BACKGROUND: Biomarkers-based prediction of long-term risk of acute coronary syndrome (ACS) is scarce. We aim to develop a risk score integrating clinical routine information (C) and plasma biomarkers (B) for predicting long-term risk of ACS patients. METHODS: We included 2729 ACS patients from the OCEA (Observation of cardiovascular events in ACS patients). The earlier admitted 1910 patients were enrolled as development cohort; and the subsequently admitted 819 subjects were treated as validation cohort. We investigated 10-year risk of cardiovascular (CV) death, myocardial infarction (MI) and all cause death in these patients. Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was derived using main part of these variables. RESULTS: During 16,110 person-years of follow-up, there were 238 CV death/MI in the development cohort. The 7 most important predictors including in the final model were NT-proBNP, D-dimer, GDF-15, peripheral artery disease (PAD), Fibrinogen, ST-segment elevated MI (STEMI), left ventricular ejection fraction (LVEF), termed as CB-ACS score. C-index of the score for predication of cardiovascular events was 0.79 (95% CI: 0.76-0.82) in development cohort and 0.77 (95% CI: 0.76-0.78) in the validation cohort (5832 person-years of follow-up), which outperformed GRACE 2.0 and ABC-ACS risk score. The CB-ACS score was also well calibrated in development and validation cohort (Greenwood-Nam-D'Agostino: P = 0.70 and P = 0.07, respectively). CONCLUSIONS CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS. This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.

BACKGROUND: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD. METHODS & RESULTS: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology. CONCLUSION The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

Objective To observe the body surface calorific value characteristics of Governor Vessel and Conception Vessel,triple energizer,and zang-fu organs chronic insomnia patients with heart-spleen deficiency syndrome through infrared thermal imaging technology.Methods Totally 150 patients with chronic insomnia with heart-spleen deficiency syndrome who were treated in the outpatient department of Shenzhen Hospital of Beijing University of Chinese Medicine(Longgang)from December 2021 to December 2022 were selected as the observation group.Another 50 healthy subjects were recruited as the normal control group.Infrared thermal imaging technology was used to collect and measure the temperature of surface areas of Governor Vessel and Conception Vessel,triple energizer,and zang-fu organs,and the calorific values were analyzed and compared.Results Compared with healthy subjects,chronic insomnia patients with heart-spleen deficiency syndrome had a statistically significant decrease in the temperature of the Governor Vessel(P<0.05);there were statistically significant decreased in the temperature of upper energizer and middle energizer(P<0.05);there were statistically significant decreased in the temperature of chest,apex,right chest,epigastric region,big abdomen,and the temperature of left and right flank increased(P<0.05).Conclusion There were significant differences in infrared thermography distribution characteristics of Governor Vessel and Conception Vessel,triple energizer,and zang-fu organs between patients with chronic insomnia with heart-spleen deficiency syndrome and healthy subjects,which can provide some reference for the clinical diagnosis and syndrome differentiation of chronic insomnia with heart-spleen deficiency syndrome.

This paper aimed to explain the clinical thinking of using the method of unblocking the bowels and harmonizing viscera. Based on theory of "viscera-bowels extraordinary connection" of The Gateway to Medicine （《医学入门》）， combined with the theoretical research， clinical practice and individual experience of ancient physicians， modern scholars， it is believed that viscera qi disorder caused by bowels qi blocking is the basic mechanism of insomnia. In clinic， it is common that gallbladder phlegm-heat harassing the heart spirit， stagnant blood and qi in stomach blocking the pericardium， turbid heat in large intestine causing fire and affecting liver， dampness insmall intestine trapping the spleen， water retention in the bladder drying up lungs， and the inhibited original qi of sanjiao damaging the kidney， which could be treated with Wendan Decoction （温胆汤）， Taohe Chengqi Decoction （桃核承气汤）， Chengqi-series Decoction （承气汤类方）， Linggui Zhugan Decoction （苓桂术甘汤）， Wuling Powder （五苓散）， Xiaochaihu Decoction （小柴胡汤）， respectively.

Objective:To investigate the possible mechanism of DiI labeled bone marrow mesenchymal stem cells (BMSCs) in contact co-cultured with neonatal rat cardiomyocytes (CMs) on polycaprolactone (PCL) film to make myocardial patch.Methods:BMSCs from Sprague Dawley rats (aged 5-6 weeks) were isolated, cultured, and characterized for surface marker expression using flow cytometry. CMs from 15 neonatal rats were isolated and cultured. After cultured for 3 generations, BMSCs were labeled with DiI dye. On PCL film, DiI labeled BMSCs were co-cultured with CMs as the experimental group, and CMs were replaced with the same amount of unlabeled BMSCs in the control group. After 24 h of co-culture, the cell growth was observed under fluorescence microscope and the co-culture was observed under scanning electron microscope. Immunofluorescence staining was performed after 7 days to detect myocardial markers, including cardiac troponin T (cTnT) and α-actinin. BMSC differentiation on the PCL film was observed under a fluorescence microscope. The differentiation efficiency of BMSCs into cardiomyoid cells was analyzed by flow cytometry on days 1 and 7 of co-culture. Intercellular dye transfer was observed by staining CMs with calcein and co-culturing them with DiI-labeled BMSCs on PCL film. The cells were stained with immunofluorescence to detect the expression of connexin 43 (Cx43) and observe the relationship between gap junction and contact co-culture.Results:Flow cytometry showed strong positivity for CD90 and CD44 and negativity for CD11b/c and CD45 on BMSCs. After 24 h of co-culture, DiI labeled BMSCs glowed red on the PCL film, while unlabeled CMs did not; the number of cells on PCL film was large and cell morphology appeared normal under scanning electron microscope. On the 7th day of co-culture, some DiI labeled BMSCs expressed cTnT and α-actinin. Flow cytometry showed a higher differentiation rate of stem cells in the experimental group on day 7 compared to the control group ((20.12±0.15)% vs. (3.49±0.20)%, P<0.05). From the second day of co-culture, some BMSCs exhibited green dot fluorescence in Cx43 immunofluorescence staining; and by the third day, dye transfer test showed green fluorescence emission from some BMSCs. Conclusion:Contact co-culture of DiI labeled BMSCs and CMs on PCL film can make myocardial patch. The mechanism of contact co-culture promoting the differentiation and formation of myocardial patch may be associated with gap junctions and intercellular signal pathways mediated by gap junctions.

Objective To develop the'E-Bone',a comprehensive one-stop preoperative planning system for reverse total shoulder arthroplasty with improved accuracy and efficiency.Methods The nnU-net deep neural network was utilized for scapula segmentation to obtain precise scapula segmentation results.Based on the 3 key factors,namely bone density,upward and downward angle and nail length,the base was automatically positioned.The quantitative parameters required for surgical planning were calculated.A personalized guide plate was generated by combining glenoid morphology and base positioning information.The system interface was developed to modularize various functions for easy use,providing interactive operation and real-time display.Results Compared with the Mimics system,the'E-bone'preoperative planning system reduced complex manual adjustments during the planning process.The average planned nail length was longer than that of the Mimics system,and the planning time was reduced by 86%.The scapula segmentation accuracy of this system reached 99.93%,better than that of Mimics to achieve a higher precision.Conclusion The"E-bone"system provides a one-stop,efficient,and accurate preoperative planning system for reverse shoulder replacement and potentially broader clinical applications.

Primary immune thrombocytopenia(ITP)is an autoimmune disease characterized by thrombocytopenia,and T cell immune dysfunction plays an important role in the formation of ITP.As a thrombopoietin receptor agonist(TPO-RA),eltrombopag can not only directly stimulate megakaryocytes to produce platelets,but also play an immunomodulatory role by inducing regulatory T cell generation and reducing proinflammatory factors.As a second-line treatment drug for adult ITP,eltrombopag is increasingly widely used in clinical practice.This review summarized the latest research progress on the mechanism of action,efficacy,safety,and how to reduce the dosage of eltrombopag in ITP.

Objective To investigate the current status of taste disorders in type 2 diabetes mellitus(T2DM)and to explore whether the taste disorders persists after 3 months of novel corona virus(COVID-19)infection.Methods 95 T2DM out patients(23 without COVID-19 infection history,72 infected with COVID-19 3～4 months ago)visiting the Endocrine Department of the Strategic Support Force Medical Center from February 20 to March 10,2023 were collected.Taste test box was used to test the taste function.General information,biochemical indicators,taste disorders,etc.were compared between the two groups.Results The average age of T2DM patients in this group was(58.3±9.6)years old,61 patients were male(64.2%),the median duration of DM was 11 years,and the median HbA1c was 7.3%.In taste testing,the proportion of sour,sweet,bitter,salty taste perception disorders was 60.0%,45.3%,57.9%,41.1%,84.2%.The average number of days from infection to enrollment into COVID-19 group was 102.4 days.The proportion of acid,sweet,bitter and salty sensory disorders was 61.1%,44.4%,55.6%and 41.7%in COVID-19 group and 56.5%,47.8%,65.2%and 39.1%in non-COVID-19 group.The prevalence of taste disorders in COVID-19 group was higher than that in non-COVID-19 group(86.1%vs 78.3%).Conclusions Taste disorders are common in T2DM patients.Compared with uninfected T2DM patients,there is no significant difference in the prevalence of taste disorders 3 months after COVID-19 infection.

Thyroid cancer is the common malignant tumor in the neck, and surgery is the important treatment measure for it. Some patients suffer from hypoparathyroidism and hypocalcemia after thyroidectomy, which will seriously affect the patient’s life quality and prognosis. This article reported a case of 42 years old female patient with hypocalcemia for 6 years after total thyroidectomy due to thyroid cancer, who still had frequent hypocalcemia with high dose of oral calcium and active vitamin D supplementation. Long-term and frequent facial and limb numbness, convulsions, epileptic-like seizures and sudden unconsciousness afflicted her due to hypocalcemia. After admission, her symptoms were obviously relieved after one week of adequate calcium supplementation through oral administration or intravenous infusion under close monitoring. Upon discharge she was able to maintain the normal level of blood calcium by decreased dose of oral calcium supplementation alone. Long-term limb numbness, convulsions, low back pain, shoulder pain, walking instability and other symptoms disappeared basically. The epileptic-like seizures did not recur. During six months of follow-up, her blood calcium was still well controlled in normal level.