Objective To analyze the relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunc-tion(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impair-ment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these pa-tients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and＜18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correla-tion coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P＜0.01).ROC curve analysis indicated that total bur-den score(AUC=0.953,95％CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95％CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95％CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82％,and 8.92％,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P＜0.05,P＜0.01).Their values were significantly lower in the mild than the moder-ate-to-severe cognitive impairment subgroups(P＜0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P＜0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.

Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.

Objective To analyze the relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunc-tion(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impair-ment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these pa-tients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and＜18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correla-tion coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P＜0.01).ROC curve analysis indicated that total bur-den score(AUC=0.953,95％CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95％CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95％CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82％,and 8.92％,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P＜0.05,P＜0.01).Their values were significantly lower in the mild than the moder-ate-to-severe cognitive impairment subgroups(P＜0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P＜0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.

Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.

Objective:To explore the value of magnetic resonance diffusion tensor imaging (DTI) in evaluating cerebrovascular small vessel disease (CSVD) in patients with systemic lupus erythematosus (SLE).Methods:Eighty-two patients with SLE combined with CSVD treated at Yixing People's Hospital from January to December 2022 were selected. They were divided into acute phase infarction group (16 cases), chronic phase infarction group (26 cases), and chronic ischemic lesion group (40 cases) based on routine MRI examination results. All patients underwent DTI examination to obtain the average diffusion coefficient (DCavg) and anisotropy score (FA) of the affected and contralateral normal white matter areas, and the evaluation value of DTI for CSVD in SLE patients was analyzed.Results:The DCavg value on the affected side of 82 patients was significantly higher than that on the healthy side: (11.10 ± 3.48) 10 -3 mm 2/s vs. (8.18 ± 2.42) 10 -3 mm 2/s, and the FA value on the affected side was significantly lower than that on the healthy side: 0.28 ± 0.05 vs. 0.45 ± 0.08, with a statistical significant differences ( P<0.05). The DCavg values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were (11.88 ± 3.50), (9.69 ± 3.24) and (8.52 ± 2.34) 10 -3 mm 2/s, respectively, with statistical significant differences ( P<0.05). The FA values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were 0.28 ± 0.04, 0.33 ± 0.06 and 0.40 ± 0.07, respectively, with statistical significant differences ( P<0.05). The receiver operating characteristic curve was drawn, and the results showed that the area under the curve (AUC) of the acute phase infarction group and the chronic phase infarction group evaluated by DCavg and FA alone and in combination were 0.757, 0.756, and 0.820, respectively. The AUC of the chronic phase infarction group and the chronic ischemic focus group evaluated by DCavg and FA were 0.772, 0.776, and 0.813, respectively. The AUC value of the combined evaluation was relatively large. Conclusions:DTI has good evaluation value for CSVD in SLE patients and can accurately determine the type of CSVD.

Cardiovascular diseases(CVDs)are a leading factor driving mortality worldwide.Iron,an essential trace mineral,is important in numerous biological processes,and its role in CVDs has raised broad discussion for decades.Iron-mediated cell death,namely ferroptosis,has attracted much attention due to its critical role in cardiomyocyte damage and CVDs.Furthermore,ferritinophagy is the upstream mechanism that induces ferroptosis,and is closely related to CVDs.This review aims to delineate the processes and mechanisms of ferroptosis and ferritinophagy,and the regulatory pathways and molecular targets involved in ferritinophagy,and to determine their roles in CVDs.Furthermore,we discuss the possibility of targeting ferritinophagy-induced ferroptosis modulators for treating CVDs.Collectively,this review offers some new insights into the pathology of CVDs and identifies possible therapeutic targets.

Objective:To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula (AVF) thrombosis.Methods:It was a single-center retrospective cohort study. Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed. According to different surgical procedures, the patients were divided into two groups. Patients treated with percutaneous transluminal angioplasty (PTA) + drilling thrombectomy were in group A, and patients treated with PTA only were in group B. After 1 year of follow-up, the surgical technique success rate, primary patency rate, secondary patency rate and complications were compared between the two groups.Results:A total of 152 patients were enrolled, including 74 in group A and 78 in group B. There were no significant differences in gender, age, proportion of patients with diabetes and hypertension, and thrombosis time of AVF between the two groups (all P>0.05). Compared with group B, the diameter and length of thrombus in group A were larger [13.0(9.0, 16.0) mm vs. 6.0(5.0, 6.5) mm, Z=-9.362, P<0.001; 12(8, 15) cm vs. 3(3, 4) cm, Z=-10.061, P<0.001], and the establishment time of AVF was longer [5(2, 7) years vs. 2(1, 5) years, Z=-2.698, P=0.007]. Among the overall patients, the success rate of surgery was 96.7% (147/152), and the success rate of surgery was 95.9% (71/74) in group A and 97.4% (76/78) in group B respectively, with no statistical difference ( χ2=0.004, P=0.952). Kaplan-Meier survival analysis showed that, overall, the primary patency rate at 3rd, 6th and 12th month after operation was 87.1%, 71.4% and 56.6%, and the secondary patency rate was 97.1%, 96.4% and 94.1%, respectively. The primary patency rate of group A at 3rd, 6th and 12th month was 82.4%, 66.7% and 53.6%, and the secondary patency rate was 95.7%, 94.2% and 89.7%, respectively. The primary patency rate of group B at 3rd, 6th and 12th month was 91.5%, 73.2% and 59.7%, and the secondary patency rate was 98.6%, 98.6% and 98.5%, respectively. There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd, 6th and 12th month (all P>0.05). The duration of operation in group A was longer than that in group B [2.0(1.9, 2.0) h vs. 2.0(1.0, 2.0) h, Z=-5.181, P<0.001], but no serious complications occurred in both groups. Conclusion:The two surgical methods are effective, safe and reliable in the treatment of AVF thrombosis, and have high clinical application value.