume Tom-Tec was used for calculation of EF and 16-segmental time-volume curves was obtained.The time to the point with minimal systolic volume(Tmsv) of each segment was calculated and by which the following indexes of systolic dyssynchrony were derived:Tmsv16-SD/Dif,Tmsv-basalSD/Dif,Tmsv-mid-SD/Dif and Tmsv-apical-SD/Dif.The correlation between systolic dyssynchrony index (SDI) and LVEF was analysed.Results ① The Tmsv16-SD/Dif,Tmsv-basal-SD/Dif,Tmsv-mid-SD/Dif and Tmsv apical-SD/Dif of left ventricle in the patients of 4 weeks and 8 weeks were smaller than those of the patients just after admission.There were significant differences among them(all P ＜0.05).②The more SDI increased,the more LVEF decreased,and vice versa.SDI was negatively associated with LVEF in the different time of admission (just after admission:r =-0.758; 4 weeks:r =-0.831 ; 8 weeks:r =-0.889;all P ＜0.05).Conclusions Left ventricular systolic dyssynchrony of severe degree is observed in patients with LVABS just after admission.But the condition of dyssynchrony has been improved gradually after 4 weeks and 8 weeks.SDI is negatively correlated with LVEF.

Objective To explore the effect of core stability training (CST) on motor of upper limbs after stroke. Methods 60 patients with stroke were divided into observation group (n=30) and control group (n=30). Both groups accepted routine medicine and motor relearning program, and the observation group accepted CST before training. They were assessed with Simple Test for Evaluating Hand Function (STEF), modified Barthel index (MBI), and the Trunk Control Test (TCT) before and 4 weeks after treatment. Results The scores of STEF,MBI, and TCT improved after treatment in both groups (P<0.01), and improved more in the observation group than in the control group (P<0.01). Conclusion CST may facilitate the motor recovery of upper limbs after stroke.

Objective To analyze the management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) in Liaoning province.Methods The data were collected from a prospective and multicenter registry study including 8 tertiary hospitals and 12 secondary hospitals in Liaoning province.Total 1429 patients with acute STEMI admitted to hospitals from June 2009 to June 2010 were included in the study.A unified follow-up questionnaire was applied on patient discharged.Results The average age of patients was (63 ± 13)years.37.4％ of patients recognized the disease as heart disease and 39.7％ were transported by emergency ambulance with a median symptom-to-door time of 150 min.52.9％ patients underwent emergency reperfusion therapy,including fibrinolytic therapy (24.4％) and primary percutaneous coronary intervention (PCI,28.1％).The in-hospital treatment included aspirin (99.6％),clopidogrel (81.9％),statins (90.1％),low molecular weight heparin (89.5％),β-blocker (66.0％),angiotensin converting enzyme inhibitor (ACEI)/ angiotensin receptor blocker (ARB)(66.6％).The in-hospital mortality was 10.7％ ; the mortality in females was higher than that in males (18.3％ vs.7.9％,P ＜ 0.01) and the mortality in older patients (≥ 65 years) was higher than that in younger patients (＜65 years)(17.0％ vs.5.2％,P ＜0.01).The follow-up treatment included:aspirin (81.1％),clopidogrel (45.0％),statins (61.0％),β-blocker (48.3％),ACEI/ARB (42.4％).The follow-up mortality was 5.0％ after hospital discharge.Conclusions Longer pre-hospital delay is commonly seen in STEMI patients.There is still certain gap of emergency reperfusion therapy and the evidence-based medication with related clinical guidelines of STEMI management in Liaoning.

Vascular cognitive impairment is the only cognitive impairment disease that can be intervened at present. In recent years, the research on its genetic factors has attracted much attention. Among them, apolipoprotein E (ApoE) and its genotypes are closely associated with lipid metabolism, β-amyloid aggregation and deposition, the changes of brain structure and function, and are closely correlated with the pathogenesis of dementia. This article discusses some possible mechanisms of ApoE and its genotypes affecting cognitive function, in order to provide reference for the management of cognitive function in patients with vascular cognitive impairment.

Atrial fibrillation is one of the most common arrhythmia types. With the increase of age, atrial fibrillation will increase the incidence of silent cerebral infarction (SCI), and the correlation between them will lead to the aggravation of cognitive impairment. Atrial fibrillation can be regarded as an independent risk factor for accelerating cognitive impairment in patients with SCI, but the possible mechanism is not completely clear. Therefore, patients with atrial fibrillation should undergo MRI examination, find SCI in time and develop corresponding intervention measures in order to reduce or delay a series of subsequent negative effects. This article reviews the related cognitive impairment of SCI patients with atrial fibrillation.

Post-stroke fatigue is one of the common symptoms of stroke patients. Continuous fatigue will affect the rehabilitation of patients' limb functions, lead to the decline of daily living ability, and at the same time, make patients lack energy, lose the initiative of rehabilitation exercise, and seriously affect the quality of life and social function. This article reviews the epidemiology, clinical characteristics, evaluation scales, influencing factors, pathophysiological mechanism and treatment of post-stroke fatigue.

Objective:To retrieve, evaluate and integrate the best evidence of blood glucose management in hemodialysis patients with end-stage diabetic kidney disease, so as to provide a basis for clinical evidence-based nursing practice.Methods:BMJ Best Clinical Practice, Cochrane, OVID, Scopus, UpToDate, CNKI, Wanfang Database, Medical Pulse database, and other guideline networks and professional association websites and databases were searched for blood glucose management in hemodialysis patients with end-stage diabetic kidney disease. The search time limit was from the establishment of the database to May 10, 2023.Results:A total of 14 articles were included, including 1 clinical decision, 5 guidelines, 6 systematic reviews, 1 randomized controlled trial, and 1 expert consensus. The best evidences for blood glucose management in hemodialysis patients were summarized, including 8 aspects of pre-dialysis assessment, pre-dialysis blood glucose management, blood glucose management during dialysis, blood glucose management during dialysis interval, diet and nutrition, exercise management, lifestyle intervention and health education, with 25 pieces of evidence.Conclusions:This study summarizes the best evidence of blood glucose management in hemodialysis patients with end-stage diabetic kidney disease, and provides evidence-based basis for clinical practice for medical staff.

Objective:To observe the therapeutic effect of intraocular lens (IOL) protected phacoemulsification (PHACO) in patients with hard nucleus cataract.Methods:A randomized controlled clinical study was conducted.A total of consecutive 120 patients (120 eyes) with hard nucleus cataract of Emery grade Ⅳ or Ⅴ were enrolled from January 2019 to May 2022.The patients were randomly divided into PHACO group receiving routine PHACO, IOL protected PHACO group receiving PHACO under IOL protection, and extracapsular cataract extraction (ECCE) group receiving ECCE, with 40 cases (40 eyes) in each group.Finally, 99 patients completed the follow-up, including 30 cases (30 eyes) in PHACO group, 35 cases (35 eyes) in IOL protected PHACO group, and 34 cases (34 eyes) in ECCE group.The total operation time, intraoperative PHACO time and cumulative energy release of each patient were recorded.The corneal endothelial cell density (ECD), coefficient of variation in endothelial cell area (CV), hexagonal endothelial cell ratio (6A), corneal astigmatism and the number of eyes with different grades of uncorrected visual acuity were measured and compared after 3-month follow-up.The intraoperative and postoperative complications were recorded.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Yanbian University Hospital (NO.2023002).Patients were informed of study content and purpose and signed a consent form before treatment.Results:There was no significant difference in ultrasonic energy and time between PHACO group and IOL protected PHACO group ( P=0.691, 0.982).The total operation time was (38.81±2.73) and (36.45±3.45) minutes in PHACO group and IOL protected PHACO group, significantly shorter than (69.60±4.35) minutes in ECCE group (both at P<0.001).There was no significant difference in age, sex, lens nucleus hardness and other baseline data among the three groups before operation (all at P>0.05).Three months after operation, the number of patients with higher uncorrected visual acuity in PHACO group and IOL protected PHACO group was larger than that in ECCE group ( P=0.006, 0.007).The ECD and 6A in IOL protected PHACO group were (2 155.57±177.88)/mm 2 and (41.31±5.18)%, respectively, which were significantly higher than (1 912.64±224.11)/mm 2 and (36.18±3.27)% in PHACO group, and the CV in IOL protected PHACO group was (50.34±5.90)%, which was lower than (55.67±3.30)% in PHACO group, showing statistically significant differences ( P=0.007, 0.003, 0.005).At 1 week and 3 months after the operation, the corneal astigmatism was significantly lower in IOL-protected PHACO group than in ECCE group, but higher than in PHACO group, and the difference were statistically significant (all at P<0.05). Conclusions:Compared with conventional PHACO, IOL-protected PHACO can effectively reduce the damage of corneal endothelium caused by ultrasonic energy, shorten the operation time and reduce postoperative inflammatory reaction compared with ECCE, and does not significantly increase postoperative corneal astigmatism.IOL-protected PHACO is an effective improved surgical method for patients with hard nucleus cataract.