Objective:To investigate the predictive value of cardiac MR (CMR)-derived left ventricular end-systolic wall stress (LVESWS) and biventricular strain parameters for different types of heart failure in patients with myocardial infarction.Methods:This retrospective cohort study included 231 patients diagnosed with myocardial infarction by clinical and CMR criteria at the Second Affiliated Hospital of Kunming Medical University between January 2015 and July 2023. The endpoint was the occurrence of heart failure, and patients were divided into 3 groups: no heart failure ( n=85), heart failure with preserved ejection fraction (HFpEF, n=74), and heart failure with reduced ejection fraction (HFrEF, n=72). Clinical indicators such as age and infarct size were collected. CMR parameters analysis included LVESWS, left ventricular global radial strain (LVGRS), left ventricular global circumferential strain (LVGCS), left ventricular global longitudinal strain (LVGLS), right ventricular global radial strain (RVGRS), right ventricular global circumferential strain (RVGCS), right ventricular global longitudinal strain (RVGLS), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). Differences in clinical baseline data and CMR parameters among the 3 groups were tested. Univariate Cox regression analysis was performed, followed by multivariate Cox modeling of statistically significant factors. Receiver operating characteristic (ROC) analysis was conducted for the influencing factors identified in the multivariate Cox model, and Kaplan-Meier survival curves for survival time were plotted. Results:Significant differences were observed in biventricular strain parameters (LVGRS, LVGCS, LVGLS, RVGRS, RVGCS, RVGLS), LVESWS, LVEDVI, and LVESVI among the 3 groups (all P<0.05). Univariate and multivariate Cox regression analyses showed that RVGCS, age, and infarct size were independent influencing factors for HFpEF after myocardial infarction (all P<0.01), while LVESWS and LVGLS were independent influencing factors for HFrEF after myocardial infarction (all P<0.001). Further ROC analysis revealed that the areas under the curve (AUC) for RVGCS, infarct size, age, RVGCS combined with age, and RVGCS combined with age and infarct size in predicting HFpEF were 0.771, 0.607, 0.615, 0.793, and 0.805, respectively. The AUCs for LVESWS, LVGLS, and LVESWS combined with LVGLS in predicting HFrEF were 0.943, 0.925, and 0.971, respectively. Kaplan-Meier survival curves based on optimal cutoff values showed statistically significant differences in survival time between HFpEF and non-heart failure patients when grouped by RVGCS and age (all P<0.05), but no significant difference when grouped by infarct size ( P=0.400). Statistically significant differences in survival time were observed between HFrEF and non-heart failure patients when grouped by LVESWS and LVGLS (all P<0.001). Conclusion:CMR-derived LVESWS and biventricular strain parameters demonstrate significant predictive value for different types of heart failure after myocardial infarction and can serve as valuable imaging markers for heart failure management and risk stratification in patients with myocardial infarction.

Objective:To investigate the predictive value of cardiac MR (CMR)-derived left ventricular end-systolic wall stress (LVESWS) and biventricular strain parameters for different types of heart failure in patients with myocardial infarction.Methods:This retrospective cohort study included 231 patients diagnosed with myocardial infarction by clinical and CMR criteria at the Second Affiliated Hospital of Kunming Medical University between January 2015 and July 2023. The endpoint was the occurrence of heart failure, and patients were divided into 3 groups: no heart failure ( n=85), heart failure with preserved ejection fraction (HFpEF, n=74), and heart failure with reduced ejection fraction (HFrEF, n=72). Clinical indicators such as age and infarct size were collected. CMR parameters analysis included LVESWS, left ventricular global radial strain (LVGRS), left ventricular global circumferential strain (LVGCS), left ventricular global longitudinal strain (LVGLS), right ventricular global radial strain (RVGRS), right ventricular global circumferential strain (RVGCS), right ventricular global longitudinal strain (RVGLS), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). Differences in clinical baseline data and CMR parameters among the 3 groups were tested. Univariate Cox regression analysis was performed, followed by multivariate Cox modeling of statistically significant factors. Receiver operating characteristic (ROC) analysis was conducted for the influencing factors identified in the multivariate Cox model, and Kaplan-Meier survival curves for survival time were plotted. Results:Significant differences were observed in biventricular strain parameters (LVGRS, LVGCS, LVGLS, RVGRS, RVGCS, RVGLS), LVESWS, LVEDVI, and LVESVI among the 3 groups (all P<0.05). Univariate and multivariate Cox regression analyses showed that RVGCS, age, and infarct size were independent influencing factors for HFpEF after myocardial infarction (all P<0.01), while LVESWS and LVGLS were independent influencing factors for HFrEF after myocardial infarction (all P<0.001). Further ROC analysis revealed that the areas under the curve (AUC) for RVGCS, infarct size, age, RVGCS combined with age, and RVGCS combined with age and infarct size in predicting HFpEF were 0.771, 0.607, 0.615, 0.793, and 0.805, respectively. The AUCs for LVESWS, LVGLS, and LVESWS combined with LVGLS in predicting HFrEF were 0.943, 0.925, and 0.971, respectively. Kaplan-Meier survival curves based on optimal cutoff values showed statistically significant differences in survival time between HFpEF and non-heart failure patients when grouped by RVGCS and age (all P<0.05), but no significant difference when grouped by infarct size ( P=0.400). Statistically significant differences in survival time were observed between HFrEF and non-heart failure patients when grouped by LVESWS and LVGLS (all P<0.001). Conclusion:CMR-derived LVESWS and biventricular strain parameters demonstrate significant predictive value for different types of heart failure after myocardial infarction and can serve as valuable imaging markers for heart failure management and risk stratification in patients with myocardial infarction.

Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose and standard-dose recombinant tissue plasminogen activator(rt-PA)in the elderly patients(aged over 80 years)with acute ischemic stroke(AIS).Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt-PA low-dose group(n=93,0.6 mg/kg)and rt-PA standard-dose group(n=108,0.9 mg/kg).The incidence of intra-cranial hemorrhage,symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety.The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness.A stratified analysis of 90-day outcomes was performed based on stroke severity and age.Results The incidence of intracranial hemorrhage,symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt-PA low-dose group was lower than that in rt-PA standard-dose group(P＜0.05).There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index.The 90-day good prognosis rate of moderate stroke sub-group and of≥90 years of age sub-group in rt-PA low-dose group were both higher than that of rt-PA standard-dose group(P＜0.05).Conclusions For AIS patients with moderate stroke and aged over 90 years,intravenous thrombolytic therapy with rt-PA 0.6 mg/kg is recommended.

Objective:To evaluate the effect of botulinum toxin type A (BTXA) on flap surgery in animal models.Methods:Nine databases (PubMed, Cochrane Library, Ovid, Web of Science, Embase, Scopus, CBM, CNKI, and WANFANG database) were searched for published literature comparing the effects of BTXA (BTXA group) versus saline or no treatment (control group) on flap operation in animal models from January 1979 to March 2022. The literature was screened according to inclusion and exclusion criteria. Indicators included flap survival rate, blood flow and vascular endothelial growth factor (VEGF) expression level after surgery. The subjects were divided into pre-operation injection group and intraoperation injection group according to the intervention timing, and were divided into random flap group and axial flap group according to the type of flaps, and subgroup analysis was conducted respectively. Review Manager (RevMan) 5.3 software and Stata 15.1 software were used for all statistical analysis.Results:A total of 603 animals from 19 studies were included after rigorous inclusion and exclusion screening. Compared with control group, BTXA group revealed a significantly higher flap survival rate [mean difference ( MD)=15.65%, 95% CI: 13.11%-18.19%, Z=12.08, P<0.001], blood flow [standardized mean difference ( SMD)=1.96, 95% CI: 1.39-2.54, Z=6.71, P<0.001] and VEGF expression (at mRNA level: SMD=6.01, 95% CI: 0.89-11.13, Z=2.30, P=0.020; at protein level: SMD=3.44, 95% CI: 2.44-4.43, Z=6.73, P<0.001). Subgroup analysis showed that the flap survival rate of the pre-operation injection group ( MD=21.54%, 95% CI: 16.07%-27.01%, Z=7.71, P<0.001) was significantly higher than that of the intraoperative injection group ( MD=9.40%, 95% CI: 6.79%-12.00%, Z=7.07, P<0.001). The flap survival rate of the random flap group ( MD=20.87%, 95% CI: 16.67%-25.07%, Z=9.73, P<0.001) was significantly higher than that of the axial flap group ( MD=13.11%, 95% CI: 8.91%-17.31%, Z=6.12, P<0.001). Conclusion:BTXA assisted flap surgery may have positive effects on the survival rate, blood flow and VEGF expression in animal models. In addition, injection timing and flap type may also be important factors in the effect of BTXA on flap surgery.

Objective:To investigate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis combined with edaravone dexborneol at different timing in super elderly patients (aged≥85 years) with moderate to severe acute ischemic stroke (AIS).Methods:A prospective study was performed. Seventy-one super elderly patients with moderate to severe AIS treated with rt-PA intravenous thrombolysis combined with edaravone dexborneol from December 2020 to March 2023 in Department of Neurology, Affiliated Fourth Central Hospital of Nankai University were selected and randomly divided into early group ( n=35) and advanced group ( n=36); patients in the early group were given edaravone dexborneol immediately after rt-PA intravenous thrombolysis, and patients in the advanced group were given edaravone dexborneol 24 h after rt-PA intravenous thrombolysis. In addition, 31 patients with moderate to severe AIS received rt-PA intravenous thrombolysis only in Department of Neurology of the hospital from August 2018 to December 2020 were selected as control group. Differences in efficacy and safety indexes among the 3 groups were compared. Results:After 7 d of treatment, the improvement rate of neurological function in early group was significantly higher than that in control group and advanced group ( P<0.05). After 90 d of treatment, modified Rankin scale (mRS) scores in early group were statistically lower than those in control group and advanced group ( P<0.05); good prognosis rate in early group was statistically higher than that in control group and advanced group ( P<0.05). The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in early group were significantly lower than those in control group and advanced group ( P<0.05). After 30 and 90 d of treatment, the advanced group had significantly lower mortality than the control group, but significantly higher mortality than the early group ( P<0.05). Conclusion:Edaravone dexborneol immediately after rt-PA intravenous thrombolysis is the optimal timing for super elderly patients with moderate to severe AIS, which can improve the efficacy and safety.

Objective:To evaluate the effect of botulinum toxin type A (BTXA) on flap surgery in animal models.Methods:Nine databases (PubMed, Cochrane Library, Ovid, Web of Science, Embase, Scopus, CBM, CNKI, and WANFANG database) were searched for published literature comparing the effects of BTXA (BTXA group) versus saline or no treatment (control group) on flap operation in animal models from January 1979 to March 2022. The literature was screened according to inclusion and exclusion criteria. Indicators included flap survival rate, blood flow and vascular endothelial growth factor (VEGF) expression level after surgery. The subjects were divided into pre-operation injection group and intraoperation injection group according to the intervention timing, and were divided into random flap group and axial flap group according to the type of flaps, and subgroup analysis was conducted respectively. Review Manager (RevMan) 5.3 software and Stata 15.1 software were used for all statistical analysis.Results:A total of 603 animals from 19 studies were included after rigorous inclusion and exclusion screening. Compared with control group, BTXA group revealed a significantly higher flap survival rate [mean difference ( MD)=15.65%, 95% CI: 13.11%-18.19%, Z=12.08, P<0.001], blood flow [standardized mean difference ( SMD)=1.96, 95% CI: 1.39-2.54, Z=6.71, P<0.001] and VEGF expression (at mRNA level: SMD=6.01, 95% CI: 0.89-11.13, Z=2.30, P=0.020; at protein level: SMD=3.44, 95% CI: 2.44-4.43, Z=6.73, P<0.001). Subgroup analysis showed that the flap survival rate of the pre-operation injection group ( MD=21.54%, 95% CI: 16.07%-27.01%, Z=7.71, P<0.001) was significantly higher than that of the intraoperative injection group ( MD=9.40%, 95% CI: 6.79%-12.00%, Z=7.07, P<0.001). The flap survival rate of the random flap group ( MD=20.87%, 95% CI: 16.67%-25.07%, Z=9.73, P<0.001) was significantly higher than that of the axial flap group ( MD=13.11%, 95% CI: 8.91%-17.31%, Z=6.12, P<0.001). Conclusion:BTXA assisted flap surgery may have positive effects on the survival rate, blood flow and VEGF expression in animal models. In addition, injection timing and flap type may also be important factors in the effect of BTXA on flap surgery.

Objective:To analyze the application value of sakubatril valsartan in the treatment of chronic heart failure (CHF) based on cardiopulmonary test system.Methods:One hundred and thirty-five CHF patients admitted to the Affiliated Hospital of Jining Medical Collegefrom January 2019 to August 2020 were divided into the observation group (67 cases) and the control group (68cases) by random number table method. Both groups were treated with bisoprolol. The observation group was treated with the combination of sakubatril valsartan, and the control group was treated with the combination of benapril. The efficacy and cardiac function indicators of the two groups were compared. The cardiopulmonary exercise test system was used to measure the patient′s maximum exercise time (Tmax), maximum exercise Watt (Wmax), peak volume oxygen (Peak VO 2) and volume of anaerobic threshold oxygen (VO 2AT), and the incidence of adverse reactions were calculated. Results:The total effective rate in the observation group was higher than that in the control group: 92.54% (62/67) vs. 77.94%(53/68), the difference was statistically significant ( χ2 = 5.70, P<0.05). After the treatment, the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and soluble ST2 (sST2) in the observation group were lower than those in the control group: (2 000.47 ± 517.85) ng/L vs. (2 777.39 ± 812.49) ng/L, (0.33 ± 0.10) μg/L vs. (0.37 ± 0.09) μg/L, and the left ventricular ejection fraction (LVEF) was higher than that in the control group: (8.12 ± 6.44)% vs. (41.93 ± 6.73)%, the differences were statistically significant ( P<0.05). After the treatment, the left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVEDs), left ventricular mass index (LVMI), left atrial volume index (LAVI) in the observation group were lower than those in the control group: (55.47 ± 6.93) mm vs. (62.00 ± 7.18) mm, (37.14 ± 6.36) mm vs. (41.35 ± 6.43) mm, (136.76 ± 7.13) mg/m 2 vs. (140.98 ± 7.47) mg/m 2, (28.23 ± 2.59) ml/m 2 vs. (31.98 ± 2.17) ml/m 2; the Tmax, Wmax, PeakVO 2 and VO 2AT in the observation group were higher than those in the control group: (619.08 ± 65.36) s vs. (58.70 ± 52.44) s, (142.96 ± 16.05) W vs. (124.19 ± 13.38) W, (20.00 ± 5.74) ml/(min·kg) vs. (18.13 ± 3.58) ml/(min·kg), (13.89 ± 3.69) ml/(min·kg) vs. (11.23 ± 2.36) ml/(min·kg), the differences were statistically significant ( P<0.05). However, there was no statistically significant in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Sakubatril valsartan in the treatment of CHF can not only optimize the efficacy and improve cardiac function, but also benefit cardiac exercise rehabilitation of patients, and not increase the safety risk.

Objective:To evaluate the efficacy of monopolar radiofrequency combined with ultrasound for abdominal obesity.Methods:A total of 24 patients (4 males, 20 females, average age was 35 years) were given monopolar radiofrequency combined with ultrasound treatment four times at (10±4) day interval at Beijing Friendship Hospital during December 2015 to December 2016. Body weight and abdomen circumferences were recorded before and after each treatment. Subcutaneous adipose tissue thickness was measured with B ultrasound at baseline and after the last treatment. 2 months after the last treatment, a third party would assess the improvement; at the same time, volunteers would assess the outcome with Global Aesthetic International Scale. Blood lipid level, liver function and renal function were tested at baseline and after the third treatment. All the treatment related adverse effect would be noted as well.Results:There was no significant difference of body weight after the treatment. The abdomen circumferences were decreased at 2 month after the last treatment, especially for the navel one, which decreased from (96.14±11.92) cm at baseline to (93.82±10.77) cm, t=4.21, P<0.05. And the subcutaneous adipose tissue thickness also decreased from (25.56±4.3) mm to (24.31±3.77) mm, ( t=6.26, P<0.05). 2 months after the last treatment, 16 volunteers were graded as 1-25% improvement, 8 volunteers were graded as 26%-50% improvement. According to GAIS, 2, 18 and 4 volunteers assess the outcome was regarded as 0 score, 1 score and 2 score respectively. The treatments showed no influence to blood lipid level, liver function and renal function. The treatment processing was tolerated well and no side effect were noted. Conclusions:Monopolar radiofrequency combined with ultrasound treatment for abdominal obesity is effective and safe.

Objective:To compare the efficacy of sakubatril valsartan and valsartan in the treatment of patients with chronic cardiac insufficiency and the influence on zinc finger protein A20 and nuclear factor-κB (NF-κB) in peripheral bloodmononuclear cells (PBMCs).Methods:Ninety-senven patients with chronic cardiac insufficiency admitted to the Affiliated Hospital of Jining Medical College from February 2019 to January 2020 were continuously selected and randomly divided into the control group (48 cases) and the observation group (49 cases). Both groups received routine anti-heart failure according to the guidelines. The control group added with valsartan and the observation group added with sakubatril valsartan treatment. Before the treatment and after 3 months of treatment, the changes of cardiac function indexes and the changes of inflammatory markers such as hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), matrix metalloproteinase 9 (MMP-9), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were compared. PBMCs was extracted to detect zinc finger protein A20 and NF-κB levels. The incidence of adverse reactions in the two groups was recorded, and the relationship between zinc finger proteins A20, NF-κB and the myocardial injury marker NT-proBNP were analyzed.Results:After 3 months of treatment, the changes of cardiac function indexes in the observation group were better than those in the control group and the levels of hs-CRP, TNF-α, MMP-9, NT-proBNP in the observation group were lower than those in the control group: (1.96 ± 0.57) mg/L vs. (2.87 ± 0.79) mg/L, (7.11 ± 1.46) μg/L vs. (8.24 ± 1.57) μg/L, (110.14 ± 10.63) μg/L vs. (129.52 ± 17.96) μg/L, (716.91 ± 105.78) ng/L vs. (965.25 ± 97.41) ng/L, there were statistical differences ( P<0.05). After 3 months of treatment, the levels of finger protein A20, NF-κB in the observation group were lower than those in the control group: (3.57 ± 1.13) % vs. (4.41 ± 1.32) %, (29.87 ± 6.58) ng/L vs. (35.71 ± 10.02) ng/L, there were statistical differences ( P<0.05). Finger protein A20 and NF-κB in patients with chronic cardiac insufficiency were positively correlated with NT-proBNP ( r = 0.487, 0.738, P<0.01). Conclusions:On the basis of conventional treatment, compared with valsartan, the addition of sakubatril valsartan, can improve the cardiac function of patients with chronic cardiac insufficiency, reduce the body′s inflammatory response, reduce the expression of myocardial injury marker NT-proBNP, inhibit the activation of PBMCs NF-κB, and reduce the level offinger protein A20.

Objective: To evaluate the effectiveness of enteral nutrition in children with accidental upper gastrointestinal injury. Methods: The medical records of 128 patients with mechanical or chemical gastrointestinal mucosal injury, who were hospitalized in Department of Gastroenterology, Children's Hospital of Zhejiang University School of Medicine from January 1, 2011 to December 30, 2017, were collected. All cases were treated with enteral nutrition. The clinical features and etiologies were retrospectively analyzed. Weight-for-age Z score and lab findings including white blood cells, C-reactive protein, neutrophils, albumin, prealbumin, urea nitrogen and hemoglobin before and after treatment were extracted. The clinical characteristics, the duration of enteral nutrition and gastrointestinal mucosal healing between different etiologies were further analyzed. Normal distribution variables and categorized variables were compared with t test and χ² test respectively, and abnormal distribution data was compared with Wilcoxon test. Results: Among all the cases, 77 were males and 51 were females. The average age was (29±22) months. The mean duration of hospitalization and enteral nutrition were (11±7)d and (27±20)d respectively. Vomiting was the most common clinical presentation (72 cases, 56.3%). In 79 cases the problems were caused by mechanical injury, among which coins were most commonly seen. The rest 49 cases were caused by chemical injury. However, the duration of hospitalization ((13±8) d vs. (10±6)d, t=-3.089, P=0.002) and enteral nutrition ((39±22) vs. (19±14) d, t=-5.365, P=0.000) were longer in children with chemical injury than those with mechanical injury. A total of 112 cases got complete blood count and C-reactive protein both before and after enteral nutrition. Inflammatory markers, including leukocytes ((7.7±2.7) ×10⁹/L vs. (13.7±5.0) ×10⁹/L, t=12.244, P <0.05), neutrophils ((3.4±1.9)×10⁹/L vs. (9.4±4.6) ×10⁹/L, t=13.655, P<0.05), and C-reactive proteins (5.0(3.0,7.8) vs. 13.5(6.0,40.5) mg/L, Z=7.776, P <0.05) were significantly decreased. The nutritional markers, including the weight-for-age z score (-0.1 ± 1.0 vs. 0.0 ± 1.0, t=-2.622, P=0.010) and the prealbumin (0.1 ± 0.1 vs. 0.2 ± 0.0 g/L, t=-3.671, P=0.001) were significantly increased. Fifty-five (82.1%) children in mechanical injury group recovered in 4 weeks, while 27 (79.4%) children in chemical injury group recovered in 7 weeks. Conclusion Enteral nutrition can provide adequate nutritional requirements for children with upper gastrointestinal injury, and may help to decrease imflammation and improve mucosal healing.