1.Research on The Genealogical Inference Efficiency of High-density SNPs
Jing LI ; Yi-Jie SUN ; Wen-Ting ZHAO ; Zi-Chen TANG ; Jing LIU ; Cai-Xia LI
Progress in Biochemistry and Biophysics 2026;53(3):740-753
ObjectiveThis study aims to explore the potential of different orders of magnitude single-nucleotide polymorphism (SNP) locus combinations for predicting distant kinship relationships. A high-density SNP locus set was constructed, and a comprehensive assessment of its inference capability was conducted. MethodsFirstly, we selected three commercial chip panels, CGA (Chinese genotyping array, Illumina), GSA (Global screening array, Illumina), Affy (23MF_V2 high-density SNP array, Affymetrix) and merged them after quality control, forming a high-density SNP locus panel(1 180 k). Secondly, we selected 161 samples and collected their peripheral blood samples by using whole-genome sequencing technology. Within this sample population, the levels of kinship relationships fully covered the range from level 1 to level 9, and the number of kinship pairs at each level was consistently maintained at over 50 pairs. From 161 samples data of whole-genome sequencing, the 1 180 k locus set was extracted, which is referred to as the high-density SNP locus set in the following text. The kinship inference was conducted using the identity-by-descent (IBD) algorithm with the selected optimal parameters. To comprehensively evaluate the performance of the high-density SNP locus set in kinship inference, we compared it with the three commercial chip panels, the intersection of these three chip loci, and the control sets constructed by randomly reducing the number of the high-density SNP locus set. Based on the changes in the IBD lengths, as well as the dynamic trends in prediction accuracy, we conducted a scientific assessment of the kinship inference capability of the high-density SNP locus set. ResultsAfter screening, a set of 1 184 334 autosomal SNPs was obtained. During the process of screening the optimal IBD length threshold, the result revealed that 0 cM, 1 cM, and 2 cM all demonstrated good applicability. However, to avoid the issue of a large amount of redundant information caused by setting a too low IBD length threshold, this study ultimately selected 2 cM as the optimal threshold. Compared with the average results of three chip panels, the high-density SNP locus set increased the total IBD length and the average IBD length across levels 1-9; the accuracy of the confidence interval for level 8 was 70.97%, which represented a 3.50% improvement; the average confidence interval accuracy for levels 1-8 was 91.39%, representing a 1.00% increase; and the false negative rates at levels 8 and 9 were reduced by 2.42% and 6.76%, respectively. The system efficacy of the high-density SNP locus set for kinship inference of first to eighth degree relationships reached 98.91%. Through random reduction of the high-density SNP locus set results, it is found that increasing the number of SNPs with the panel, the detection efficiency of IBD length showed a significant upward trend. At the same time, the overall trend in the accuracy of kinship relationship prediction as well as the confidence interval accuracy also indicated that both metrics steadily increased with the addition of more loci. ConclusionThe results show that the high-density SNPs panel significantly enhances the efficacy of distant kinship inference, accurately covering kinship degrees, with the average confidence interval accuracy for first to eighth degree relationships stably above 90%. The study finds that increasing the number of SNPs panel can improve the ability to predict distant kinship.
2.Identification and infection rate of densovirus in Culex pipiens pallens in Beijing in 2023
Xiu-yan XU ; Ting YAN ; Si-jie ZHU ; Jing LI ; Mei-de LIU ; Hong-jiang ZHANG ; Ting LIU ; Qiu-hong LI ; Xiao-jie ZHOU ; Ying TONG ; Yong ZHANG
Acta Parasitologica et Medica Entomologica Sinica 2026;33(1):25-30
Objective This study conducted molecular biological identification of the viruses carried by Culex pipiens pallens specimens collected in Shunyi District, Beijing in 2023, and observed the changes in the infection rate of the viruses carried by Cx. pipiens pallens at different collection times. Methods Cx. pipiens pallens were collected using carbon dioxide mosquito traps. The mosquito samples were ground in batches and analyzed by molecular biology technologies. The virus infection rate at different collection times was analyzed statistically. Results 17 strains of Culex pipiens pallens densovirus(CppDNV)were identified from Cx. pipiens pallens samples collected in Shunyi District, Beijing, in 2023. The nucleotide sequence analysis of the virus genome coding region showed that CppDNV was a single-stranded DNA virus with a total length of 3 335 nt, encoding 2 non-structural proteins(NS1, NS2)and 1 capsid protein(VP). The nucleotide(amino acid)sequence lengths of the three proteins were 2 376 nt(791 aa),1 092 nt(363 aa)and 1 071 nt(356 aa), respectively. Phylogenetic analysis showed that CppDNV was located in genus Brevihamaparvovirus. Statistical analysis showed no significant difference in infection rates across collection times(χ2=4.429, P=0.194). Conclusions CppDNV was identified in Cx. pipiens pallens in Beijing, and it was stably maintained in this natural population.
3.Buzhong Yiqitang Regulates Mitochondrial Homeostasis of Skeletal Muscle via PINK1 Pathways to Resist Exercise-induced Fatigue
Huani WEI ; Ting JIANG ; Juan PENG ; Chunxiang JING ; Wei LIU ; Huashan PAN ; Daorui CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):31-39
ObjectiveTo explore the effect of Buzhong Yiqitang on exercise-induced fatigue and its potential mechanism. MethodsSixty male SPF-grade C57BL/6J mice were randomized into blank, model, low-, medium-, high-dose (4.1, 8.2, 16.4 g·kg-1, respectively) Buzhong Yiqitang, and vitamin C (0.04 g·kg-1) groups. The blank and model groups were administrated with normal saline. Each group was administrated with corresponding agents by gavage at a dose of 0.2 mL once a day. Except the blank group, other groups underwent a 6-weeks exhaustive swimming test under negative gravity. At the end of the experiment, blood was collected, and the thymus, spleen, liver, and kidney weights were measured. Serum levels of lactic acid (LD), blood urea nitrogen (BUN), creatine kinase (CK), and malondialdehyde (MDA) were assessed by kits to evaluate fatigue. Hematoxylin-eosin staining was performed to observe pathological changes in the skeletal muscle. Electron microscopy was used to examine the skeletal muscle cell ultrastructure, with a focus on mitochondrial morphological changes. The adenosine triphosphate (ATP) content and activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ in skeletal muscle were determined by kits. The expression levels of key genes and proteins in the PTEN-induced putative kinase 1 (PINK1)-mediated mitochondrial homeostasis pathways in the skeletal muscle were evaluated via Real-time PCR and Western blot, respectively. ResultsCompared with the blank group, the model group showed reductions in weight gain rate (P<0.01) and thymus index (P<0.01), rises in serum levels of LD, BUN, MDA, and CK (P<0.01), disarrangement of skeletal muscle, broken muscle fibers, inflammatory cell infiltration in muscle fiber gaps, abnormal morphological changes (increased vacuolated mitochondria and disappearance of cristae) of mitochondria in skeletal muscle cells, and decreased mitochondria. In addition, the skeletal muscle in the model group showed reduced content of ATP, weakened activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05), up-regulated mRNA levels of PINK1, E3 ubiquitin-protein ligase (Parkin), hairy/enhancer-of-split related with YRPW motif 1 (HEY1), dynamin-related protein 1 (Drp1), sequestosome 1 (p62), and hypoxia-inducible factor 1 alpha (HIF-1α) (P<0.05), and down-regulated protein level of microtubule-associated protein 1-light chain 3B (LC3B) (P<0.01). Compared with the model group, Buzhong Yiqitang prolonged the swimming exhaustion time (P<0.01), increased the weight gain rate (P<0.01) and thymus index (P<0.01), lowered the serum levels of LD, BUN, MDA, and CK (P<0.05, P<0.01). The skeletal muscle in the Buzhong Yiqitang groups showed neat arrangement, reduced inflammatory cells, intact mitochondria with dense cristae, and increased mitochondria. In addition, the skeletal muscle in the Buzhong Yiqitang groups showcased increased ATP content, enhanced activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05, P<0.01), up-regulated protein levels of PINK1, Parkin, HEY1, LC3B, and Drp1 and mRNA level of HIF-1α (P<0.05, P<0.01), and down-regulated expression level of p62 (P<0.05, P<0.01). ConclusionBuzhong Yiqitang can prevent and treat exercise-induced fatigue by regulating the mitochondrial homeostasis of skeletal muscle via the HIF-1α/PINK1/Parkin and HIF-1α/HEY1/PINK1 signaling pathways.
4.Buzhong Yiqitang Regulates Mitochondrial Homeostasis of Skeletal Muscle via PINK1 Pathways to Resist Exercise-induced Fatigue
Huani WEI ; Ting JIANG ; Juan PENG ; Chunxiang JING ; Wei LIU ; Huashan PAN ; Daorui CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):31-39
ObjectiveTo explore the effect of Buzhong Yiqitang on exercise-induced fatigue and its potential mechanism. MethodsSixty male SPF-grade C57BL/6J mice were randomized into blank, model, low-, medium-, high-dose (4.1, 8.2, 16.4 g·kg-1, respectively) Buzhong Yiqitang, and vitamin C (0.04 g·kg-1) groups. The blank and model groups were administrated with normal saline. Each group was administrated with corresponding agents by gavage at a dose of 0.2 mL once a day. Except the blank group, other groups underwent a 6-weeks exhaustive swimming test under negative gravity. At the end of the experiment, blood was collected, and the thymus, spleen, liver, and kidney weights were measured. Serum levels of lactic acid (LD), blood urea nitrogen (BUN), creatine kinase (CK), and malondialdehyde (MDA) were assessed by kits to evaluate fatigue. Hematoxylin-eosin staining was performed to observe pathological changes in the skeletal muscle. Electron microscopy was used to examine the skeletal muscle cell ultrastructure, with a focus on mitochondrial morphological changes. The adenosine triphosphate (ATP) content and activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ in skeletal muscle were determined by kits. The expression levels of key genes and proteins in the PTEN-induced putative kinase 1 (PINK1)-mediated mitochondrial homeostasis pathways in the skeletal muscle were evaluated via Real-time PCR and Western blot, respectively. ResultsCompared with the blank group, the model group showed reductions in weight gain rate (P<0.01) and thymus index (P<0.01), rises in serum levels of LD, BUN, MDA, and CK (P<0.01), disarrangement of skeletal muscle, broken muscle fibers, inflammatory cell infiltration in muscle fiber gaps, abnormal morphological changes (increased vacuolated mitochondria and disappearance of cristae) of mitochondria in skeletal muscle cells, and decreased mitochondria. In addition, the skeletal muscle in the model group showed reduced content of ATP, weakened activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05), up-regulated mRNA levels of PINK1, E3 ubiquitin-protein ligase (Parkin), hairy/enhancer-of-split related with YRPW motif 1 (HEY1), dynamin-related protein 1 (Drp1), sequestosome 1 (p62), and hypoxia-inducible factor 1 alpha (HIF-1α) (P<0.05), and down-regulated protein level of microtubule-associated protein 1-light chain 3B (LC3B) (P<0.01). Compared with the model group, Buzhong Yiqitang prolonged the swimming exhaustion time (P<0.01), increased the weight gain rate (P<0.01) and thymus index (P<0.01), lowered the serum levels of LD, BUN, MDA, and CK (P<0.05, P<0.01). The skeletal muscle in the Buzhong Yiqitang groups showed neat arrangement, reduced inflammatory cells, intact mitochondria with dense cristae, and increased mitochondria. In addition, the skeletal muscle in the Buzhong Yiqitang groups showcased increased ATP content, enhanced activities of mitochondrial respiratory chain complexes Ⅰ, Ⅱ, and Ⅴ (P<0.05, P<0.01), up-regulated protein levels of PINK1, Parkin, HEY1, LC3B, and Drp1 and mRNA level of HIF-1α (P<0.05, P<0.01), and down-regulated expression level of p62 (P<0.05, P<0.01). ConclusionBuzhong Yiqitang can prevent and treat exercise-induced fatigue by regulating the mitochondrial homeostasis of skeletal muscle via the HIF-1α/PINK1/Parkin and HIF-1α/HEY1/PINK1 signaling pathways.
5.Practical research on nursing coordination training for rapid sequential intubation in children based on LSPPDM framework
Yu-xia YANG ; Jing HU ; Wei-ming CHEN ; Ye CHENG ; Wei-jie SHEN ; Yi ZHANG ; Ting-ting XUE ; Bei-bei WANG ; Yu-qing WANG ; Pan LIU ; Ying-ying ZHANG ; Guo-ping LU ; Ying GU
Fudan University Journal of Medical Sciences 2025;52(6):847-853
Objective To investigate the practical effects of pediatric rapid sequence intubation(RSI)nursing coordination training based on the LSPPDM(learn,see,practice,prove,do,maintain)framework in order to provide evidence for optimizing pediatric RSI nursing training programs.Methods Nurses from the intensive care unit(ICU)of Children's Hospital,Fudan University during Feb 2023 and Jan 2024 were divided into the experimental group(n=35)and the control group(n=35)by block randomization.The experimental group received LSPPDM framework-based training,while the control group underwent conventional training with theoretical lectures and procedural demonstrations.Outcomes included training satisfaction,theoretical knowledge and procedural skill assessment scores,team collaboration compliance and RSI procedure time were compared between the two groups.Results The experimental group demonstrated significantly higher training satisfaction(123.80±2.04 vs.117.26±9.82,P<0.05),superior post-training theoretical knowledge and procedural skills(P<0.05),enhanced team collaboration compliance(P<0.05),and shorter RSI completion time(P<0.05)compared with the control group.Conclusion Pediatric RSI nursing coordination training based on the LSPPDM framework can effectively increase training satisfaction,promote theoretical and procedural skills and reduce completion time in nurses.
6.Research on the construction and application of a communication skills assessment scale for newly employed nurses
Yiqing LIU ; Yin ZHANG ; Minjie QIAN ; Yimin QIU ; Jing ZHANG ; Ting ZHANG ; Jiequn YANG ; Jiayu WANG
Chinese Journal of Medical Education Research 2025;24(7):878-884
Objective:To construct a communication skills assessment scale for newly employed nurses, verify the reliability and validity of the scale in a simulated setting, and develop and construct an effective and structured assessment tool for the communication skills of newly employed nurses.Methods:The Chinese version of the Liverpool Communication Skills Assessment Scale was modified and two rounds of expert consultation were conducted to construct the communication skills assessment scale for newly employed nurses. A total of 194 newly employed nurses at a tertiary hospital between 2024 and 2025 were selected using convenience sampling. Data were collected using a teacher-based evaluation method during simulated communication scenarios. The performance of the nurses was scored, and the reliability and validity of the scale were analyzed.Results:The final version of the scale consisted of 4 dimensions and 11 items, and can be used in both workplace-based and simulation-based evaluations. The expert authority coefficients of both rounds were greater than 0.70. The Kendall's W coordination coefficients for the two rounds of consultation were 0.278 and 0.309 for workplace-based evaluations and 0.256 and 0.295 for simulation-based evaluations. The coefficients of variation for the 11 items in both application scenarios were <0.250. The total Cronbach's alpha coefficient of the scale was 0.805 and the total split-half reliability coefficient was 0.814. In the two application scenarios, the item-level content validity index ranged from 0.769 to 1.000 (all >0.750). The scale-level content validity index was 0.916 and 0.909 (>0.900), respectively, in the workplace-based and simulation-based evaluations. The exploratory factor analysis extracted a total of four common factors, with a cumulative variance contribution of 69.09%, and all item loadings on their corresponding factors exceeded 0.500. Conclusions:The communication skills assessment scale for newly employed nurses has moderate and validated content and number of items. The scale demonstrates high reliability and validity in simulation-based evaluations, and can be used as an effective tool for assessing the communication skills of newly employed nurses.
7.Mediating effect of psychological stress between sleep disorder and fatigue in patients with acute coronary syndrome undergoing PCI
Wenyue SUN ; Shan JIANG ; Ting QI ; Ping YANG ; Jing GUO ; Jingru LIU
Chinese Journal of Modern Nursing 2025;31(30):4164-4169
Objective:To investigate the mediating effect of psychological stress between sleep disorder and fatigue in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) .Methods:Convenience sampling was used to select 305 ACS patients with PCI from August to September 2024 in China-Japan Union Hospital of Jilin University. General Information Questionnaire, Multidimensional Fatigue Inventory-20 (MFI-20), Symptom Checklist 90 (SCL-90), and Pittsburgh Sleep Quality Index (PSQI) were used to survey the patients at discharge, and one month after discharge.Results:The MFI-20, SCL-90, and PSQI scores at discharge of 305 patients with PCI for ACS were (59.27±18.33), (141.09±49.08), and (10.72±4.95), respectively. The MFI-20, SCL-90, and PSQI scores at one month after discharge were (55.58±19.28), (134.08±44.29), and (9.17±5.20), respectively. Mediating effect analysis showed that at discharge, the direct effect of sleep disorder on fatigue was 0.403, the mediating effect was 0.216, and the total effect was 0.619, with the mediating effect accounting for 34.89% of the total effect. One month after discharge, the direct effect of sleep disorder on fatigue was 0.385, the mediating effect was 0.355, and the total effect was 0.740, with the mediating effect accounting for 47.97% of the total effect.Conclusions:Psychological stress plays a mediating role between sleep disorder and fatigue at different time points in ACS patients undergoing PCI. Clinical attention should be paid to sleep disorders and psychological stress of ACS patients undergoing PCI, so as to improve their fatigue.
8.Effect of baicalin regulating HMGB1-RAGE axis on autoimmune myocarditis in rats
Zhen ZENG ; Jing LIU ; Ting YU ; Yuanyuan ZHANG
Chinese Journal of Immunology 2025;41(10):2411-2415,2421
Objective:To investigate the effect of baicalin on Th17/Treg cell balance in autoimmune myocarditis(AM)rats and its possible mechanism.Methods:AM rats were grouped into control group,model group,low-dose baicalin group[20 mg/(kg·d)],high-dose baicalin group[100 mg/(kg·d)],and high mobility group B1(HMGB1)inhibitor group;the cardiac ultrasound diagnostic instrument was applied to detect the cardiac function of rats in each group,the cardiac mass index,hematoxylin eosin(HE)staining was applied to detect myocardial pathology,ELISA was applied to detect serum levels of cytokines such as IFN-γ,IL-4,IL-17 and TGF-β,Western blot was applied to detect the expression levels of myocardial HMGB1 and receptor for advanced glycation end product(RAGE)proteins,flow cytometry was applied to detect the proportions of Th17 and Treg cells in the spleen.Results:Com-pared with the control group,the rats in the model group showed myocarditis symptoms and diffuse inflammatory cell infiltration under the endocardium,the left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVEDs),IFN-γ,IL-4,IL-17,TGF-β,the proportion of Th17 cells and the expression levels of HMGB1 and RAGE proteins increased,the left ventricular short axis shortening fraction(FS%),ejection fraction(LVEF%),cardiac mass index,and the proportion of Treg cell decreased(P<0.05);compared with the model group,the myocardial interstitial edema and inflammatory cell infiltration were reduced in the ba-icalin low and high dose groups and HMGB1 inhibitor groups,and the proportion of LVEDd,LVEDs,serum IFN-γ and IL-17,spleen Th17 cells and the expression levels of myocardial HMGB1 and RAGE protein were decreased.FS%,LVEF%,heart mass index,IL-4,TGF-β,Treg cell proportion increased;compared with the low-dose baicalin group,the symptoms of myocarditis in the high-dose baicalin group and the HMGB1 inhibitor group were obviously improved,the LVEDd,LVEDs,IFN-γ,IL-17,the proportion of Th17 cells,and the expression levels of HMGB1 and RAGE proteins decreased,the FS%,LVEF%,cardiac mass index,IL-4,TGF-β,and the proportion of Treg cells increased(P<0.05);there was no statistically obvious difference in each index between the high-dose baicalin group and the HMGB1 inhibitor group(P>0.05).Conclusion:The protective effect of baicalin on AM rats is related to the inhibition of HMGB1/RAGE axis activation.
9.Construction of CD8+T cell-associated Risk Model in Hepatocellular Carcinoma Based on Bulk and Single-cell RNA-seq Data
Xin-Tong ZHANG ; Jian-Jun ZHU ; Jin WU ; Hao WU ; Fan LU ; Wen-Tao ZHANG ; Jing-Jia CHANG ; Ting TANG ; Zhi-Gao OU ; Feng-Feng JIA ; Li LI ; Peng-Fei YU ; Ming LIU
Chinese Journal of Biochemistry and Molecular Biology 2025;41(10):1511-1528
Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8+T cell immune infiltration and immune suppression.We constructed a CD8+T cells related risk score model to pre-dict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8+T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS2,and TN-FRSF1B was constructed.The risk score model was well validated through an independent external validation co-hort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differ-ences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P<0.0001)and lower CD8+T cells infiltration(P<0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P<0.01).Drug sensitivity a-nalysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene mod-el was verified by immunohistochemistry.In summary,the establishment and validation of a CD8+T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.
10.Mechanism of silibinin derivative Sil-1 modulating MAPK signaling pathway to inhibit acute myocardial infarction in rats
Yi-fan LIU ; Meng LI ; De-yu CUI ; Xiao-yan LU ; Ting-bo NING ; Chun-xiu XU ; Jing-chun YAO ; Ji-dong ZHOU ; Zhong LIU
Chinese Pharmacological Bulletin 2025;41(8):1453-1462
Aim To study the protective effect of the silibinin derivative Sil-1 on acute myocardial ischemia in SD rats and its mechanism of action.Methods Af-ter 18 hours of oxygen-glucose deprivation and treat-ment of H9c2 cells,the protective effect of Sil-1 on rat cardiomyocytes was examined.SD rats were treated 30 minutes before surgery,followed by 24 h ligation of the left anterior descending coronary artery.The cardiopro-tective effects of Sil-1 and its mechanisms for improving myocardial ischemic injury were investigated using pro-teomics technology.Results In vitro,compared with the control group,the activity of H9c2 cells in the mod-el group showed reduced cell viability,increased dead cells,elevated ROS and higher levels of LDH and in-flammatory cytokines TNF-α,IL-1β and IL-6 in the culture medium.Sil-1 could improve the above condi-tions to different degrees.In vivo,compared with the control group,rats in the model group showed signifi-cantly higher T waves on electrocardiogram,significant ischemic areas in the heart section,disorganized ar-rangement of cardiomyocytes,increased inflammatory factor infiltration and elevated CK,CK-MB,LDH and inflammatory factors TNF-α,IL-6 and IL-1β.Besides,NF-κB phosphorylation levels in myocardial tissue in-creased.Sil-1 improved the above conditions to varying degrees.The results of proteomics showed that 90 pro-teins were found between the control vs model group and the Sil-1 vs model group,and KEGG enrichment a-nalysis showed that MAPK,chemokines,VEGF and other signaling pathways were abundant.Western blot results showed that Sil-1 blocked the phosphorylation of ERK,JNK and p38 MAPK.Conclusions Sil-1 inhib-its the MAPK pathway by blocking the phosphorylation of JNK,ERK,and p38 MAPK,and achieves a protec-tive effect on rats with acute myocardial infarction.


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