The outcomes of patients with myocardial infarction (MI) have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention, and the majority of MI patients subsequently enter a chronic stable phase. Therefore, the long-term management of patients with MI has become a core issue in daily clinical practice for cardiologists. The long-term incidence of adverse events can be further reduced using newly developed medications and therapies ranging from lipid-lowering agents (eg, proprotein convertase subtilisin/kexin type 9 inhibitors) to anti-thrombotic treatments (eg, shortened dual anti-platelet therapy). However, a considerable number of patients still experience adverse events, as some residual risk can remain despite intensive secondary prevention, such as continuously elevated cholesterol levels, chronic cardiovascular inflammation, and rapid atherosclerosis progression due to increased plaque instability. Therefore, the present review sought to summarize and discuss recent advances in several key aspects regarding the long-term management of MI patients, with the expectation of clarifying the available treatment strategies for various clinical scenarios, examining the gaps between trial evidence and clinical practice, and providing possible directions for future research.

The outcomes of patients with myocardial infarction (MI) have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention, and the majority of MI patients subsequently enter a chronic stable phase. Therefore, the long-term management of patients with MI has become a core issue in daily clinical practice for cardiologists. The long-term incidence of adverse events can be further reduced using newly developed medications and therapies ranging from lipid-lowering agents (eg, proprotein convertase subtilisin/kexin type 9 inhibitors) to anti-thrombotic treatments (eg, shortened dual anti-platelet therapy). However, a considerable number of patients still experience adverse events, as some residual risk can remain despite intensive secondary prevention, such as continuously elevated cholesterol levels, chronic cardiovascular inflammation, and rapid atherosclerosis progression due to increased plaque instability. Therefore, the present review sought to summarize and discuss recent advances in several key aspects regarding the long-term management of MI patients, with the expectation of clarifying the available treatment strategies for various clinical scenarios, examining the gaps between trial evidence and clinical practice, and providing possible directions for future research.

Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.

Objective To explore the expression and relationship with the clinical pathological features of CD34,CD117,smooth muscle actin(SMA),S -100 protein in gastrointestinal stromal tumor.Methods 60 cases of resection of gastrointestinal stromal tumor specimens were collected,all cases were confirmed by postoperative patholo-gy,explored the expression of CD34,CD117,SMA,S -100 protein expression in gastrointestinal stromal tumor with immunohistochemical method,analyzed the relationship with the clinical pathological features of CD34,CD117,SMA, S -100 protein.Results CD34 positive signal located in the cytoplasm,CD117 positive signal mainly located in cyto-plasm,a few located in the cell membrane,nuclear yellow particles diffuse distribution in cells,SMA and S -100 pro-tein located in the cytoplasm of focal or scattered point positive expression of CD34,CD117,SMA,S -100 protein pos-itive expression rate in gastrointestinal stromal tumor tissue were 88.33% (53 /60),95.00% (57 /60),43.33%(26 /60)and 6.67% (4 /60);CD34 positive expression rate was related to area (χ2 =9.093,P <0.05),S -100 protein positive expression rate related to the histological type (χ2 =10.447,P <0.05).Conclusion CD34,CD117 in gastrointestinal stromal tumor tissue in the positive expression rate is very high,detection jointed with CD34,CD117 can improve the gastrointestinal stromal tumor diagnosis accuracy.