Objective:To evaluate the diagnostic value of coronary angiography-derived fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) for identifying coronary functional abnormalities.Methods:This diagnostic study enrolled patients with clinically suspected or diagnosed coronary artery disease who underwent coronary angiography at Beijing Anzhen Hospital, TEDA International Cardiovascular Hospital, and Qilu Hospital of Shandong University between December 2021 and June 2022. All enrolled patients successfully underwent invasive wire-based FFR and IMR measurements during angiography. In a core laboratory, FFR and IMR for the target vessels were measured using artificial intelligence technology based on coronary angiographic images. Spearman correlation analysis was used to evaluate the correlation between angiography-derived FFR and wire-based FFR, and between angiography-derived IMR and wire-based IMR. Coronary hemodynamic abnormality was defined as FFR≤0.80; the diagnostic performance of angiography-derived FFR for identifying this abnormality was evaluated. Microcirculatory dysfunction was defined as IMR≥25; the diagnostic performance of angiography-derived IMR for identifying microcirculatory dysfunction was evaluated.Results:A total of 181 patients, aged (60.6±8.8) years, with 62 (34.3%) females, and 181 target vessels were included in the final analysis. Angiography-derived FFR showed a significant positive correlation with wire-based FFR ( r=0.78, P<0.001). For identifying coronary hemodynamic abnormality, angiography-derived FFR showed an accuracy of 89.0%, sensitivity of 88.8%, specificity of 89.1%, positive predictive value (PPV) of 88.8%, negative predictive value (NPV) of 89.1%, and an area under the receiver operating characteristic curve ( AUC) of 0.88. Angiography-derived IMR showed a significant positive correlation with wire-based IMR ( r=0.93, P<0.001). For identifying microcirculatory dysfunction, angiography-derived IMR demonstrated an accuracy of 89.5%, sensitivity of 86.8%, specificity of 90.2%, PPV of 70.2%, NPV of 96.3%, and an AUC of 0.95. Conclusion:Angiography-derived FFR and IMR exhibit strong correlations with their invasive wire-based counterparts and demonstrate high diagnostic value for assessing coronary hemodynamics and coronary microcirculatory function.

Objective:The aim of this study was to assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients.Methods:We retrospectively included 374 patients with chronic heart failure who underwent CRT-D treatment at the First Affiliated Hospital of Xinjiang Medical University between June 2020 and June 2024. Based on the Tilburg Debilitation Assessment Scale, 175 patients (46.8%) were classified as frail while 199 (53.2%) were classified as non-frail. The baseline data between the two groups was compared using Cox regression analysis and Kaplan-Meier curves were used for survival analysis. P-values of <0.05 indicated statistically significant differences. Results:A total of 374 patients aged 25-93 (68±11) years were enrolled in this study, 101 (27.0%) of which were female. Among these, 175 (46.8%) were categorized as frail, and 199 (53.2%) were classified as non-frail. Over a median follow-up time of 23 (5, 45) months, 35 (9.4%) patients experienced all-cause mortality, with 30 (17.1%) deaths occurring in the frail group and 5 (2.5%) in the non-frail group; meanwhile, readmission events due to heart failure occurred in a total of 174 (46.5%) patients, including 122 (70.1%) in the frail group, and 52 (29.9%) in the non-frail group. Cox analysis showed that frailty was a significant determinant of all-cause mortality ( HR=21.25, 95% CI 3.99-113.30, P<0.001) and readmission among heart failure patients receiving CRT-D ( HR=2.52, 95% CI 1.73-3.68, P<0.001). Log-rank tests showed that the survival rate of patients in the frail group was significantly lower than that of patients in the non-frail group ( HR=7.22, 95% CI 2.80-18.60, P<0.001) and the risk of readmission events due to heart failure was significantly higher among patients in the frail group than among those in the non-frail group ( HR=2.75, 95% CI 1.98-3.81, P<0.001). Conclusions:Frailty is an independent predictor of postoperative all-cause mortality and the occurrence of heart failure-related readmissions in patients with heart failure treated receiving CRT-D.

Objective:The aim of this study was to assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients.Methods:We retrospectively included 374 patients with chronic heart failure who underwent CRT-D treatment at the First Affiliated Hospital of Xinjiang Medical University between June 2020 and June 2024. Based on the Tilburg Debilitation Assessment Scale, 175 patients (46.8%) were classified as frail while 199 (53.2%) were classified as non-frail. The baseline data between the two groups was compared using Cox regression analysis and Kaplan-Meier curves were used for survival analysis. P-values of <0.05 indicated statistically significant differences. Results:A total of 374 patients aged 25-93 (68±11) years were enrolled in this study, 101 (27.0%) of which were female. Among these, 175 (46.8%) were categorized as frail, and 199 (53.2%) were classified as non-frail. Over a median follow-up time of 23 (5, 45) months, 35 (9.4%) patients experienced all-cause mortality, with 30 (17.1%) deaths occurring in the frail group and 5 (2.5%) in the non-frail group; meanwhile, readmission events due to heart failure occurred in a total of 174 (46.5%) patients, including 122 (70.1%) in the frail group, and 52 (29.9%) in the non-frail group. Cox analysis showed that frailty was a significant determinant of all-cause mortality ( HR=21.25, 95% CI 3.99-113.30, P<0.001) and readmission among heart failure patients receiving CRT-D ( HR=2.52, 95% CI 1.73-3.68, P<0.001). Log-rank tests showed that the survival rate of patients in the frail group was significantly lower than that of patients in the non-frail group ( HR=7.22, 95% CI 2.80-18.60, P<0.001) and the risk of readmission events due to heart failure was significantly higher among patients in the frail group than among those in the non-frail group ( HR=2.75, 95% CI 1.98-3.81, P<0.001). Conclusions:Frailty is an independent predictor of postoperative all-cause mortality and the occurrence of heart failure-related readmissions in patients with heart failure treated receiving CRT-D.

Objective:To evaluate the diagnostic value of coronary angiography-derived fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) for identifying coronary functional abnormalities.Methods:This diagnostic study enrolled patients with clinically suspected or diagnosed coronary artery disease who underwent coronary angiography at Beijing Anzhen Hospital, TEDA International Cardiovascular Hospital, and Qilu Hospital of Shandong University between December 2021 and June 2022. All enrolled patients successfully underwent invasive wire-based FFR and IMR measurements during angiography. In a core laboratory, FFR and IMR for the target vessels were measured using artificial intelligence technology based on coronary angiographic images. Spearman correlation analysis was used to evaluate the correlation between angiography-derived FFR and wire-based FFR, and between angiography-derived IMR and wire-based IMR. Coronary hemodynamic abnormality was defined as FFR≤0.80; the diagnostic performance of angiography-derived FFR for identifying this abnormality was evaluated. Microcirculatory dysfunction was defined as IMR≥25; the diagnostic performance of angiography-derived IMR for identifying microcirculatory dysfunction was evaluated.Results:A total of 181 patients, aged (60.6±8.8) years, with 62 (34.3%) females, and 181 target vessels were included in the final analysis. Angiography-derived FFR showed a significant positive correlation with wire-based FFR ( r=0.78, P<0.001). For identifying coronary hemodynamic abnormality, angiography-derived FFR showed an accuracy of 89.0%, sensitivity of 88.8%, specificity of 89.1%, positive predictive value (PPV) of 88.8%, negative predictive value (NPV) of 89.1%, and an area under the receiver operating characteristic curve ( AUC) of 0.88. Angiography-derived IMR showed a significant positive correlation with wire-based IMR ( r=0.93, P<0.001). For identifying microcirculatory dysfunction, angiography-derived IMR demonstrated an accuracy of 89.5%, sensitivity of 86.8%, specificity of 90.2%, PPV of 70.2%, NPV of 96.3%, and an AUC of 0.95. Conclusion:Angiography-derived FFR and IMR exhibit strong correlations with their invasive wire-based counterparts and demonstrate high diagnostic value for assessing coronary hemodynamics and coronary microcirculatory function.

AIM:To investigate the role of renal denervation(RDN)in treatment of obesity-related atrial fi-brillation(AF)in rats.METHODS:A high-fat diet AF-susceptible rat model was constructed.The rats in control group was fed with a standard diet,while those in RDN group was subjected to RDN via surgical and chemical ablation.The re-nal tyrosine hydroxylase expression level was detected by Western blot.An in vivo electrophysiological instrument was used to detect the cardiac electrophysiological parameters of rats,including atrial effective refractory period(AERP),AF induction rate,and AF duration.Alterations in cardiac structure and function of the rats were assessed using echocar-diography.PowerLab bioinformatics acquisition system was used to analyze alterations in the tension of the rat cardiac au-tonomic nervous system.Transmission electron microscopy was used to further observe structural changes in the rat atrial mitochondria.The protein levels of mammalian target of rapamycin(mTOR)and phosphorylated mTOR(p-mTOR)were detected by Western blot.Masson staining and HE staining were used to detect the extent of structural changes in the left atrium.RESULTS:(1)Compared with standard diet group,the AF induction rate and duration of the rats fed with a high-fat diet were significantly increased;however,the AERP significantly decreased.RDN reduced the increases in AF induction rate and duration in the rats fed with a high-fat diet,and even restored the AERP.(2)Cardiac low frequency significantly increased whereas cardiac high frequency decreased in heart autonomic nerves of the rats fed with a high-fat diet.After RDN,low frequency was significantly restored,suggesting that RDN could reverse the cardiac autonomic ner-vous system disorder induced by a high-fat diet.(3)Ultrasound results showed that compared with standard diet group,the left atrial diameter and left ventricular end-systolic diameter(LVESD)of the rats fed with high-fat diet were increased,whereas the left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were decreased.Af-ter RDN,the LVEF and LVFS of high-fat diet-fed rats increased,whereas the LVESD decreased.Ultrasound results showed that RDN could attenuate the cardiac functional and structural damage induced by a high-fat diet.Masson and HE staining results showed that compared with standard diet group,atrial fibrosis and atrial cardiomyocyte hypertrophy in-creased in high-fat diet-fed rats,while atrial fibrosis was significantly attenuated after RDN.(4)Transmission electron mi-croscopy showed that the functional structure of atrial mitochondria in high-fat diet-fed rats was damaged,with disordered arrangement and increased number of vacuoles.Western blot results showed that mTOR and p-mTOR protein levels in-creased in the left atrium of high-fat diet-fed rats.Mitochondrial autophagy and structural damage were attenuated after RDN.CONCLUSION:Renal denervation may reduce high-fat diet-induced AF susceptibility via alleviating autonomic nervous system disorders and cardiac structural and functional remodeling.

AIM:To investigate the role of renal denervation(RDN)in treatment of obesity-related atrial fi-brillation(AF)in rats.METHODS:A high-fat diet AF-susceptible rat model was constructed.The rats in control group was fed with a standard diet,while those in RDN group was subjected to RDN via surgical and chemical ablation.The re-nal tyrosine hydroxylase expression level was detected by Western blot.An in vivo electrophysiological instrument was used to detect the cardiac electrophysiological parameters of rats,including atrial effective refractory period(AERP),AF induction rate,and AF duration.Alterations in cardiac structure and function of the rats were assessed using echocar-diography.PowerLab bioinformatics acquisition system was used to analyze alterations in the tension of the rat cardiac au-tonomic nervous system.Transmission electron microscopy was used to further observe structural changes in the rat atrial mitochondria.The protein levels of mammalian target of rapamycin(mTOR)and phosphorylated mTOR(p-mTOR)were detected by Western blot.Masson staining and HE staining were used to detect the extent of structural changes in the left atrium.RESULTS:(1)Compared with standard diet group,the AF induction rate and duration of the rats fed with a high-fat diet were significantly increased;however,the AERP significantly decreased.RDN reduced the increases in AF induction rate and duration in the rats fed with a high-fat diet,and even restored the AERP.(2)Cardiac low frequency significantly increased whereas cardiac high frequency decreased in heart autonomic nerves of the rats fed with a high-fat diet.After RDN,low frequency was significantly restored,suggesting that RDN could reverse the cardiac autonomic ner-vous system disorder induced by a high-fat diet.(3)Ultrasound results showed that compared with standard diet group,the left atrial diameter and left ventricular end-systolic diameter(LVESD)of the rats fed with high-fat diet were increased,whereas the left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were decreased.Af-ter RDN,the LVEF and LVFS of high-fat diet-fed rats increased,whereas the LVESD decreased.Ultrasound results showed that RDN could attenuate the cardiac functional and structural damage induced by a high-fat diet.Masson and HE staining results showed that compared with standard diet group,atrial fibrosis and atrial cardiomyocyte hypertrophy in-creased in high-fat diet-fed rats,while atrial fibrosis was significantly attenuated after RDN.(4)Transmission electron mi-croscopy showed that the functional structure of atrial mitochondria in high-fat diet-fed rats was damaged,with disordered arrangement and increased number of vacuoles.Western blot results showed that mTOR and p-mTOR protein levels in-creased in the left atrium of high-fat diet-fed rats.Mitochondrial autophagy and structural damage were attenuated after RDN.CONCLUSION:Renal denervation may reduce high-fat diet-induced AF susceptibility via alleviating autonomic nervous system disorders and cardiac structural and functional remodeling.

ObjectiveTo systematically review the intervention effect of Chinese medicine on the structure and function of testicular Sertoli cells in animal models of impaired spermatogenesis. MethodThe databases， such as China National Knowledge Infrastructure （CNKI），VIP，Wanfang Data，EMbase，and Pubmed，were searched for experimental studies on the effect of Chinese medicine on the structure and function of testicular Sertoli cells in animal models with impaired spermatogenesis. The included studies were evaluated for risks of bias，and the outcome indicators were analyzed with RevMan and Stata software. ResultThirty studies were included，involving 37 randomized controlled trials （RCTs）. As indicated by the Meta-analysis results， compared with the model group，Chinese medicine increased sperm density（SMD=2.42，95% confidence interval（CI）［1.47，3.37］，P<0.000 01）， promoted sperm motility（SMD=2.35，95%CI ［1.70， 2.99］，P<0.000 01）， up-regulated the protein and mRNA levels of Vimentin （related to Sertoli cell cytoskeleton）， elevated the levels of Occludin and Claudin-11 （related to tight junction of blood-testis barrier）， boosted the levels of β-catenin and N-cadherin （related to adherens junction of blood-testis barrier）， raised the level of connexin 43 （Cx43， related to gap junction of blood-testis barrier）， improved the function of Sertoli cells， increased the serum content of Inhibin B （INHB）， and up-regulated the levels of testicular follicle-stimulating hormone receptor （FSHR）， INHB mRNA， androgen-binding protein （ABP） mRNA， transferrin（TF），stem cell factor（SCF），SCF mRNA，glial cell line-derived neurotrophic factor （GDNF），GDNF mRNA，bone morphogenetic protein 4（BMP4），and BMP4 mRNA （P<0.05）. ConclusionChinese medicine can effectively increase sperm density and motility of animal models of impaired spermatogenesis，and improve the structure and function of testicular Sertoli cells. However，affected by the quality of the included studies，the above conclusion needs to be further verified by relevant high-quality studies.

Under the background of technological assistance to prepare for the Beijing Winter Olympics in China, the biomechanical research highlights and the latest achievements related to competitive performance of alpine skiers in recent years were systematically analyzed in this paper, so as to determine biomechanical factors affecting competitive performance of alpine skiers, including aerodynamic drag, frictional forces, ground reaction force (GRF), energy dissipation, turn radius, trajectory of the skis and/or center of mass (COM). In addition, biomechanical differences in turn techniques, multiple turns connections and abilities of individuals were also considered as important factors affecting the alpine skiing performance. In the case of slalom and giant slalom events, the earlier initiation of turns, longer path length and trajectory, earlier and smoother application of GRF, and carbene technique carving to reduce the ski-snow friction and thereby dissipate energy should be used to improve sports performance. During speed skiing, minimizing the exposed frontal area and positioning the arms close to the body can reduce the energy loss caused by aerodynamic drag, thereby improving sports performance. Top-level alpine skiers will always perform well on different courses, terrains and snow conditions during the race. Excellent alpine ski performance from a biomechanical perspective includes the efficient use of potential energy, minimizing ski-snow friction and aerodynamic drag, choosing optimal trajectory and maintaining high-speed skiing. Individual tactics and techniques should be valued in training and competition. For better results, the same performance on multiple sections and on different terrains is more important than excellence in individual sections and specific conditions.

Objective To compare the clinical effect between CO2-1aser assisted and cold instrument assisted suspension laryngoscopic surgery for vocal fold cyst.Methods From January, 2011 to December, 2014, 72 patients with vocal fold cyst, which diagnosed by strobolaryngoscopy, were randomly divided into CO2-1aser assisted group and cold instrument group.Strobolaryngoscopy, acoustic analysis and perceptual voice analyses were performed on each patient before surgery, 1 month, and 3 months after surgery, respectively.Results All operations were successfully completed.The complete vocal fold cyst resection rate of CO2-1aser assisted group was significantly higher than cold instrument group (29/36, 80.5％ vs 21/36, 58.3％, P ＜ 0.05), especially the left vocal fold cyst (13/16, 81.3％ vs 9/19, 47.4％, P ＜ 0.05).The complete right vocal fold epidermoid cyst resection rate was significantly higher than retention cyst (17/19, 89.4％ vs 11/18, 61.1％, P ＜ 0.05).Two recurrent cases were found in cold instrument group but no recurrent cases in CO2-laser assisted group (0/36, 0％ vs 2/36, 5.6％, P ＞ 0.05).Correlation analysis showed that vocal fold cyst recurrence was related to complete resection rate and has no relation with surgical methods, histopathological types and position.Subjective and objective assessment of voice quality in preoperative, 1-month postoperative and 3-month postoperative were similer between CO2-1aser assisted group and cold instrument group (P ＞ 0.05).Conclusion The CO2-laser assisted suspension laryngoscopic surgery for vocal fold cyst, can increase the surgical precision, reduce the left hand impact, improve the complete resection rate and reduce the recurrence rate.

[ABSTRACT]OBJECTIVETo evaluate the short-term efficacy of Eustachian tube balloon dilation (ETBD) in the treatment of symptomatic Eustachian tube dysfunction (SETD) by subjective and objective analysis.METHODS Forty patients who underwent ETBD were included. Subjects’ inclusion criteria were as followed: symptoms of ETD (aural fullness predominantly, with or without otalgia, muffle hearing and tinnitus), normal tympanic membrane, type A or C tympanograms, and without a history of any middle ear diseases. Main outcomes including subjective improvement, otoscopy, pure-tone audiometry, impedance audiometry, R-value in tubomanometry (TMM) and Eustachian Tube Score (ETS) were assessed 1 week and 6 months postoperatively.RESULTSAll cases were dilated successfully. A significant effect of treatment was documented when measuring subjective improvement, impedance audiometry, R-value in TMM and ETS 1 week and 6 month postoperatively. Subjective symptoms were not relieved only in one patient. The overall success rate for all patients was 98%.CONCLUSIONETBD can provide short-term benefits to those who are diagnosed with SETD and refractory to medical management. SETD might be an optimal indication for ETBD in the treatment of ETD.