Aim To investigate the effect of cumulative non-high density lipoprotein cholesterol/high density lip-oprotein cholesterol(non-HDLC/HDLC)exposure on atherosclerotic cardiovascular disease(ASCVD).Methods A prospective cohort study was conducted.A total of 50 777 employees of Kailuan Group who participated in three physical examinations in 2006-2007,2008-2009 and 2010-2011 were selected as the study subjects.Groups were divided into Q1,Q2,Q3 and Q4 according to the cumulative non-HDLC/HDLC exposure quartiles.Kaplan-Meier curve was used to calculate the cumulative incidence of ASCVD in different cumulative non-HDLC/HDLC groups,and Log-rank test was used to compare the differences among groups.Cox proportional risk model was used to analyze the effect of cumulative non-HDLC/HDLC exposure on ASCVD.Results The average follow-up was(10.19±2.21)years,and 5 003 new cases of ASCVD occurred.The cumulative incidence of ASCVD in groups Q1 to Q4 was 6.49％,8.71％,10.86％and 14.85％,respectively(Log-rank P＜0.01).Multivariate Cox regression analysis showed that compared with group Q1,the HR(95％CI)of ASCVD in groups Q2,Q3 and Q4 were 1.13(1.03～1.24),1.18(1.07～1.29),1.22(1.12～1.34),respectively;the HR(95％CI)of myocardial infarction were 1.15(0.87～1.53),1.44(1.10～1.88),1.67(1.29～2.17),respectively;the HR(95％CI)of revascularization were 1.21(0.99～1.49),1.31(1.07～1.60)and 1.49(1.22～1.81),respectively;the HR(95％CI)of ischemic stroke were 1.17(1.03～1.32),1.17(1.04～1.33)and 1.21(1.06～1.37),respectively;but the above association was not found when heart failure and atrial fibrillation were used as the outcome events.The restricted cubic spline showed that cumulative non-HDLC/HDLC values were line-arly associated with the risk of ASCVD.Conclusion Cumulative non-HDLC/HDLC exposure was positively associated with the risk of ASCVD.

Aim To investigate the effect of cumulative non-high density lipoprotein cholesterol/high density lip-oprotein cholesterol(non-HDLC/HDLC)exposure on atherosclerotic cardiovascular disease(ASCVD).Methods A prospective cohort study was conducted.A total of 50 777 employees of Kailuan Group who participated in three physical examinations in 2006-2007,2008-2009 and 2010-2011 were selected as the study subjects.Groups were divided into Q1,Q2,Q3 and Q4 according to the cumulative non-HDLC/HDLC exposure quartiles.Kaplan-Meier curve was used to calculate the cumulative incidence of ASCVD in different cumulative non-HDLC/HDLC groups,and Log-rank test was used to compare the differences among groups.Cox proportional risk model was used to analyze the effect of cumulative non-HDLC/HDLC exposure on ASCVD.Results The average follow-up was(10.19±2.21)years,and 5 003 new cases of ASCVD occurred.The cumulative incidence of ASCVD in groups Q1 to Q4 was 6.49％,8.71％,10.86％and 14.85％,respectively(Log-rank P＜0.01).Multivariate Cox regression analysis showed that compared with group Q1,the HR(95％CI)of ASCVD in groups Q2,Q3 and Q4 were 1.13(1.03～1.24),1.18(1.07～1.29),1.22(1.12～1.34),respectively;the HR(95％CI)of myocardial infarction were 1.15(0.87～1.53),1.44(1.10～1.88),1.67(1.29～2.17),respectively;the HR(95％CI)of revascularization were 1.21(0.99～1.49),1.31(1.07～1.60)and 1.49(1.22～1.81),respectively;the HR(95％CI)of ischemic stroke were 1.17(1.03～1.32),1.17(1.04～1.33)and 1.21(1.06～1.37),respectively;but the above association was not found when heart failure and atrial fibrillation were used as the outcome events.The restricted cubic spline showed that cumulative non-HDLC/HDLC values were line-arly associated with the risk of ASCVD.Conclusion Cumulative non-HDLC/HDLC exposure was positively associated with the risk of ASCVD.

Objectives:To investigate the association of trajectories of atherogenic index of plasma(AIP)with the risk of atherosclerotic cardiovascular disease(ASCVD). Methods:A total of 51 831 employees and retirees who participated in Kailuan Group health examination for three consecutive times from 2006 to 2010 were included in this study.AIP was calculated using the log(triglycerides[TG]/high-density lipoprotein-cholesterol[HDL-C])formula.AIP trajectory models were fitted by the SAS Proc Traj program,and according to AIP trajectory,the subjects were divided into low stability group(n=11 114),low to moderate stability group(n=21 647),medium to high stability group(n=13 659),and high stability group(n=5 411).Kaplan-Meier method was used to calculate the cumulative incidence of ASCVD in different groups and compared by log-rank test.Cox proportional risk regression model was used to analyze the effects of different AIP trajectories on ASCVD risk. Results:Finally,51 831 patients were included in the analysis.During a mean follow-up of(10.19±2.22)years,5 142(9.92%)subjects developed ASCVD,4 013(7.74%)subjects died.Cox regression analysis after adjusting for confounding factors showed:compared with the low stability group,the risk of ASCVD increased by 13%(HR=1.13,95%CI:1.04-1.23,P=0.003)and 20%(HR=1.20,95%CI:1.10-1.31,P＜0.001)and 41%(HR=1.41,95%CI:1.27-1.57,P＜0.001)in the low to moderate stability group,moderate to high stability group and high stability group,respectively,and the risk increased gradually(Ptrend＜0.001).Stratified analysis showed that the risk of ASCVD in people aged＜65 years and low-density lipoprotein cholesterol(LDL-C)＜3.4 mmol/L with long-term high levels of AIP was higher than that in people aged≥65 years and LDL-C≥3.4 mmol/L(both Pinteraction＜0.01). Conclusions:In Kailuan Study cohort,those with long-term high levels of AIP had a higher risk of ASCVD,and the risk gradually increased.In addition,we found that the risk of ASCVD in people with long-term high levels of AIP was higher in＜65 years old than in≥65 years old,and the risk of ASCVD in people with LDL-C＜3.4 mmol/L was higher than that in people with LDL-C≥3.4 mmol/L.

Objectives:To investigate the impact of resting heart rate on the risk of all-cause mortality in ultra-high risk atherosclerotic cardiovascular disease(ASCVD)patients. Methods:A total of 3 645 patients with ultra-high risk ASCVD(as defined in the 2023 Chinese Lipid Management Guidelines)were screened from the 2006 to 2020 Kailuan Study cohort,and after excluding 602 patients with missing resting heart rate,3 043 patients were included in the final analysis.Patients were divided into＜68 beats/min group(n=744),68-74 beats/min group(n=786),75-80 beats/min group(n=760),and≥81 beats/min group(n=753)according to the resting heart rate.Cox proportional regression model was used to estimate the hazard ratios(HRs)and 95%CI for all-cause mortality associated with the different resting heart rate groups and every 10 beats/min increase of resting heart rate.The dose-effect relationship of resting heart rate level and all-cause mortality was assessed by a restricted cubic spline regression model.The Kaplan-Meier method was applied to calculate the cumulative all-cause mortality in different groups,and the differences were compared using log-rank test. Results:The median follow-up time was 5.81(3.46,9.64)years,there were 772(25.37%)all-cause deaths during follow up.After adjusting major confounding factors,the results showed that compared with＜68 beats/min group,the risk of all-cause mortality in 75-80 beats/min group and≥81 beats/min group increased by 24%(HR=1.24,95%CI:1.01-1.52,P=0.047)and 47%(HR=1.47,95%CI:1.20-1.81,P＜0.001),respectively;the risk of all-cause mortality in 68-74 beats/min group was similar(HR=1.06,95%CI:0.86-1.31,P=0.625).In addition,an increase of 10 beats/min in resting heart rate was associated with a 13%increase in the risk of all-cause mortality(HR=1.13,95%CI:1.07-1.19,P＜0.001).In stratified analyses,it was found that for every 10 beats/min increase in resting heart rate,women faced a higher risk of all-cause mortality than men,and patients＜65 years old faced a higher risk of all-cause mortality than patients≥65 years old.The restricted cubic spline analysis also showed that resting heart rate was linearly associated with the risk of all-cause mortality(Poverall＜0.001,Pnon-linear=0.933),and the risk increased significantly with resting heart rate＞70 beats/min. Conclusions:Increased resting heart rate is linearly associated with increased risk of all-cause mortality in patients with ultra-high risk ASCVD.The appropriate intervention cut-off point of resting heart rate for ultra-high risk ASCVD patients may be＞75 beats/min.

Objective:To investigate the impact of non-high-density lipoprotein cholesterol (non-HDL-C) level on major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality in the Kailuan Study cohort undergoing revascularization.Methods:This is a prospective cohort study, with participants from the Kailuan Study cohort who participated in physical examinations from 2006 to 2020 and received revascularization therapy for the first time. According to the level of non-HDL-C, the study subjects were divided into 3 groups:<2.6 mmol/L group, 2.6-<3.4 mmol/L group, and≥3.4 mmol/L group. Annual follow-up was performed, and the endpoint events were MACCE and all-cause mortality. Cox proportional regression model was implemented to estimate the impact on MACCE and all-cause mortality associated with the different non-HDL-C groups. The partial distributed risk model was used to analyze the impact of different non-HDL-C levels on MACCE event subtypes, and death was regarded as a competitive event. The restricted cubic spline regression model was used to explore the dose-response relationship between non-HDL-C level and all-cause mortality, MACCE and its subtypes.Results:A total of 2 252 subjects were enrolled in the study, including 2 019 males (89.65%), aged (62.8±8.3) years, the follow-up time was 5.72 (3.18, 8.46) years. There were 384 cases(17.05%) of MACCE and 157 cases(6.97%) of all-cause mortality. Compared with patients with non-HDL-C≥3.4 mmol/L, patients with non-HDL-C<2.6 mmol/L were associated with a 38% reduced risk of MACCE after revascularization [ HR=0.62(95% CI: 0.48-0.80)]. Every 1 mmol/L decrease in non-HDL-C was associated with a 20% reduction in the risk of MACCE [ HR=0.80(95% CI: 0.73-0.88)]. The results of restricted cubic spline also showed that non-HDL-C levels after revascularization therapy were positively correlated with MACCE events (overall association P<0.001, non-linear association P=0.808). For all-cause mortality, compared to the non-HDL-C≥3.4 mmol/L group, the HR for all-cause mortality after revascularization in non-HDL-C<2.6 mmol/L group was 0.67(95% CI: 0.46-1.01). Every 1 mmol/L decrease in non-HDL-C was associated with a 15% reduction in the risk of all-cause mortality [ HR=0.85(95% CI: 0.73-0.99)]. The restricted cubic spline results showed a linear association between non-HDL-C levels after revascularization therapy and the risk of all-cause mortality (overall association P=0.039, non-linear association P=0.174). Conclusion:The decrease in non-HDL-C levels after revascularization were significantly associated with a reduced risk of MACCE and all-cause mortality.

Objective:To evaluate the effect of regulation of balance between cerebral oxygen supply and demand on wake-up test in patients with ankylosing spondylitis (AS) undergoing pedicle subtraction osteotomy (PSO).Methods:In this randomized controlled study, 64 AS patients of either sex, aged 18-65 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing PSO in Nanjing Drum Tower Hospital from July 2021 to April 2023, were assigned into intervention group (I group, n=32) and control group (C group, n=32). The regional cerebral oxygen satruation (rSO 2) breathed in a lateral position after entering the operating room was considered as baseline. In group M, rSO 2 was maintained within 10% of the baseline value: Lowering the partial pressure of end-tidal CO 2 and mean arterial pressure, increasing the consumption of propofol and giving mannitol were countermeasures against an elevated rSO 2 >10% of baseline; whereas elevating partial pressure of end-tidal CO 2 and mean arterial pressure and increasing the concentration of inhaled oxygen, and transfusing red blood cells were performed in AS patients with a rSO 2 <10% of baseline in I group. A routine anesthesia management and rSO 2 monitoring were performed in C group. The rSO 2 was recorded on admission to the operating room in a quiet lateral position (T 0), 10 min after tracheal intubation (T 1), 10 min after the placement of the "arch bridge" position (T 2), 30 min after the start of operation (T 3), at the end of osteotomy (T 4), at the time point of intraoperative awakening (T 5), 30 min after awakening (T 6), and at the end of operation (T 7). The occurrence of increase and decrease in rSO 2>10% of the baseline (for 5 min) during the pre-awakening stage and throughout operation was recorded. The wake-up quality was assessed during the wake-up test. The wake-up time, Ramsay Sedation Scale scores and Riker Sedation-Agitation Scale scores were recorded. The length of stay in postanesthesia care unit and extubation time were also recorded. Delirium was assessed during emergence from anesthesia using the Confusion Assessment Method for the intensive care unit. The Visual Analogue Scale score was recorded to assess the pain. Results:Compared with group C, rSO 2 was significantly decreased at T 3-T 5, rSO 2 was increased at T 6, the incidence of increase in rSO 2>10% of the baseline in the pre-awakening stage was decreased ( P<0.05), no significant change was found in the incidence of decrease in rSO 2>10% of the baseline ( P>0.05), the incidence of increase and decrease in rSO 2>10% of the baseline throughout operation was decreased, the wake-up quality grade was increased, the wake-up time was shortened, the Ramsay sedation score was increased during the wake-up period, and the Riker agitation score was decreased, the length of stay in postanesthesia care unit and extubation time were shortened, the incidence of delirium was decreased ( P<0.05), and no significant change was found in the Visual Analogue Scale score in group I ( P>0.05). Conclusions:rSO 2-oriented anesthesia management effectively regulates the balance between cerebral oxygen supply and demand, optimizes wake-up test and is helpful in increasing the anesthesia emergence quality.

Objective:To evaluate the effect of regulation of balance between cerebral oxygen supply and demand on wake-up test in patients with ankylosing spondylitis (AS) undergoing pedicle subtraction osteotomy (PSO).Methods:In this randomized controlled study, 64 AS patients of either sex, aged 18-65 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing PSO in Nanjing Drum Tower Hospital from July 2021 to April 2023, were assigned into intervention group (I group, n=32) and control group (C group, n=32). The regional cerebral oxygen satruation (rSO 2) breathed in a lateral position after entering the operating room was considered as baseline. In group M, rSO 2 was maintained within 10% of the baseline value: Lowering the partial pressure of end-tidal CO 2 and mean arterial pressure, increasing the consumption of propofol and giving mannitol were countermeasures against an elevated rSO 2 >10% of baseline; whereas elevating partial pressure of end-tidal CO 2 and mean arterial pressure and increasing the concentration of inhaled oxygen, and transfusing red blood cells were performed in AS patients with a rSO 2 <10% of baseline in I group. A routine anesthesia management and rSO 2 monitoring were performed in C group. The rSO 2 was recorded on admission to the operating room in a quiet lateral position (T 0), 10 min after tracheal intubation (T 1), 10 min after the placement of the "arch bridge" position (T 2), 30 min after the start of operation (T 3), at the end of osteotomy (T 4), at the time point of intraoperative awakening (T 5), 30 min after awakening (T 6), and at the end of operation (T 7). The occurrence of increase and decrease in rSO 2>10% of the baseline (for 5 min) during the pre-awakening stage and throughout operation was recorded. The wake-up quality was assessed during the wake-up test. The wake-up time, Ramsay Sedation Scale scores and Riker Sedation-Agitation Scale scores were recorded. The length of stay in postanesthesia care unit and extubation time were also recorded. Delirium was assessed during emergence from anesthesia using the Confusion Assessment Method for the intensive care unit. The Visual Analogue Scale score was recorded to assess the pain. Results:Compared with group C, rSO 2 was significantly decreased at T 3-T 5, rSO 2 was increased at T 6, the incidence of increase in rSO 2>10% of the baseline in the pre-awakening stage was decreased ( P<0.05), no significant change was found in the incidence of decrease in rSO 2>10% of the baseline ( P>0.05), the incidence of increase and decrease in rSO 2>10% of the baseline throughout operation was decreased, the wake-up quality grade was increased, the wake-up time was shortened, the Ramsay sedation score was increased during the wake-up period, and the Riker agitation score was decreased, the length of stay in postanesthesia care unit and extubation time were shortened, the incidence of delirium was decreased ( P<0.05), and no significant change was found in the Visual Analogue Scale score in group I ( P>0.05). Conclusions:rSO 2-oriented anesthesia management effectively regulates the balance between cerebral oxygen supply and demand, optimizes wake-up test and is helpful in increasing the anesthesia emergence quality.

Objective To analyze the incidence trend of hand-foot-mouth disease (HFMD) and its correlation with meteorological factors in Children in Kaizhou District, Chongqing from 2018 to 2021, and to provide a theoretical basis for the diagnosis and treatment of HFMD in children. Methods The HFMD epidemic information was collected from 2018 to 2021 in Kaizhou District of Chongqing by using the China Disease Surveillance Information and Report Management System. The epidemiological characteristics of HFMD were descriptively analyzed, and the correlation between HFMD incidence and meteorological factors was analyzed by multiple regression. Results A total of 5 121 HFMD cases were reported in Kaizhou District of Chongqing from 2018 to 2021, with an average annual incidence of 143.30/100 000. The incidence of HFMD fluctuated from 120.87/100,000 to 159.78/100,000 from 2018 to 2021, showing a downward trend year by year. There were 2929 males and 2192 females with HFMD. The incidence of HFMD was the highest in early childhood (70.13/100 000), followed by pre-school age (43.06/100 000). There was significant difference in the incidence of HFMD among different age groups (χ²=53.497, P<0.05). The cases were mainly scattered children (3127 cases, 61.06%). The second was nursery children (1627 cases, 31.77%). In addition, there were 289 cases of students (5.64%). There were 1084 laboratory-confirmed cases in Kaizhou District of Chongqing from 2018 to 2021, including 269 (24.82%) children with EV71 infection, 178 (16.42%) children with Cox A16 infection, and 637 (58.76%) children with other enterovirus infections. There were significant differences in pathogen composition among different years (Z=32.75, P<0.05). From 2018 to 2021, the proportion of EV71 increased year by year, while COX16 and other enterovirus infections showed a downward trend year by year. Average daily temperature (OR=1.873) and average daily pressure (OR=-1.498) were independent risk factors for HFMD in Kaizhou District of Chongqing (P<0.05). Conclusion The reported incidence of HFMD in Kaizhou District of Chongqing shows a decreasing trend, and the incidence is closely related to temperature and atmospheric pressure. It is still necessary to strictly implement the prevention and control measures in key population in the season of high incidence. The main virus is EV71, which can be vaccinated with EV71 HFMD vaccine to reduce the occurrence of severe cases.

Objective To investigate the death prognosis and risk factors of extensively drug-resistant Acinetobacter baumannii in hospitalized elderly patients with hematological infection, so as to facilitate clinical prevention and treatment. Methods The elderly (> 80 years old) hospitalized patients with hematological infection in our hospital from 2015 to 2021 were selected for analysis. Firstly, 314 patients with extensively drug-resistant Acinetobacter baumannii hematological infection were distinguished by etiological analysis. A total of 98 cases of death were detected during hospitalization (later referred to as the observation group). By comparing with the surviving patients (216 cases) (later referred to as the control group), the general data of patients with XDRAB infection were collected, and the risk of death and its influencing factors were analyzed. Results In the study, the proportion of patients in the observation group who used catheters was higher, the catheter retention time was longer, the acute physiology and chronic health status II scores were higher, and the proportion of patients who lost self-care ability was also higher. Conclusion The death of blood borne infection of extensively drug-resistant Acinetobacter baumannii in elderly patients is affected by many factors. Among them, patients who use catheters for a long time, have poor self-care ability and lose self-care ability have a higher risk of death, which is worthy of clinical attention.

Objective To investigate the impacts of sirolimus (SRL)on the survival time of graft and the differentiation and proliferation of regulatory T cell (Treg ) of spleen in mouse heterotopic heart transplantation model. Methods Male BALB /c → C57BL/6 mice cervical heterotopic heart transplantation model was established by Cuff method. The mice were divided into 3 groups randomly with 10 mice in each group. The control group received no treatment of special medicine after operation. Mice in SRL group were gavaged with SRL 10 mg/(kg·d)at 1-14 d after operation. Mice in ciclosporin (CsA)group were gavaged with CsA 30 mg/(kg·d) at 1-14 d after operation. The survival time of cardiac grafts were recorded. The spleen was procured after asystole of cardiac graft or 14 d after operation. Mononuclear cells were isolated and the proportion of CD4 +CD25 +Treg in CD4 +T cell (CD4 +CD25 +Treg%)were detected by flow cytometry and reverse transcription polymerase chain reaction (RT-PCR)was used to examine the expression of Foxp3 messenger ribonucleic acid (mRNA ) semi-quantitatively. Results Compared with the control group,the survival time of cardiac grafts prolonged significantly in SRL and CsA group (all in P <0.01 ),but no significant difference was observed between SRL and CsA group (P>0.05 ). Compared with the control group,CD4 +CD25 +Treg% significantly decreased in the spleen of CsA group and significantly increased in SRL group (all in P<0.01 ). And significant difference was observed between SRL and CsA group (P<0.01). Expression of Foxp3 mRNA of T lymphocyte in the spleen of SRL group was significantly higher than those in control and CsA group (P<0.01). And expression of Foxp3 mRNA in control group was significantly higher than that in CsA group (P<0.01 ). Conclusions In mouse heart transplantation model,SRL can prolong the survival time of graft and promote the proliferation and growth of CD4 +CD25 +Treg to facilitate the establishment of immune tolerance.