Objective To investigate the association of neutrophil-to-lymphocyte ratio(NLR)with all-cause and cause-specific mortality in elderly hypertensive patients.Methods In this cohort study,9939 elderly hypertensive patients were enrolled from the National Health and Nutrition Examination Survey between 1999 and 2018.According to the quartile of NLR,the participants were divided into Q1(n=2461),Q2(n=2460),Q3(n=2522)and Q4(n=2496)groups.Their survival status was determined based on National Death Index records.Cox proportional risk regression model,restricted cubic spline curve,Kaplan-Meier survival analysis and ROC analysis were performed.Results After adjusting for confounding factors,Cox proportional risk regression analysis showed a progressive increase in all-cause and cause-specific mortality across quartiles of NLR in elderly hypertensive patients.Compared with the Q1 group,the Q4 group had higher risks for all-cause mortality(HR=1.52,95％CI:1.32-1.74,P=0.000),cardiovascular mortality(HR=2.04,95％CI:1.63-2.56,P=0.000),and non-cardiovascular mortality(HR=1.30,95％CI:1.11-1.53,P=0.000)after adjustment.Restricted cubic spline curve analysis indicated that NLR was positively correlated with all-cause mortality,cardiovacular mortality and non-cardio-vascular mortality.More pronounced association between NLR and cardiovascular death was observed in patients not taking statins(P=0.035).ROC analysis revealed that the AUC value of NLR in predicting all-cause mortality,cardiovascular mortality and non-cardiovascular mortality was 0.612,0.597 and 0.581,respectively,showing better performance than high-sensitivity C-reac-tive protein and neutrophils.Conclusion Elevated NLR level is independently associated with increased risks of all-cause and cause-specific mortality in elderly hypertensive patients.In the patients not taking statins,a stronger association is observed between NLR and cardiovascular mortality.

Objective To investigate the relationship between abnormal expression of angiotensin-converting enzyme(ACE)and lipoprotein(a)[Lp(a)]with hypertension-diabetes comorbidity.Methods A case-control analysis was conducted on 342 patients with metabolic diseases admitted in our hospital between January 2021 and May 2024,and they were divided into in a diabetes-hypertension comorbidity group(114 cases),a diabetes group(114 cases)and a hypertension group(114 cases).Another 114 matched healthy individuals who taking physical examination in our hospital during the same period were subjected and served as the control group.Clinical data were collected and serum levels of ACE and Lp(a)were measured in all the groups.Multivariate logistic regression analysis was applied to analyze the independent risk factors for hypertension-diabetes comorbidity,and ROC curve analysis was performed to evaluate and predict the efficacy.Results The serum levels of ACE and Lp(a)were significantly higher in the comorbidity group than the control,hypertension and diabetes groups(P＜0.01),and in the hypertension and diabe-tes groups than the control group(P＜0.01).After adjusting for waist-to-hip ratio,alanine amin-otransferase and triglyceride,multivariate logistic regression analysis revealed that serum ACE and Lp(a)still were risk factors for the occurrence of hypertension-diabetes comorbidity(P＜0.01).ROC curve analysis demonstrated that when the cut-off value was 39.01 pg/L,ACE had an AUC value of 0.884(95％CI:0.789-0.980),a sensitivity of 76.67％and a specificity of 75.28％in predicting the comorbidity,and when the cut-off value for Lp(a)was 254.33 mg/L,the AUC value was 0.899(95％CI:0.799-0.919),the sensitivity was 85.83％,and the specificity was 82.22％.Their combination improved the AUC value to 0.993(95％CI:0.979-1.000),with a sensitivity of 95.00％and a specificity of 95.28％in the prediction.Conclusion Serum ACE and Lp(a)are independent risk factors for hypertension-diabetes comorbidity,and can be combined together and regarded as biomarkers for early identification of the comorbidity.

Objective To investigate the correlation between Traditional Chinese Medicine(TCM)constitution types and disease progression in elderly patients with hypertension complicated by heart failure(HF).Methods A total of 200 eligible elderly patients treated in our hospital from June 2021 to June 2023 were recruited,and based on TCM constitution types,they were classified as balanced constitution(n=20,10.0％),qi-deficiency(n=35,17.5％),yang-deficiency(n=30,15.0％),yin-deficiency(n=21,10.5％),phlegm-dampness(n=35,17.5％),damp-heat(n=16,8.0％),blood-stasis(n=25,12.5％),qi-stagnation(n=11,5.5％),and inherited special constitu-tion(n=7,3.5％).TCM constitution,blood pressure,and cardiac function indicators were as-sessed.All patients were followed up for 1 year,and acute exacerbations was recorded to analyze disease progression.Blood pressure,cardiac function indicators,and acute exacerbation frequency were compared among different TCM constitution types,and Spearman correlation analysis was used to assess the relationship between TCM constitution types and the frequency of acute exacer-bations.Results Significant differences were observed in SBP,DBP and frequency of acute exacer-bations among elderly hypertension patients with HF having different TCM constitution types(P＜0.01).The patients with a phlegm-dampness constitution had obviously higher SBP,DBP,mean arterial pressure,stroke volume,central venous pressure and frequency of acute exacerba-tions than those with other constitution types,while the patients with a balanced constitution had the notably highest left ventricular ejection fraction(P＜0.01).Spearman correlation analysis showed that balanced,phlegm-dampness,and blood-stasis constitutions were positively correlated with the frequency of acute exacerbations in these patients(r=0.480,r=0.375,r=0.295,P＜0.01),whereas qi-deficiency constitution was negatively correlated(r=-0.235,P＜0.01).Conclusion Elderly patients with hypertension and HF are predominantly of the qi-deficiency,phlegm-dampness,and yang-deficiency constitution types.Among them,the patients with phlegm-dampness constitution exhibit notably higher blood pressure and cardiac function indicators.TCM constitution types such as balanced and phlegm-dampness are closely related to disease progres-sion in these patients.

Objective To investigate the effect of abnormal iron metabolism on neurological func-tion in elderly patients with hypertensive intracerebral hemorrhage(HICH)after minimally inva-sive surgical evacuation.Methods A prospective study was conducted on 300 elderly patients with HICH admitted to our hospital from January 2021 to December 2023.At 28 d after surgery,Glas-gow Outcome Scale(GOS)was used to assess the presence of neurological deficits or not,and then they were divided into a good neurological function group(GOS score≥4,175 cases)and a poor neurological function group(GOS score＜4,125 cases).Iron deposition in cerebrospinal fluid and serum iron metabolism were compared between the two groups,and the risk factors for neu-rological deterioration were analyzed.Results Compared with the good neurological function group,the poor neurological function group exhibited significantly decreases in Glasgow coma scale(GCS)scores at admission and 7 d after admission and iron ions(P＜0.01).Bleeding vo-lume,ferritin,transferrin,and quantitative susceptibility mapping(QSM)values of the thalamus and the hippocampus were obviously increased upon admission(P＜0.01).Multi variate logistic regression analysis showed that admission bleeding volume(OR=1.083,95％CI:1.012-1.159,P=0.021),ferritin(OR=1.065,95％CI:1.016-1.116,P=0.009),and thalamic QSM value(OR=4.075,95％CI:2.848-5.830,P=0.000)were risk factors for neurological dysfunction in the HICH patients after minimally invasive surgical treatment,while GCS score(OR=0.430,95％CI:0.259-0.715,P=0.001)and iron ions(OR=0.193,95％CI:0.064-0.581,P=0.003)at 7 d of admission were protective factors.Conclusion Iron deposition in cerebrospinal fluid and abnormal iron metabolism in serum are related to the deterioration of neurological function in eld-erly patients with HICH after minimally invasive hematoma evacuation,and are regarded as po-tential therapeutic targets.

Objective To explore the impact of Yixinshu tablet on clinical efficacy and serum levels of microRNA-206(miR-206)and growth differentiation factor-15(GDF-15)in elderly patients with chronic heart failure(CHF).Methods A total of 108 elderly CHF patients admitted in our department from January 2020 to January 2024 were prospectively recruited and then randomly divided into a western medicine group(conventional treatment with western medicine,54 cases)and Yixinshu tablet group(conventional western medicine+Yixinshu tablet,54 cases).General clinical data,efficacy,echocardiographic parameters,myocardial injury markers,vascular endothe-lial function indicators,miR-206 and GDF-15 levels,and incidence of adverse reactions were com-pared between the two groups.Results The total effective rate was significantly higher in the Yixinshu tablet group than the western medicine group(94.44％vs 81.48％,P＜0.05).After treatment,the Yixinshu tablet group obtained obviously higher LVEF,LVFS,and NO and miR-206 levels,but lower cardiac troponin(cTnI),creatine kinase MB isoenzyme(CK-MB),endothe-lin-1(ET-1)and GDF-15 levels when compared with the western medicine group(P＜0.01).There was no statistical difference in the incidence of adverse reactions between the Yixinshu tab-let group and the western medicine group(7.41％vs 5.56％,P＞0.05).Conclusion Yixinshu tab-let shows exact efficacy for elderly CHF patients,and it can effectively relieve cardiac load and im-prove endothelial vascular function and cardiac function,with certain clinical application value.

Objective To construct a prediction model for in-hospital mortality in the elderly(≥65 years)patients undergoing unsynchronous cardioversion in ICU and to evaluate its effectiveness.Methods A retrospective study was conducted on 276 elderly eligible patients in the ICU of the Ninth and the First Medical Centers of Chinese PLA General Hospital between June 2022 and August 2024.According to their clinical outcomes,they were divided into a non-in-hospital dead group(111 cases)and an in-hospital dead group(165 cases).Clinical data were collected,and pre-dictive factors for in-hospital mortality were screened.And then a nomogram prediction model was developed based on the obtained predictive factors,which was evaluated with ROC curve and deci-sion curve analyses.Results When compared to the non-in-hospital dead group,the in-hospital dead group had significantly higher heart rate,ratio of hemodialysis,and levels of alanine amin-otransferase,aspartate aminotransferase,lactate dehydrogenase,alkaline phosphatase,serum cre-atinine,blood glucose,lactate,low base excess,sequential organ failure assessment(SOFA)score,model for end-stage liver disease score,and larger proportions of ventricular fibrillation/flutter and structural heart disease induced by pulseless ventricular tachycardia,and had significantly lower Glasgow Coma Scale(GCS)(P＜0.05).Multivariate logistic regression analysis identified body temperature＞37℃(OR=0.426,95％CI:0.198-0.915,P=0.029),chronic obstructive pulmonary disease(OR=2.333,95％CI:1.217-4.473,P=0.011),GCS score(OR=0.622,95％CI:0.410-0.944,P=0.026),hemoglobin(OR=0.817,95％CI:0.715-0.934,P=0.003),lactate(OR=1.365,95％CI:1.174-1.587,P=0.000),heart rate＞100 bpm(OR=2.757,95％CI:1.397-5.441,P=0.003),and SOFA score(OR=1.112,95％CI:1.032-1.198,P=0.005)as pre-dictors of in-hospital mortality.ROC curve analysis showed an AUC value of above indicators combined together in the prediction was 0.797,with a sensitivity of 76.97％and a specificity of 65.77％.Calibration curve analysis demonstrated good consistency between predicted and observed outcomes.Decision curve analysis indicated favorable clinical utility of the model.Conclusion This study identifies independent risk factors for in-hospital mortality among elderly patients in the ICU who underwent asynchronous cardioversion.Based on these factors,a nomo-gram model is established,demonstrating good discrimination,calibration,and model fit,with high clinical applicability.

Objective To compare the clinical efficacy of PCI with radial artery approach and bra-chial artery approach in acute myocardial infarction(AMI).Methods A retrospective analysis was performed on 173 AMI patients undergoing PCI in Department of Cardiology of Affiliated Hospi-tal of Chengde Medical College from September 2022 to September 2024.According to surgical ap-proach,they were divided into the radial artery group(97 cases)and the brachial artery group(76 cases).The X-ray exposure rate,puncture time,operation time and total hospital stay were observed in the two groups,and the puncture success rate,postoperative complication rate and incidence of 30-day cardiovascular adverse events were compared between the two groups.Results There were statistical differences in puncture time,operation duration and length of hospital stay between the two groups(P＜0.05,P＜0.01).The brachial artery group had a higher puncture success rate than the radial artery group(94.7％vs 90.7％,P=0.390),while the radial artery group had a higher incidence of postoperative complications,adverse vascular events due to coro-nary heart disease(P＜0.05,P＜0.01).Conclusion Both radial artery approach and brachial artery approach for PCI can effectively treat AMI patients.Compared with transradial approach,transbrachial approach can effectively improve the success rate of surgery,reduce postoperative complications and the occurrence of cardiovascular adverse events within 30 d of follow-up.

Objective To investigate the risk factors for AHRE after dual-chamber pacemaker im-plantation in elderly patients without history of atrial fibrillation.Methods A retrospective analy-sis was conducted on 159 elderly patients receiving implantation of cardiac dual-chamber pace-makers in the Chinese PLA General Hospital from January 2018 to December 2020.Based on oc-currence of AHRE or not,they were divided into an AHRE group(73 cases)and a non-AHRE group(86 cases).Cox proportional hazards analysis were performed to analyze the survival and risk factors of AHRE.Results Heart failure(HR=2.134,95％CI:1.212-3.758,P=0.009),his-tory of stroke/transient ischemic attack/thromboembolism(HR=2.378,95％CI:1.293-4.375,P=0.005),atrial sensing amplitude＜2.0 mV(HR=2.258,95％CI:1.307-3.900,P=0.004),NT-proBNP＞900 ng/L(HR=1.740,95％CI:1.024-2.955,P=0.040),and eGFR＜60 ml/(min·1.73 m2)(HR=2.118,95％CI:1.227-3.655,P=0.007)were independent risk factors for new-onset AHRE in elderly patients after dual-chamber pacemaker implantation.Conclusion For elderly patients without history of atrial fibrillation after cardiac dual-chamber pacemaker implan-tations,the occurrence of AHRE is significantly associated with multiple risk factors such as heart failure,history of stroke/transient ischemic attack/thromboembolism,eGFR＜60 ml/(min·1.73 m2),atrial sensing amplitude＜2.0 mV,and NT-proBNP＞900 ng/L.

Objective To explore the correlation of changes in neutrophil gelatinase associated lipocalin(NGAL)and neutrophil to lymphocyte ratio(NLR)with risk of acute kidney injury(AKI)in elderly patients with coronary heart disease(CHD)after PCI.Methods A total of 150 elderly CHD patients admitted in our hospital from September 2020 to September 2024 were ret-rospectively included,and according to whether AKI occurred after PCI,they were divided into AKI group(46 cases)and non-AKI group(104 cases).NGAL and NLR were detected,and the relationship between their changes and risk of AKI after PCI was analyzed.Results The AKI group had significantly advanced age,higher serum creatinine(sCr)level,higher contrast agent dose,and elevated NGAL and NLR levels after PCI than the non-AKI group(P＜0.01).The NGAL and NLR were positively correlated with sCr level(r=0.272,r=0.370,P＜0.01).The NGAL,NLR,age and contrast agent dose were risk factors for AKI after PCI(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of NGAL and NLR in evaluating the risk of AKI after PCI was 0.844(95％CI:0.774-0.913,P=0.000)and 0.854(95％CI:0.779-0.929,P=0.000),respectively.Conclusion Elevated NGAL and NLR levels are related to the risk of AKI in elderly CHD patients after PCI,and they are helpful for early clinical identification.

Objective To investigate the value of fragmented QRS complex(fQRS)in the electro-cardiogram,heart rate variability(HRV)and LVEF in evaluating the prognosis in patients with dilated cardiomyopathy(DCM).Methods A retrospective analysis was conducted on 59 DCM pa-tients admitted in the Second Affiliated Hospital of Wannan Medical College from January 2020 to December 2023.According to the occurrence of MACE during 6-month follow-up period,they were classified into a poor prognosis group(26 cases)and a good prognosis group(33 cases).Clin-ical baseline data,positive rate of fQRS,HRV and LVEF were compared between the two groups.Time-domain measurements of HRV included standard deviation of normal NN intervals(SDNN),standard deviation of the averages of NN intervals in all 5 min segments of the entire recording(SDANN),mean of the standard deviation of NN intervals for all 5 min segments of the entire recording(SDNN index),root mean square of standard deviation of NN intervals(r-MSSD)and HRV triangular index.Spearman/Pearson correlation analysis was performed to analyze the correlation of prognosis of DCM with positive rate of fQRS,HRV and LVEF.ROC curve was drawn to analyze the efficiency of fQRS,HRV and LVEF in predicting the prognosis of DCM.Results The poor prognosis group exhibited significantly higher positive rate of fQRS and obvi-ously reduced SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF when compared with the good prognosis group(P＜0.01).Correlation analysis suggested that poor prognosis of DCM was positively correlated with the positive rate of fQRS(P＜0.01),and negatively with SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of above indicators in turn in predicting the prognosis of DCM was 0.718,0.7 56,0.7 62,0.807,0.858,0.805 and 0.747,respectively,and the AUC value of their combination was 0.980(P＜0.01).Conclusion fQRS,HRV and LVEF have important cor-relation with poor prognosis of DCM patients.Their combination can be used as an effective mark-er for clinical evaluation and prediction of poor prognosis of DCM.