OBJECTIVE: To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event. METHODS: One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event. RESULTS: CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035). CONCLUSION The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.
Humans ; Heart Failure/physiopathology* ; Microcirculation ; Percutaneous Coronary Intervention/adverse effects* ; Myocardial Infarction/complications* ; Male ; Female ; Hospitalization ; Middle Aged ; Aged ; Echocardiography ; Coronary Circulation ; Predictive Value of Tests ; Troponin I/blood*

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Aim To investigate the correlation between serum solube growth stimulation expressed gene 2 protein(sST2)and early reperfusion arrhythmia(ERA)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 202 STEMI patients who under-went emergency PCI from November 2020 to August 2022 in the Cardiac Center of Liaoning Provincial People's Hospital were divided into two groups based on the occurrence of ERA within 48 hours after PCI:ERA group and non-ERA group.Serum sST2 level and clinical data were compared between the groups.Univariable and multivariable Logistic regression analysis were used to explore the association between serum sST2 level and ERA occurrence,and restricted cubic spline model was applied to identify independent risk factors for ERA.Results There were 83(41.1％)patients experi-enced ERA within 48 hours after PCI.Compared with the non-ERA group,the patients in ERA group had shorter time from chest pain to reperfusion and higher serum sST2 level(P＜0.001).Multivariate Logistic regression analysis showed that for STEMI patients,elevated serum sST2 level(sST2≥45.03 μg/L),early reperfusion time(chest pain to successful reperfusion time≤5.23 h),high thrombosis burden,and right coronary artery as the infarct related artery(IRA)were in-dependent risk factors for ERA after emergency PCI.The restricted cubic spline model suggested that the serum sST2 lev-el of STEMI patients was nonlinearly correlated with the risk of ERA after PCI(P＜0.01),and the cutoff point was 45.12 μg/L.ROC curve analysis showed that the area under the ROC curve of serum sST2 level in predicting ERA oc-currence after PCI was 0.827(95％CI:0.771～0.883).Conclusion The high serum sST2 level before PCI is an independent risk factor for ERA occurrence after PCI in patients with STEMI.When serum sST2＞45.12 μg/L,its level is positively correlated with the risk of ERA.

Aim To investigate the correlation between serum solube growth stimulation expressed gene 2 protein(sST2)and early reperfusion arrhythmia(ERA)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 202 STEMI patients who under-went emergency PCI from November 2020 to August 2022 in the Cardiac Center of Liaoning Provincial People's Hospital were divided into two groups based on the occurrence of ERA within 48 hours after PCI:ERA group and non-ERA group.Serum sST2 level and clinical data were compared between the groups.Univariable and multivariable Logistic regression analysis were used to explore the association between serum sST2 level and ERA occurrence,and restricted cubic spline model was applied to identify independent risk factors for ERA.Results There were 83(41.1％)patients experi-enced ERA within 48 hours after PCI.Compared with the non-ERA group,the patients in ERA group had shorter time from chest pain to reperfusion and higher serum sST2 level(P＜0.001).Multivariate Logistic regression analysis showed that for STEMI patients,elevated serum sST2 level(sST2≥45.03 μg/L),early reperfusion time(chest pain to successful reperfusion time≤5.23 h),high thrombosis burden,and right coronary artery as the infarct related artery(IRA)were in-dependent risk factors for ERA after emergency PCI.The restricted cubic spline model suggested that the serum sST2 lev-el of STEMI patients was nonlinearly correlated with the risk of ERA after PCI(P＜0.01),and the cutoff point was 45.12 μg/L.ROC curve analysis showed that the area under the ROC curve of serum sST2 level in predicting ERA oc-currence after PCI was 0.827(95％CI:0.771～0.883).Conclusion The high serum sST2 level before PCI is an independent risk factor for ERA occurrence after PCI in patients with STEMI.When serum sST2＞45.12 μg/L,its level is positively correlated with the risk of ERA.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Objectives:To evaluate the impact of global longitudinal strain(GLS)for prognosis in ST-segment elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention(PCI). Methods:We enrolled 156 STEMI patients who underwent PCI and spackle tracking imaging(STI)during hospitalization from September 2020 to August 2023.Patients with Killip Ⅱ-Ⅳ at baseline were excluded,138 patients were finally included.GLS was detected by STI.Patients were divided into more impaired group(GLS>-11.7%,n=57)and less impaired group(GLS≤-11.7%,n=81)according to Youden index.Clinical characteristics and echocardiography data were analyzed.Patients were followed up for a median of 21(13,28)months.Heart failure events were compared between the two groups. Results:The peak troponin I(TnI)was significantly higher in patients with GLS>-11.7%than those with GLS≤-11.7%at admission(85 160[31 297,214 226]pg/ml vs.34 942[13 571,92 713]pg/ml,P<0.001).Culprit vessel was different between the 2 groups(P<0.001).Compared with patients with GLS≤-11.7%,patients with GLS>-11.7%had lower left ventricular ejection fraction(LVEF)([60.1±8.7]%vs.[49.2±8.3]%,P<0.001),higher proportion of regional wall motion abnormality(90.1%vs.100%,P=0.015).Both LVEF and GLS recovered in patients with GLS>-11.7%during follow-up,but remained lower as compared to patients with GLS≤-11.7%(both P<0.001).The median follow-up time was 21(13,28)months.After adjusting age,sex,culprit vessel and peak TnI,the risk of heart failure of patients with GLS>-11.7%was significant higher(HR=9.123,95%CI:1.720-43.394,P=0.009). Conclusions:STEMI patients with more impaired GLS have a higher risk of heart failure post PCI.

ObjectiveTo investigate the effect and mechanism of total saponins from Panax japonicus （TSPJ） on white adipose tissue （WAT） browning/brown adipose tissue （BAT） activation in C57BL6/J male mice fed on a high-fat diet （HFD）. MethodThirty-two C57BL6/J male mice （8-week-old） were randomly divided into a normal group， a model group， a low-dose TSPJ group， and a high-dose TSPJ group. The mice in the low-dose and high-dose TSPJ groups were given TSPJ for four months by gavage at 25， 75 mg·kg^-1·d^-1， respectively， and those in the other groups were given 0.5% sodium carboxymethyl cellulose （CMC-Na） accordingly. After four months of feeding， all mice were placed at 4 ℃ for acute cold exposure， and the core body temperature was monitored. Subsequently， all mice were sacrificed， and BAT and inguinal WAT （iWAT） were separated rapidly to detect the corresponding indexes. Hematoxylin-eosin （HE） staining was used to observe the morphological changes in each group. The effect of TSPJ on the mRNA expression of uncoupling protein 1 （UCP1）， fatty acid-binding protein 4 （FABP4）， cytochrome C （CytC）， PR domain-containing protein 16 （PRDM16）， elongation of very long chain fatty acids protein 3 （ELOVL3）， peroxisome proliferator-activated receptor γ （PPARγ）， and peroxisome proliferator-activated receptor-γ coactivator-1α （PGC-1α） in iWAT and BAT was detected by Real-time polymerase chain reaction （Real-time PCR）. Western blot was also used to detect the protein expression of UCP1， PRDM16， PPARγ， and PGC-1α in BAT and iWAT of each group. The effect of TSPJ on UCP1 expression in BAT and iWAT was detected by immunohistochemistry. Result① Compared with the model group， TSPJ could decrease the body weight and proportions of iWAT and BAT in the HFD-induced mice （P<0.05， P<0.01）. ② The body temperature of mice in the model group decreased compared with that in the normal group in the acute cold exposure tolerance test （P<0.05）. The body temperature in the high-dose TSPJ group increased compared with that in the model group （P<0.01）. ③ Compared with the normal group， the model group showed increased adipocyte diameter in iWAT and BAT and decreased number of adipocytes per unit area. Compared with the model group， the TSPJ groups showed significantly reduced cell diameter and increased number of cells per unit area， especially in the high-dose TSPJ group. ④ Compared with the normal group， the model group showed decreased mRNA expression of FABP4， UCP1， CytC， PRDM16， ELOVL3， PGC-1α， and PPARγ in adipose tissues of mice （P<0.05， P<0.01）. Compared with the model group， after intervention with TSPJ， the mRNA expression was significantly up-regulated （P<0.05， P<0.01）. ⑤ Compared with the normal group， the model group showed decreased protein expression of UCP1， PRDM16， PPARγ， and PGC-1α in adipose tissues of mice （P<0.05， P<0.01）. Compared with the model group， after intervention with TSPJ， the protein expression increased significantly （P<0.05， P<0.01）. ConclusionTSPJ could induce the browning of iWAT/BAT activation and enhance adaptive thermogenesis in obese mice induced by HFD. The underlying mechanism may be attributed to the activation of the PPARγ/PGC-1α signaling pathway.

Objective:To investigate whether long non-coding RNA(lncRNA) AW112010 can improve insulin resistance in aging adipocytes through the miR-204/POU2F2 signaling pathway.Methods:In vivo experiment: C57BL/6 mice were divided into young control group(4 months old) and aging model group(18 months old) based on body weight. The expression levels of AW112010, miR-204-5p, POU2F2, aging related indicators(p16, p21), and insulin signaling pathway genes [insulin receptor(INSR), insulin receptor substrate 1(IRS1), phosphatidylinositol kinase(PI3K), protein kinase B(AKT)] in epididymal adipose tissue were detected using real-time fluorescence quantitative PCR(RT-qPCR) and Western blotting. In vitro experiment: Using adriamycin(ADR) to induce 3T3-L1 aging adipocyte model, β-gal staining was used to observe cellular senescence, and miR-204 inhibitor and miR-204 mimic small interfering RNA were successfully constructed and transfected into 3T3-L1 adipocytes. Results:RT-qPCR and Western blot results showed that compared with the young group, the expression of AW112010 in the adipose tissue of aging mice was increased, while the expression of miR-204-5p was decreased. The expressions of POU2F2, p16, and p21 in the adipose tissue of aging mice were increased, while the expressions of INSR, IRS1, PI3K, GLUT4 mRNA and protein were decreased. The β-gal stainging results showed that the number of 3T3-L1 senescent adipocytes induced by ADR was significantly increased, and the expression levels of AW112010, POU2F2, p16, and p21 in ADR-induced senescent adipocytes were increased compared with the control group, while the expression levels of miR-204-5p, INSR, IRS1, PI3K, GLUT4 were decreased, and remaining glucose in the culture medium was increased. Compared with control, overexpression of miR-204 resulted in decreased expressions of aging indicators p16, p21, and target gene POU2F2 while the expressions of INSR and GLUT4 were increased.Conclusion:Upregulation of lncRNA AW112010 in adipocytes of aging mice may induce insulin resistance by targeting miR-204-5p/POU2F2/IRS1.

Objective: To analyze the clinicopathological features of primary hyperthyroidism complicated with thyroid carcinoma. Methods: From January 2010 to July 2018, 418 patients complicated with thyroid cancer underwent thyroidectomy in the First Affiliated Hospital of Xiamen University were retrospectively analyzed.According to thyroid function, 418 patients were divided into two group: A group(n=39) had hyperthyroidism with thyroid carcinoma, and B group(n=379) had normal thyroid function.The clinicopathological features of the two groups were analyzed and compared. Results: There were no statistically significant differences in age, sex, tumor stage and tumor diameter between the two groups(all P>0.05). The lymph node metastasis rate in A group was 17.9%(7/39), which was higher than that in B group[6.1%(23/379)](χ²=5.814, P=0.016). The incidence rate of temporary hypoparathyroidism in A group was 28.2%(11/39), which was higher than that in B group[13.2%(50/379)](χ²=6.394, P<0.05). The local recurrence rate in A group was 5.1%(2/39), which was higher than that in B group[2.4%(9/379)], but there was no statistically significant difference(χ²=0.248, P=0.619). The 5-year disease-free survival rate in A group was 84.6%(33/39), which was lower than that in B group [95.8%(363/379)](χ²=6.740, P<0.05). Conclusion Hyperthyroidism complicated with thyroid carcinoma has high aggressive behavior and should be treated actively.

Objective To understand the prevalence,treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province.Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern,northern and central Anhui Province were investigated.Their demographic characteristics,primary disease,complications,medications,dialysis and laboratory examination were explored.The prevalence treatment rate and control rate of hypertension were analyzed.Associated factors for controlling hypertension [systolic blood pressure (SBP) ＜ 140 mmHg and diastolic blood pressure (DBP) ＜ 90 mmHg] were assessed by logistic regression analysis.Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0％.Their treatment rate and control rate were 93.2％ and 23.9％ respectively.The average of SBP was (145.90±21.18) mmHg,and the DBP on average was (83.60± 12.21) mmHg.The most commonly used anti-hypertensive drug is calcium channel blocker (88.2％).Over one third (45.7％) of patients were treated with two kinds of anti-hypertensive drug,26.2％ with 1 kind,21.7％ with 3 kinds,and 6.4％ with 4 kinds or more.(2) Compared with non-hypertension patients,patients with hypertension have older age,higher body mass index (BMI),phosphorus,SBP and DBP,as well as lower hemoglobin and Kt/V (all P ＜ 0.05).(3) The multivariate logistic regression analysis showed that Ca ＞ 2.50 mmol/L (OR=2.084,95％CI 1.008-4.307,P=0.047) positively correlated with controlling hypertension,while smoke (OR=0.594,95％CI 0.356-0.911,P=0.046) and BMI 18.5 ～ 23.9 kg/m2 (OR=0.516,95％CI 0.293-0.907,P=0.022) negatively correlated with it.Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed.Hypocalcemia may be a protective factor for hypertension control,while smoke and BMI may be risk factors for it.