Objective:To investigate the impact of receptor-interacting protein kinase 3 (RIPK3) on major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), as well as the predictive performance of RIPK3 combined with traditional cardiovascular risk factors.Methods:This study was a single-center prospective cohort study. It included patients with AMI who underwent PCI at Peking Union Medical College Hospital between September 2017 and November 2017. Baseline clinical data were collected, and plasma samples were obtained 6 hours after PCI to measure RIPK3 levels. Follow-up was conducted via outpatient visits or phone calls to record the occurrence of MACE, including cardiovascular death, hospitalization for heart failure, and vascular events (recurrent AMI or stroke). The predictive performance of RIPK3, traditional cardiovascular risk factors and their combination for MACE was compared using receiver operating characteristic (ROC) curves. Patients were divided into low- and high-RIPK3 level groups based on the optimal cutoff value of RIPK3. Multivariate Cox proportional hazards regression analysis was used to assess the impact of RIPK3 levels on MACE after PCI in AMI patients. Kaplan-Meier survival curves were plotted, and the log-rank test was used to compare MACE incidence between the low-and high-RIPK3 groups.Results:A total of 103 AMI patients who underwent PCI were included, aged 63.0 (56.0, 69.0) years, and 83 (80.6%) were male. The follow-up time was 5.17 (2.81, 5.17) years, during which 44 patients (42.7%) experienced MACE. The ROC curve analysis showed that the area under the curve ( AUC) for traditional cardiovascular risk factors was 0.68 (95% CI: 0.58-0.78), while the AUC for plasma RIPK3 was 0.72 (95% CI: 0.62-0.82). The combined AUC for traditional risk factors and RIPK3 was 0.75 (95% CI: 0.65-0.85). Multivariate Cox proportional hazards regression analysis indicated that plasma RIPK3 level is greater than or equal to the optimal cutoff value of 440.9 μg/L ( HR=3.31, 95% CI: 1.53-8.30, P=0.005) was an independent risk factor for MACE in AMI patients after PCI. Kaplan-Meier survival analysis demonstrated that the high-RIPK3 group had a significantly higher risk of MACE after PCI compared to the low-RIPK3 group (log-rank P=0.006). Conclusions:Elevated plasma RIPK3 level is an independent risk factor for MACE in AMI patients after PCI. Plasma RIPK3 combined with traditional cardiovascular risk factors can more effectively predict the occurrence of MACE in AMI patients after PCI. AMI patients with RIPK3≥440.9 μg/L have a higher risk of MACE after PCI.

Objective:To investigate the impact of receptor-interacting protein kinase 3 (RIPK3) on major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), as well as the predictive performance of RIPK3 combined with traditional cardiovascular risk factors.Methods:This study was a single-center prospective cohort study. It included patients with AMI who underwent PCI at Peking Union Medical College Hospital between September 2017 and November 2017. Baseline clinical data were collected, and plasma samples were obtained 6 hours after PCI to measure RIPK3 levels. Follow-up was conducted via outpatient visits or phone calls to record the occurrence of MACE, including cardiovascular death, hospitalization for heart failure, and vascular events (recurrent AMI or stroke). The predictive performance of RIPK3, traditional cardiovascular risk factors and their combination for MACE was compared using receiver operating characteristic (ROC) curves. Patients were divided into low- and high-RIPK3 level groups based on the optimal cutoff value of RIPK3. Multivariate Cox proportional hazards regression analysis was used to assess the impact of RIPK3 levels on MACE after PCI in AMI patients. Kaplan-Meier survival curves were plotted, and the log-rank test was used to compare MACE incidence between the low-and high-RIPK3 groups.Results:A total of 103 AMI patients who underwent PCI were included, aged 63.0 (56.0, 69.0) years, and 83 (80.6%) were male. The follow-up time was 5.17 (2.81, 5.17) years, during which 44 patients (42.7%) experienced MACE. The ROC curve analysis showed that the area under the curve ( AUC) for traditional cardiovascular risk factors was 0.68 (95% CI: 0.58-0.78), while the AUC for plasma RIPK3 was 0.72 (95% CI: 0.62-0.82). The combined AUC for traditional risk factors and RIPK3 was 0.75 (95% CI: 0.65-0.85). Multivariate Cox proportional hazards regression analysis indicated that plasma RIPK3 level is greater than or equal to the optimal cutoff value of 440.9 μg/L ( HR=3.31, 95% CI: 1.53-8.30, P=0.005) was an independent risk factor for MACE in AMI patients after PCI. Kaplan-Meier survival analysis demonstrated that the high-RIPK3 group had a significantly higher risk of MACE after PCI compared to the low-RIPK3 group (log-rank P=0.006). Conclusions:Elevated plasma RIPK3 level is an independent risk factor for MACE in AMI patients after PCI. Plasma RIPK3 combined with traditional cardiovascular risk factors can more effectively predict the occurrence of MACE in AMI patients after PCI. AMI patients with RIPK3≥440.9 μg/L have a higher risk of MACE after PCI.

Objective:To understand the current status of financial toxicity in patients with heart failure and the factors affecting it, and to provide ideas for making personalized and informed decisions.Methods:Using a scoping review methodological framework, PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, Wanfang, and SinoMed Databases were searched and screened for relevant literature on financial toxicity in patients with heart failure, with a timeframe of January 1, 2014-October 31, 2023, respectively. Relevant literature was identified based on inclusion and exclusion criteria, and data were extracted, collected, summarized, and the findings were reported.Results:Ten literatures that met the inclusion and exclusion criteria were identified. The results showed 5 cross-sectional surveys, 2 qualitative studies, and 1 each of reviews, mixed studies and commentaries. Heart failure patients generally faced high levels of financial toxicity, the incidence and severity of patient financial toxicity varied somewhat between study outcomes. Factors influencing financial toxicity in heart failure patients included age, education level, family income level, discussion of medical costs with physicians, type of insurance the patient had, and occupational status.Conclusions:In the future, we can develop and apply a specialized assessment tool for financial toxicity in heart failure patients in China, further explore the factors affecting financial toxicity in heart failure patients, and formulate personalized treatment plans and financial support strategies for patients according to the influencing factors, so as to reduce the impact of financial toxicity on heart failure patients.

Childhood arterial ischemic stroke (AIS) refers to an ischemic stroke caused by intracranial artery stenosis or occlusion that occurs between the ages of 29 days and 18 years. Although relatively rare, AIS is an important cause of disability or death in children. The etiologies and risk factors for AIS in childhood are significantly different from those in adults. This article reviews the common causes and risk factors for AIS in childhood.

Objective:To evaluate the feasibility of using Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in inpatients in general hospitals.Methods:Using the convenient sampling method, a total of 695 inpatients from 10 ClassⅡ Grade A and above comprehensive hospitals in Nanjing from January to June 2021 were selected as the research objects. They were investigated by PHQ-4, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) to compare the screening results of different measuring tools for depression and anxiety. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of PHQ-4, Kappa test was used to analyze the consistency, Cronbach's α coefficient was used to evaluate the internal consistency of the scale, and Pearson correlation analysis was used to evaluate the calibration correlation validity. A total of 695 questionnaires were sent out in this study, and 672 were effectively collected, with an effective recovery rate of 96.69% (672/695) .Results:Among 672 inpatients in general hospitals, the detection rate of depression and anxiety in patients using PHQ-4 was 38.39% (258/672), while that in patients using PHQ-9 and GAD-7 was 41.82% (281/672), and the difference showed no statistical significance (χ 2=1.64, P=0.20). Cronbachs'α coefficient of PHQ-4 was 0.913, and the half reliability coefficient was 0.888. The Kappa value of the consistency test between PHQ-4, PHQ-9, and GAD-7 for depression and anxiety screening results was 0.756 ( P<0.01). The correlation coefficients between the total scores of PHQ-4, PHQ-9 and GAD-7 in 672 inpatients from general hospitals were 0.822 and 0.802, respectively (both P<0.01). The area under the ROC curve of PHQ-4 was 0.936. With a critical score of 3, the sensitivity and specificity of PHQ-4 were 81.9% and 92.8%, respectively. Conclusions:The detection rate of PHQ-4 and PHQ-9 and GAD-7 on depression and anxiety state of inpatients in general hospital is similar, and has good reliability and validity, which is suitable for the screening of depression and anxiety of inpatients in general hospital.

OBJECTIVE： To study the repair effect of artificial Isaria cicadae on intestinal mucosal injury induced by 5-fluorouracil （5-FU） in rats. METHODS： Forty SD rats were randomly divided into normal group （normal saline）， model group （normal saline）， artificial I. cicadae high-dose， medium-dose and low-dose groups （3.5， 1.75， 0.875 g/kg）， with 8 rats in each group. Except for normal group， other groups were given intraperitoneal injection of 5-FU （0.25 g/10 mL） 30 mg/kg， once a day， for consecutive 5 days. At the same time， each group was given relevant medicine/normal saline intragastrically， once a day， for consecutive 8 d. After medication， body weight of rat was determined in each group. HE staining was used to observe the pathological change of small intestine. The levels of biobarrier-related factor [endotoxin （ET）， D-lactic acid （D-LA）]， immune barrier related factors （TNF-α， IFN-γ， sIgA， IL-15， G-CSF in serum and MPO， MDA in small intestine） and the levels of mechanical barrier related factors （connexin ZO-1 and Claudin-1） were detected. RESULTS： Compared with normal group， body weight of rats in model group was decreased significantly （P＜0.01）. Intestinal villus exfoliated obviously， the crypt structure was scattered， a large number of inflammatory cells gathered， and intestinal mucosa was seriously damaged. Serum levels of ET and D-LA， the levels of TNF-a， IFN-γ， MPO and G-CSF in serum， MDA level in small intestine were increased significantly （P＜0.01）. Serum levels of sIgA and IL-15 as well as the expressions of ZO-1 and Claudin-1 in small intestine were decreased significantly （P＜0.05 or P＜0.01）. Compared with model group， body weight of rats in artificial I. cicadae high-dose group was increased significantly （P＜0.01）. The pathological changes of the small intestine of rats in each administration group were improved to varying degrees. The intestine morphology of artificial I. cicadae high-dose and medium-dose groups was close to that of the normal group. The levels of and ET， D-LA， TNF-α， IFN-γ， MPO， G-CSF in serum and the level of MDA in intestinal were decreased significantly （P＜0.01）. Serum levels of   sIgA and IL-15 in administration groups as well as the expressions of ZO-1 and Claudin-1 in intestinal tissue were increased significantly （P＜0.01）. CONCLUSIONS： Artificial I. cicadae can repair intestinal mucosal damage caused by 5-FU in respects of mechanical barrier， immune barrier， biological barrier.

OBJECTIVE:To investigate the effects of blood concentration monitoring of cylosporin A(CsA) in patients with nephrotic syndrome(NS)on efficacy and safety. METHODS:The medical records of 154 NS patients receiving CsA and blood concentration monitoring in nephrology department of China-Japan Friendship Hospital during Jan. 2014-Aug. 2017 were analyzed retrospectively. The results of blood concentration monitoring in 63 adult inpatients with refractory NS receiving CsA for the first time within 6 months of initial treatment were analyzed statistically. The relationship of blood concentration monitoring with efficacy and safety was analyzed. RESULTS:The blood concentration of CsA in 154 patients were monitored for 512 times with an average of 3.32 times/person,and average blood concentration was(125.98±105.13)ng/mL. The patients with blood concentration of CsA＜100 ng/mL accounted for 44.14%. There was no statistical significance in average monitoring times or average blood concentration between male and female,average blood concentration of CsA among different age groups (P＞0.05). The blood concentration was monitored for 237 times in 63 adult inpatients with refractory NS receiving CsA for the first time within 6 months of initial treatment(induction period). Average blood concentration of effective group were significantly higher than ineffective group;the proportion of effective group with blood concentration＜100 ng/mL was significantly lower than that of ineffective group,with statistical significance (P＜0.05). Among 63 patients,17 patients suffered from ADR (the incidence of ADR was 26.98%). The average blood concentrations of ADR patients were significantly higher than those without ADR;the monitoring times of ADR patients with blood concentration＞150 ng/mL was significantly higher than those without ADR,with statistical significance(P＜0.05). There was no statistical significance in the incidence of ADR between effective group and ineffective group (P＞0.05). Among effective group,there was no statistically significance in average blood concentration between ADR patients and patients without ADR(P＞0.05);the monitoring times of ADR patients with blood concentration＞150 ng/mL was significantly higher than patients without ADR,with statistical significance(P＜0.05). With the increase of monitoring times,the incidence of ADR decreased gradually. There was no statistical significance in the incidence of ADR among patients who were monitored for different times (P＞0.05). CONCLUSIONS:The pharmacokinetics of CsA varies in different patients and many factors affect its blood concentration. The changes of blood concentration affect the efficacy and safety of CsA. It is difficult to determine the dosage of CsA based on experience in the treatment of NS with CsA. Great importance should be attached to blood concentration monitoring of CsA and the implementation of individualized dosage regimen based monitoring results so as to improve therapeutic efficacy and reduce the occurrence of ADR.

Objective: To establish the UPLC typical chromatogram and evaluate the quality of Jinji pills. Methods: The UPLC typi-cal chromatogram was performed on an Agilent proshell 120 C18column (150 mm×4. 6 mm,2. 7 μm) with gradient elution by the mobile phase of acetonitrile-0. 1% phosphoric acid aqueous solution system at a flow rate of 0. 8 ml·min-1. The detection wavelength was 240 nm. Results: The UPLC typical chromatogram included 15 common peaks when taking berberine hydrochloride as the reference peak, and 7 of them were identified by the comparison with the reference substances. Conclusion: The established methods have high specificity and good repeatability, and can be used for the quality control of the product.

Objective To observe the effect of rosuvastatin on vascular cell adhesion molecule-1 (VCAM -1),C-reactive protein (CRP),TG,TC and LDC in patients with acute cerebral infarction at the early stage.Methods According to the random number expression method,90 patients with acute cerebral infarction were divided into rosuvastatin treatment group and control group,with 45 cases in each group.The course of treatment was 21 days.The control group was given conventional western medicine (aspirin,mannitol etc.),the treatment group received rosuvastatin on the basis of the control group.Before and after treatment,the plasma VCAM-1,CRP,TG,TC,LDLch levels,clinical efficacy,efficacy of regulating dyslipidemia and drug safety were compared.Results After treatment,the CRP levels in the two groups were improved.After treatment for 7 days,14 days,the CRP levels of the treatment group were (23.68 ± 5.23) mg/L,(16.68 ± 6.76) mg/L,respectively,which improved more significantly than those of the control group [(30.12 ± 6.68) mg/L,(21.12 ± 6.35) mg/L],the differences were statistically significant (t =5.092,3.230,all P ＜ 0.05).After 21 days of treatment,the CRP of treatment group was better than the control group,but the difference was not statistically significant (P ＞ 0.05).The VCAM-1 levels of the two groups after treatment were improved.After treatment for 7 days,14 days,the VCAM-1 levels of the treatment group were (1 205.1 ±61.8)mg/L,(852.1 ± 60.2)mg/L,respectively,which were improved more significantly than those of the control group[(1 415.6 ± 62.9) mg/L,(963.1 ± 53.3) mg/L],there were statistically significant differences between the two groups (t =21.815,9.261,all P ＜ 0.05),21 days after treatment,there was no statistically significant difference (P ＞ 0.05).The levels of TG,TC,LDC in the two groups were all decreased after treatment for 7 days,14 days and 21 days,and the improvement in the treatment group was more obvious,the differences between the two groups were statistically significant (t =5.219,7.303,4.044,2.232,4.336,3.612,2.689,7.817,11.057,all P ＜0.05).Conclusion Compared with the conventional western medicine treatment,rosuvastatin can decrease the plasma levels of CRP,VCAM-1,TG,TC,LDC,further improve the pathological basis of ischemic cerebrovascular disease,eliminate the risk factors,it is more conducive to the prognosis of acute cerebral infarction.

Objective:To identify toddalolactone and establish the analysis method for Jinji tablets.Methods: An Hypersil DBS C18column(250 mm×4.6 mm,5 μm) was used. The mobile phase consisted of acetonitrile-0.1% phosphoric acid solution. The flow rate was 0.8 ml·min-1and the detection wavelength was at 330 nm. Toddalolactone was identified by an LC-MS method and the re-sult was compared with that of the reference regent.TLC and HPLC analytical methods were used for analysis of toddalolactone.Re-sults:Totally 58 batches of Jinji tablets were tested,and the suspected samples were confirmed by HPLC-MS/MS.Toddalolactone was detected out from 20 batches of samples. Conclusion:The method is simple,rapid and accurate, which is able to detect toddalolac-tone quickly and effectively.