BACKGROUND:Traditional surgery for lumbar disc herniation involves extensive excision of tissue surrounding the nerve for decompression and removal of protruding lumbar intervertebral discs,which poses various risks and complications such as nerve damage causing paralysis,lumbar instability,herniation recurrence,intervertebral space infection,and adjacent vertebral diseases. OBJECTIVE:To propose the symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous technique for lumbar spine symmetrically decompression,showing the induced resorption of herniated nucleus pulpous phenomenon and early clinical efficacy,and then analyze its decompression mechanism. METHODS:214 patients with lumbar disc herniation at Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from March 2021 to May 2023 were enrolled in this study.Among them,81 patients received conservative treatment as the control group,and 133 patients received symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous treatment as the trial group.Before surgery,immediately after surgery(7-14 days),and early after surgery(over 1 year),MRI images were used to measure the volume changes of lumbar disc herniation.CT images were used to measure the posterior displacement distance of the lumbar spinous process ligament complex,as well as the width and height of the lateral recess.Japanese Orthopaedic Association scores were used to evaluate the patient's neurological function recovery. RESULTS AND CONCLUSION:(1)Control group:81 patients with lumbar disc herniation were treated conservatively,with a total of 171 herniated lumbar discs.The average follow-up time was(22.7±23.1)months.The first and second MRI measurements of 171 herniated lumbar discs showed herniated lumbar disc volumes of(551.6±257.9)mm3 and(792.2±330.4)mm3,respectively,with an average volume increase rate of(53.2±44.4)%,showing statistically significant differences(P<0.001).Out of 171 herniated lumbar discs,4 experienced natural shrinkage,with an absorption ratio of 2.3%(4/171)and an absorption rate of(24.5±9.9)%.(2)Trial group:133 patients with lumbar disc herniation had a total of 285 herniated lumbar discs.(1)Immediately after surgery:All patients were followed up immediately after surgery.229 out of 285 herniated lumbar discs experienced retraction,with an absorption ratio of 80.3%(229/285)and an average absorption rate of(21.5±20.9)%,with significant and complete absorption accounting for 6.5%.There were a total of 70 herniated lumbar discs in the upper lumbar spine,with an absorption ratio of 85.7%(60/70),an average absorption rate of(23.1±19.5)%,and a maximum absorption rate of 86.6%.There were 215 herniated lumbar discs in the lower lumbar spine,with an absorption ratio of 78.6%(169/215),an average absorption rate of(21.0±21.3)%,and a maximum absorption rate of 83.2%.Significant and complete absorption of the upper and lower lumbar vertebrae accounted for 5.7%and 6.5%,respectively,with no statistically significant difference(P>0.05).The average distance of posterior displacement of the spinous process ligament complex immediately after surgery was(5.2±2.8)mm.There were no significant differences in the width and height of the left and right lateral recess before and immediately after surgery(P>0.05).The Japanese Orthopaedic Association score immediately after surgery increased from(10.1±3.4)before surgery to(17.0±4.8),and the immediate effective rate after surgery reached 95.6%.(2)Early postoperative period:Among them,46 patients completed the early postoperative follow-up.There were 101 herniated lumbar discs,with an absorption ratio of 94%(95/101)and an average absorption rate of(36.9±23.7)%.Significant and complete absorption accounted for 30.6%,with a maximum absorption rate of 100%.Out of 101 herniated lumbar discs,3 remained unchanged in volume,with a volume invariance rate of 2.97%(3/101).Out of 101 herniated lumbar discs,3 had an increased volume of herniated lumbar discs,with an increase ratio of 2.97%(3/101)and an increase rate of(18.5±18.4)%.The Japanese Orthopaedic Association score increased from preoperative(9.3±5.1)to(23.5±4.0),with an excellent and good rate of 93.4%.(3)The early postoperative lumbar disc herniation absorption ratios of the control group and trial group were 2.3%and 85.9%,respectively,with statistically significant differences(P<0.001).(4)Complications:There were two cases of incision exudation and delayed healing in the trial group.After conservative treatment such as dressing change,no nerve injury or death occurred in the incision healing,and no cases underwent a second surgery.(5)It is concluded that symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous is a new method for treating lumbar disc herniation that can avoid extensive excision of the"ring"nerve and achieve satisfactory early clinical efficacy.It does not damage the lumbar facet joints or alter the basic anatomical structure of the lateral recess,fully preserves the herniated lumbar discs,and can induce significant or even complete induced resorption of herniated nucleus pulpous.Symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous provides a new basis and method for the clinical treatment of lumbar disc herniation.

Objective:To construct and validate a three-level early warning model of moderate to severe ovarian hyperstimulation syndrome (OHSS) in assisted reproductive technology.Methods:A case-control study was conducted. Totally 10 181 infertility patients who underwent in vitro fertilization treatment in Reproductive Medicine Center, Women and Children's Medical Center Affiliated to Guangzhou Medical University from April 2013 to April 2023 were retrospectively analyzed and divided into modeling group (8 145 cases) and validation group (2 036 cases) by random number table method. The clinical data of the two groups were analyzed, and the risk factors affecting the occurrence of moderate and severe OHSS after oocytes retrieval were screened by multi-factor logistic regression analysis. The early warning model was established and the column diagram was drawn at three nodes which were before ovarian stimulation, before trigger and 3 d after oocyte retrieval. The receiver operating characteristic (ROC) curve and calibration curve were used to verify the models. Results:The antral follicle count (AFC, OR=1.045, 95% CI: 1.020-1.071, P<0.001), anti-Müllerian hormone (AMH)>3.36 μg/L ( OR=7.135, 95% CI: 2.084-24.432, P=0.002) and number of cycles ( OR=0.149, 95% CI: 0.022-1.026, P=0.049) were included in the pre-stimulation prediction model. AFC ( OR=1.046, 95% CI: 1.018-1.074, P=0.001), AMH>3.36 μg/L ( OR=5.780, 95% CI: 1.661-20.116, P=0.006), gonadotropin releasing hormone-agonist protocols ( OR=3.895, 95% CI=1.913-7.931, P<0.001), estrogen peak≥18 350 pmol/L ( OR=2.258, 95% CI: 1.092-4.666, P=0.028), the number of follicles with a diameter of ≥10 mm>20 ( OR=2.377, 95% CI: 1.092-5.172, P=0.029) were included in the pre-trigger prediction model. AMH>3.36 μg/L ( OR=8.374, 95% CI: 2.417-29.019, P=0.001), estrogen peak≥18 350 pmol/L ( OR=3.947, 95% CI: 1.533-10.167, P=0.004), total number of oocytes retrived ( OR=1.042, 95% CI: 0.996-1.090, P=0.025), abdominal distension ( OR=60.181, 95% CI: 22.515-160.854, P<0.001), fresh transplantation ( OR=21.766, 95% CI: 7.119-66.544, P<0.001), human chorionic gonadotropin trigger ( OR=17.752, 95% CI: 3.993-78.924, P<0.001) were included in the prediction model of 3 d after oocyte retrieval. The areas under ROC curves of the three models were 0.830 (95% CI: 0.782-0.878), 0.859 (95% CI: 0.812-0.906) and 0.948 (95% CI: 0.919-0.977), respectively. The areas under ROC curves of the validation groups of the three models were 0.922 (95% CI: 0.880-0.965), 0.936 (95% CI: 0.886-0.986), and 0.971 (95% CI: 0.938-0.999), respectively. The calibration curve indicated that the early-warning evaluation model has good stability. Conclusion:The three-level early warning model of moderate and severe OHSS has good differentiation, reliable predictability and clinical practicability, which is conducive to the dynamic and continuous assessment of the risk of moderate and severe OHSS, adjustment of treatment plan at any time, and timely adoption of effective preventive measures.

Objective This study aims to explore the efficacy and complication rates of the transcranial approach(TCA)and extended endoscopic endonasal approach(EEEA)for the treatment of craniopharyngiomas based on the QST classification,providing a scientific reference for clinical decision-making on surgical approach.Methods A total of 151 patients who underwent craniopharyngioma surgery at our center from January 2018 to December 2023 were enrolled.The patients were categorized into Q-CP(suprasellar type),S-CP(infundibular type),and T-CP(tuberal type)according to the QST classification.Systematic collection and analysis were performed on the outcomes of TCA and EEEA treatments,respectively.The differences in effectiveness between the two approaches were evaluated based on the QST classification.Results The improvement rate of visual symptoms was overall higher in the EEEA group than in the TCA group(59.1%vs.36.5%,P=0.006),and the visual deterioration rate was lower(3.0%vs.14.1%,P=0.006).However,the incidence of cerebrospinal fluid leakage was higher in the EEEA group(15.2%vs.3.5%,χ2=4.986,P=0.026).The incidence of postoperative seizures(8.2%vs.0,P=0.019),brain contusions(10.6%vs.0,P=0.005),and subdural hematoma(9.4%vs.0%,P=0.01)was higher in the TCA group.For patients with Q-CP type,the EEEA group had a higher rate of total tumor resection(92.9%vs.65.2%,P=0.025)and a lower recurrence rate(3.6%vs.21.7%,P=0.047),with shorter hospital stays and lower postoperative costs.The TCA group had higher intraoperative blood loss in this type(300 mL vs.200 mL,Z=-2.261,P=0.024).For S-CP type patients,the EEEA group showed a higher rate of total tumor resection(91.3%vs.74.2%)and a lower recurrence rate(0 vs.12.9%,P=0.031),with lower postoperative hospital costs.In T-CP type,due to the deeper location,EEEA showed limitations in protecting hypothalamic function and the TCA group had a better postoperative hypothalamic function score(P=0.035).Conclusion Based on QST classification,EEEA has advantages in Q-CP and S-CP types and is recommended as the preferred surgical procedure;In the T-CP type,TCA surgery is more helpful in protecting hypothalamic function.

Objective To assess the efficacy of combining specialized scenarios with workshop-based teaching in training newly recruited nurses for occupational exposure.Methods This study was conducted with 200 nurses recruited between January 2020 and December 2021 as the control group and 200 nurses from January 2022 to December 2023 as the intervention group.The control group and the intervention group received routine training and workshop-based training,respectively.The efficacy was assessed through theoretical exams,skills assessments,occupational exposure incidence,and training satisfaction,measured u-sing the Simulation Design Scale(SDS).Results The intervention group demonstrated higher scores on theoretical knowledge and operational skills assessments compared to the control group.The occupational exposure were lower in the intervention group.Additionally,the intervention group scored higher on the SDS and reported greater satisfaction with the training(P＜0.05).Conclusion The teaching method integrated with specialized scenarios and workshop-based teaching effectively enhances the theoretical knowledge and operational skills related to occupational exposure among newly recruited nurses.It reduces the inci-dence of occupational exposure,such as needlestick injuries,and improves training outcomes and nurse satisfaction,making it a valuable approach for clinical application.

Objective:To investigate the correlation of neutrophil-to-albumin ratio (NAR) and glucose-to-lymphocyte ratio (GLR) with in-hospital death in patients with acute myocardial infarction (AMI).Methods:The clinical data of 2 657 patients with AMI from January 2017 to December 2022 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Using receiver operating characteristic (ROC) curve to determine the optimal cutoff values of GLR and NAR (6.02 and 0.25) for predicting in-hospital mortality in patients with AMI, the patients were divided into high GLR group (GLR≥6.02, 768 cases) and low GLR group (GLR<6.02, 1 889 cases), high NAR group (NAR≥0.25, 547 cases) and low NAR group (NAR<0.25, 2 110 cases) according the optimal cutoff values. The baseline characteristics and occurrence of in-hospital major adverse cardiovascular events (MACE) were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for in-hospital death in patients with AMI.Results:Among the 2 657 patients with AMI, 265 patients had in-hospital MACE (10.0%), and 50 patients (1.9%) died. The age, proportion of Killip≥ 2 grade, proportion of diabetes, proportion of myocardial infarction, proportion of cerebral infarction history, proportion of ST-elevation myocardial infarction (STEMI), thrombolysis in myocardial infarction clinical trial score (TIMI score), global registry of acute coronary event score (GRACE score), fibrinogen, fasting blood glucose, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), cardiac troponin I (cTnI) peak, N-terminal B-type natriuretic peptide (NT-proBNP), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), NAR, GLR, neutrophil count, left ventricular end-diastolic diameter (LVEDD) in high GLR group were significantly higher than those in low GLR group, the proportion of males, body mass index (BMI), proportion of smoking history, proportion of non-ST elevation myocardial infarction (NSTEMI), albumin, estimated glomerular filtration rate (eGFR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), lymphocyte count, monocyte count and left ventricular ejection fraction (LVEF) were significantly lower than those in low GLR group, and there were statistical differences ( P<0.01 or <0.05). The proportion of Killip≥2 grade, proportion of STEMI, TIMI score, GRACE score, fibrinogen, fasting blood glucose, TC, LDL-C, cTnI peak, hs-CRP, IL-6, NAR, GLR, white blood cell count, neutrophil count and monocyte count in high NAR group were significantly higher than those in low NAR group, the age, proportion of myocardial infarction history, proportion of NSTEMI, albumin, lymphocyte count, left atrial diameter (LAD) and LVEF were significantly lower than those in low NAR group, and there were statistical differences ( P<0.01 or <0.05). The incidences of in-hospital MACE, death, ventricular fibrillation or pulseless ventricular tachycardia, atrial fibrillation, cardiac arrest and bleeding in high GLR group were significant higher than those in low GLR group: 15.2% (117/768) vs. 7.8% (148/1 889), 4.6% (35/768) vs. 0.8% (15/1 889), 5.3% (41/768) vs. 2.9% (54/1 889), 6.9% (53/768) vs. 4.0% (75/1 889), 4.7% (36/768) vs. 1.4% (26/1 889) and 2.3% (18/768) vs. 0.7% (13/1 889), and there were statistical differences ( P<0.01); there was no statistical difference in the incidence of heart rupture between two groups ( P>0.05). The incidence of in-hospital MACE, death, ventricular fibrillation or pulseless ventricular tachycardia, cardiac arrest, cardiac rupture and bleeding in high NAR group were significantly higher than those in low NAR group: 16.6% (91/547) vs. 8.2% (174/2 110), 5.9% (32/547) vs. 0.9% (18/2 110), 8.0% (44/547) vs. 2.4% (51/2 110), 5.9% (32/547) vs. 1.4% (30/2 110), 1.6% (9/547) vs. 0.4% (9/2 110) and 2.4% (13/547) vs. 0.9% (18/2 110), and there were statistical differences ( P<0.01); there was no statistical difference in the incidence of atrial fibrillation between two groups ( P>0.05). Multivariate Logistic regression analysis result showed that the Killip 3 and 4 grades, high NAR, high GRACE score, high fasting glucose and low LVEF were independent risk factors for in-hospital death in patients with AMI ( OR = 3.827, 4.660, 3.779, 1.020, 1.095 and 0.962; 95% CI 1.158 to 12.649, 1.184 to 18.344, 1.856 to 7.649, 1.009 to 1.032, 1.027 to 1.167 and 0.932 to 0.993; P<0.05 or <0.01). Conclusions:The NAR can independently predict the risk of in-hospital death in patients with AMI.

BACKGROUND:Induced resorption of herniated nucleus pulpous is a minimally invasive,non-invasive and innovative method for the treatment of cervical/lumbar intervertebral disc herniation.After induced resorption of herniated nucleus pulpous,the research about whether cervical/lumbar intervertebral disc can maintain the original biomechanical strength has not been reported.OBJECTIVE:To measure the height of adjacent vertebral centroid of cervical/lumbar intervertebral disc before and after induced resorption of herniated nucleus pulpous operation to analyze the changes of the biomechanical strength of the intervertebral disc after reclining and to provide a new basis for induced resorption of herniated nucleus pulpous treatment of cervical and lumbar intervertebral disc herniation.METHODS:A retrospective analysis was performed on 140 patients with cervical/lumbar intervertebral disc herniation who received induced resorption of herniated nucleus pulpous surgery in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2023.Related software was used to measure the height of adjacent vertebral centroid of cervical/lumbar intervertebral disc of patients at each follow-up time point before and after induced resorption of herniated nucleus pulpous surgery in Magnetic Resonance Imaging image data under Artificial Intelligence-assisted calibration.Unoperated T1/T2 and T12/L1 segments were taken respectively as controls.Those with preoperative height of adjacent vertebral centroid less than 8％of the corresponding T1/T2 or T12/L1 control segment were in the"height reduction group"(hereafter referred to as group A)and the rest were in the"height unchanged group"(hereafter referred to as group B).The difference of height of adjacent vertebral centroid before and after operation between the group A and the group B was statistically analyzed.Simultaneously,the correlation between the volume of cervical and lumbar herniated discs and the changes of height of adjacent vertebral centroid was analyzed according to the result measured by artificial intelligence.RESULTS AND CONCLUSION:(1)The study maintained a total of 140 patients,including 60 cases of cervical disc herniation and 80 cases of lumbar disc herniation.The postoperative follow-up period was 7 days to 12 months.(2)A total of 281 discs were measured in the cervical vertebra group,including 60 intervertebral discs in the control group.The mean value of height of adjacent vertebral centroid before and at the last postoperative follow-up was about 20.46 mm and 20.17 mm,respectively,with no statistical difference(P＞0.05).There were 162 cervical discs in group A.The average height of adjacent vertebral centroid before and after operation was 16.65 mm and 15.92 mm,respectively,with no statistically significant difference(P＞0.05).The mean cervical disc herniation volume before and after surgery was 510.28 mm3 and 364.76 mm3,respectively,which was not significantly correlated with height of adjacent vertebral centroid change(P＞0.05).There were 64 discs in the group B,with average of 20.15 mm before operation and 19.09 mm at the last follow-up,and there was no significant difference(P＞0.05).The mean volume of cervical disc herniation before and after surgery was 515.32 mm3 and 361.98 mm3,respectively,and there was no significant correlation with the change of height of adjacent vertebral centroid(P＞0.05).(3)A total of 258 discs were measured in the lumbar spine group,of which 80 intervertebral discs in the control group,the average height of adjacent vertebral centroid was 33.03 mm before operation and 32.40 mm at the last follow-up,and there was no significant difference.There were 59 discs in the group A,and the average height of adjacent vertebral centroid before and after operation was 30.08 mm and 31.67 mm,respectively,with no statistically significant difference.The mean volume of lumbar disc herniation before and after operation was 690.51 mm3 and 496.58 mm3,respectively,and there was no significant correlation with the change of height of adjacent vertebral centroid(P＞0.05).There were 119 discs in the group B,with an average height of adjacent vertebral centroid of 35.91 mm before surgery and 34.12 mm at the last follow-up.The mean volume of lumbar disc herniation before and after operation was 698.70 mm3 and 535.99 mm3,respectively,and there was no significant correlation with the change of height of adjacent vertebral centroid.(4)It is concluded that patients with cervical/lumbar intervertebral disc herniation can maintain the same intervertebral height level after induced resorption of herniated nucleus pulpous regardless of whether the intervertebral height has decreased before operation.It can be inferred that the resorption of the herniated disc does not affect its biomechanical strength.It suggests that induced resorption of herniated nucleus pulpous surgery should be performed before the intervertebral height of the degenerate segment has decreased.The induced resorption of herniated nucleus pulpous is more valuable to maintain the biomechanical strength of the resorptive disc.

Objective To investigate the anatomical structure and surface location of the Lieque(LU7)acupoint.Methods Firstly,the anatomical localization descriptions of the Lieque(LU7)acupoint from classical medical literature were reviewed and summarized.A total of 21 participants were recruited from Shandong Provincial Hospital Affiliated to Shandong First Medical University from January to March 2025.A Cartesian coordinate system was established over the Lieque(LU7)region on the right forearm.Following standardized manual pressure stimulation,the coordinates of the participant′s reported acupoint sensations were recorded.Based on surface pressure mapping result,10 participants were arbitrarily selected for acupuncture intervention.Upon elicitation of acupoint sensation,the ultrasound imaging was used for real-time visualization of anatomical spatial relationships between the needle tip and distal radial osseous landmarks.Five red latex-perfused adult upper limb specimens were selected for microdissection of the Lieque(LU7)regions pre-localized via ultrasonography,achieving definitive structural characterization of its anatomical strata.Another 10 participants were arbitrarily selected to find the physical structure of the Lieque(LU7)acupoint using ultrasound,and the similarities and differences of acupoint sensation responses were verified using acupuncture needle insertions into both the demarcated zone and peripheral tissues.Results The descriptions of the localization of the Lieque(LU7)acupoint in ancient books can be summarized as"one and a half cun above the wrist side"longitudinally,and"at the intersection head,between two tendons and two bones in the hollow"transversely.During surface pressure application,the sites of the participant′s elicited acupoint sensation were anatomically concentrated in the proximal depression adjacent to the radiopalmar ridge,specifically at the transitional interface between the extensor pollicis brevis tendon and scaphoid bone.During acupuncture-induced acupoint sensation,ultrasound imaging demonstrated that the location of the needle tip was located within the proximal depression adjacent to the radiopalmar ridge,accompanied by arterial hemodynamic perfusion signals into adjacent osseous interfaces.Microdissection findings revealed perforating branches of the radial artery traversing the cortical bone interface within the Lieque(LU7)acupoint region.Acupuncture stimulation at the proximal depression adjacent to the radiopalmar ridge elicited consistent acupoint sensations in all 10 participants,and the acupoint sensations differed from those of other surrounding tissues.Conclusion The anatomical structure of Lieque(LU7)acupoint is located within the proximal depression adjacent to the radiopalmar ridge,characterized by the presence of"hilus of bone"structure.

Epicardial adipose tissue(EAT)is a type of fat tissue that is closely adjacent to the coronary arteries and myocardium,and it caused physiological and pathological changes to the body through the secretion of autocrine and paracrine active factors.EAT is regarded as a diagnostic marker and a potential therapeutic target for cardiovascular diseases,and it is of great significance to segment and quantify EAT.This article introduced the evolution of the EAT segmentation and quantification methods from the aspects of traditional imaging,atlas,and artificial intelligence.Furthermore,it reviewed the research progresses on automatically quantified EAT indices in the diagnosis and treatment of cardiovascular diseases.

Purpose To explore the clinical value of screening for partial agenesis of the corpus callosum(PACC)via measuring the distance from the end of the fetal corpus callosum to the occipital bone.Materials and Methods A Prospective study were performed from October 2017 to April 2023 in Ji’an Maternal and Child Health Care Hospital and Jiangxi Maternal and Child Health Hospital.A total of 33 PACC fetuses(abnormal group)and 396 normal fetuses(normal group)were selected as the research subjects.The distance(Z value)from the terminal posterior edge of the corpus callosum to the occipital bone was measured,Z value was calculated and compared between groups.The truncation value and related diagnostic efficiency indexes were calculated by receiver operator characteristic curve analysis,and the positive rate of Z value of abnormal group was compared with that of indirect signs.Results The distance from the terminal posterior edge of the corpus callosum to the occipital bone was positively correlated with the gestational age(r=0.913,P<0.001).The best regression equation was that the distance from the terminal posterior edge of the corpus callosum to the occipital bone was 3.879+1.115×gestational age,and the standard deviation was 1.670.The results of mean comparison showed that the Z value of the abnormal group was significantly higher than that of the normal group(t=11.223 9,P<0.001).When Z value 2.199 7 was used as the cut-off value for the diagnosis of PACC,the area under the curve was 0.9981,the Yoden index was 0.959 6,and the sensitivity,specificity,positive and negative predictive values were 96.97%,98.99%,88.89%and 99.75%,respectively.The positive rate of Z value in abnormal group was significantly higher than that of indirect signs(96.97%vs.63.64%,χ2=7.692 3,P<0.01).Conclusion The distance from the terminal posterior edge of corpus callosum to the occipital bone of PACC fetus is larger than that of normal fetus.The increase of Z value indicates that the end of corpus callosum moves forward,which can be used as one of the basis for screening PACC,and it has high clinical value when Z value 2.199 7 is used as the cut-off value for PACC screening.

Objective:To investigate the correlation of neutrophil-to-albumin ratio (NAR) and glucose-to-lymphocyte ratio (GLR) with in-hospital death in patients with acute myocardial infarction (AMI).Methods:The clinical data of 2 657 patients with AMI from January 2017 to December 2022 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Using receiver operating characteristic (ROC) curve to determine the optimal cutoff values of GLR and NAR (6.02 and 0.25) for predicting in-hospital mortality in patients with AMI, the patients were divided into high GLR group (GLR≥6.02, 768 cases) and low GLR group (GLR<6.02, 1 889 cases), high NAR group (NAR≥0.25, 547 cases) and low NAR group (NAR<0.25, 2 110 cases) according the optimal cutoff values. The baseline characteristics and occurrence of in-hospital major adverse cardiovascular events (MACE) were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for in-hospital death in patients with AMI.Results:Among the 2 657 patients with AMI, 265 patients had in-hospital MACE (10.0%), and 50 patients (1.9%) died. The age, proportion of Killip≥ 2 grade, proportion of diabetes, proportion of myocardial infarction, proportion of cerebral infarction history, proportion of ST-elevation myocardial infarction (STEMI), thrombolysis in myocardial infarction clinical trial score (TIMI score), global registry of acute coronary event score (GRACE score), fibrinogen, fasting blood glucose, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), cardiac troponin I (cTnI) peak, N-terminal B-type natriuretic peptide (NT-proBNP), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), NAR, GLR, neutrophil count, left ventricular end-diastolic diameter (LVEDD) in high GLR group were significantly higher than those in low GLR group, the proportion of males, body mass index (BMI), proportion of smoking history, proportion of non-ST elevation myocardial infarction (NSTEMI), albumin, estimated glomerular filtration rate (eGFR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), lymphocyte count, monocyte count and left ventricular ejection fraction (LVEF) were significantly lower than those in low GLR group, and there were statistical differences ( P<0.01 or <0.05). The proportion of Killip≥2 grade, proportion of STEMI, TIMI score, GRACE score, fibrinogen, fasting blood glucose, TC, LDL-C, cTnI peak, hs-CRP, IL-6, NAR, GLR, white blood cell count, neutrophil count and monocyte count in high NAR group were significantly higher than those in low NAR group, the age, proportion of myocardial infarction history, proportion of NSTEMI, albumin, lymphocyte count, left atrial diameter (LAD) and LVEF were significantly lower than those in low NAR group, and there were statistical differences ( P<0.01 or <0.05). The incidences of in-hospital MACE, death, ventricular fibrillation or pulseless ventricular tachycardia, atrial fibrillation, cardiac arrest and bleeding in high GLR group were significant higher than those in low GLR group: 15.2% (117/768) vs. 7.8% (148/1 889), 4.6% (35/768) vs. 0.8% (15/1 889), 5.3% (41/768) vs. 2.9% (54/1 889), 6.9% (53/768) vs. 4.0% (75/1 889), 4.7% (36/768) vs. 1.4% (26/1 889) and 2.3% (18/768) vs. 0.7% (13/1 889), and there were statistical differences ( P<0.01); there was no statistical difference in the incidence of heart rupture between two groups ( P>0.05). The incidence of in-hospital MACE, death, ventricular fibrillation or pulseless ventricular tachycardia, cardiac arrest, cardiac rupture and bleeding in high NAR group were significantly higher than those in low NAR group: 16.6% (91/547) vs. 8.2% (174/2 110), 5.9% (32/547) vs. 0.9% (18/2 110), 8.0% (44/547) vs. 2.4% (51/2 110), 5.9% (32/547) vs. 1.4% (30/2 110), 1.6% (9/547) vs. 0.4% (9/2 110) and 2.4% (13/547) vs. 0.9% (18/2 110), and there were statistical differences ( P<0.01); there was no statistical difference in the incidence of atrial fibrillation between two groups ( P>0.05). Multivariate Logistic regression analysis result showed that the Killip 3 and 4 grades, high NAR, high GRACE score, high fasting glucose and low LVEF were independent risk factors for in-hospital death in patients with AMI ( OR = 3.827, 4.660, 3.779, 1.020, 1.095 and 0.962; 95% CI 1.158 to 12.649, 1.184 to 18.344, 1.856 to 7.649, 1.009 to 1.032, 1.027 to 1.167 and 0.932 to 0.993; P<0.05 or <0.01). Conclusions:The NAR can independently predict the risk of in-hospital death in patients with AMI.