Objective To evaluate the efficacy and safety of high-power,short-duration radiofrequency catheter ablation for the treatment of persistent atrial fibrillation.Methods This retrospective study included 392 patients diagnosed with persistent atrial fibrillation who underwent catheter radiofrequency ablation at Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,from January 2019 to December 2023.Of these,256 patients were treated with high-power,short-duration ablation,and 136 patients with low-power,long-duration ablation.The following parameters were compared:radiofrequency ablation time,total procedure time,single-circle pulmonary vein isolation rate,immediate procedural success rate,number of ablation points,and perioperative complications(including pericardial tamponade,pseudoaneurysm,arteriovenous fistula,stroke,etc.).Follow-up assessments were conducted at 3,6,and 12 months post-surgery to evaluate the 12-month sinus rhythm maintenance rate.Results The ablation time in the high-power group was significantly shorter than that in the low-power group[(14.6±2.3)min vs.(30.3±4.2)min,P＜0.001],as was the total procedure time[(113.8±24.8)min vs.(128.5±26.7)min,P=0.001].There were no significant differences between the two groups in terms of pulmonary vein isolation rate(97.7％vs.94.9％,P=0.823),number of ablation points[(71.2±8.0)vs.(74.3±14.3),P=0.168],or perioperative complications(3.1％vs.4.4％,P=0.571).Regarding the maintenance rate of sinus rhythm at 12 months post-operation,the high-power group showed a higher rate than the low-power group,but no statistically significant difference was observed(82.8％vs.79.4％,P=0.399).Conclusions High-power,short-duration radiofrequency catheter ablation can improve procedural efficiency in the treatment of persistent atrial fibrillation.Its efficacy and safety are similar to those of the low-power,long-duration technique.

his study was aimed at understanding the drug resistance of Acinetobacter baumannii,exploring the consistency between resistance genes and resistance phenotypes,and providing a basis for the rational use of antibiotics in clinical practice.A total of 88 strains of Acinetobacter baumannii were isolated from hospitals at tertiary level or above within the jurisdiction from 2021 to 2023,and subjected to drug resistance testing and whole genome sequencing.The original data were analyzed for the entire genome process with a Microobench pathogenic microorganism analysis workstation(without reference splicing),and resistance genes were predicted and annotated.The strains were subjected to multi-point sequence analysisand minimum spanning tree construction.Among 88 strains of Acinetobacter baumannii,carbapenem resistant strains(CRAB)accounted for 72.73%,and 98.44%of CRAB showed multidrug resistance.In the past three years,the resistance to multiple drugs has increased.The cgMLST analysis showed that the ST2 type accounted for 89.77%,and a new ST type was discovered.After cgMLST analysis,the minimum spanning tree was generated,and the genetic relationship of the same ST type was closer.The same ST2 type was further divided into four clusters.Binary logistic regression analysis conducted on resistance genes and resistance phenotypes revealed that resistance genes APH(3″)-Ib,armA,ADC-73,sul1,and sul2 positively correlated with resistance phenotypes.The ST2 type was the main Acinetobacter baumannii type,and showed high rates of multidrug resistance and carriage of multiple resistance genes.The drug resistance situation is severe.The consistency between common resistance genes and resistance phenotypes is good.Clinical management of Acinetobacter baumannii infection must be strengthened to prevent outbreaks and transmission.

his study was aimed at understanding the drug resistance of Acinetobacter baumannii,exploring the consistency between resistance genes and resistance phenotypes,and providing a basis for the rational use of antibiotics in clinical practice.A total of 88 strains of Acinetobacter baumannii were isolated from hospitals at tertiary level or above within the jurisdiction from 2021 to 2023,and subjected to drug resistance testing and whole genome sequencing.The original data were analyzed for the entire genome process with a Microobench pathogenic microorganism analysis workstation(without reference splicing),and resistance genes were predicted and annotated.The strains were subjected to multi-point sequence analysisand minimum spanning tree construction.Among 88 strains of Acinetobacter baumannii,carbapenem resistant strains(CRAB)accounted for 72.73%,and 98.44%of CRAB showed multidrug resistance.In the past three years,the resistance to multiple drugs has increased.The cgMLST analysis showed that the ST2 type accounted for 89.77%,and a new ST type was discovered.After cgMLST analysis,the minimum spanning tree was generated,and the genetic relationship of the same ST type was closer.The same ST2 type was further divided into four clusters.Binary logistic regression analysis conducted on resistance genes and resistance phenotypes revealed that resistance genes APH(3″)-Ib,armA,ADC-73,sul1,and sul2 positively correlated with resistance phenotypes.The ST2 type was the main Acinetobacter baumannii type,and showed high rates of multidrug resistance and carriage of multiple resistance genes.The drug resistance situation is severe.The consistency between common resistance genes and resistance phenotypes is good.Clinical management of Acinetobacter baumannii infection must be strengthened to prevent outbreaks and transmission.

BACKGROUND: Blood glucose and serum albumin have been associated with cardiovascular disease prognosis, but the impact of admission-blood-glucose-to-albumin ratio (AAR) on adverse outcomes in critical ill coronary artery disease (CAD) patients was not investigated. METHODS: Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR. The primary outcome was 1-year mortality, and secondary endpoints were in-hospital mortality, acute kidney injury (AKI), and renal replacement therapy (RRT). A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients. Kaplan-Meier survival analysis determined differences in endpoints across subgroups. RESULTS: A total of 8360 patients were included. There were 726 patients (8.7%) died in the hospital and 1944 patients (23%) died at 1 year. The incidence of AKI and RRT was 63% and 4.3%, respectively. High AAR was markedly associated with in-hospital mortality (HR = 1.587, P = 0.003), 1-year mortality (HR = 1.502, P < 0.001), AKI incidence (HR = 1.579, P < 0.001), and RRT (HR = 1.640, P < 0.016) in CAD patients in the completely adjusted Cox proportional hazard model. Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles. Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes. CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality, 1-year mortality, and adverse renal prognosis in critical CAD patients.

Objective To evaluate the efficacy and safety of high-power,short-duration radiofrequency catheter ablation for the treatment of persistent atrial fibrillation.Methods This retrospective study included 392 patients diagnosed with persistent atrial fibrillation who underwent catheter radiofrequency ablation at Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,from January 2019 to December 2023.Of these,256 patients were treated with high-power,short-duration ablation,and 136 patients with low-power,long-duration ablation.The following parameters were compared:radiofrequency ablation time,total procedure time,single-circle pulmonary vein isolation rate,immediate procedural success rate,number of ablation points,and perioperative complications(including pericardial tamponade,pseudoaneurysm,arteriovenous fistula,stroke,etc.).Follow-up assessments were conducted at 3,6,and 12 months post-surgery to evaluate the 12-month sinus rhythm maintenance rate.Results The ablation time in the high-power group was significantly shorter than that in the low-power group[(14.6±2.3)min vs.(30.3±4.2)min,P＜0.001],as was the total procedure time[(113.8±24.8)min vs.(128.5±26.7)min,P=0.001].There were no significant differences between the two groups in terms of pulmonary vein isolation rate(97.7％vs.94.9％,P=0.823),number of ablation points[(71.2±8.0)vs.(74.3±14.3),P=0.168],or perioperative complications(3.1％vs.4.4％,P=0.571).Regarding the maintenance rate of sinus rhythm at 12 months post-operation,the high-power group showed a higher rate than the low-power group,but no statistically significant difference was observed(82.8％vs.79.4％,P=0.399).Conclusions High-power,short-duration radiofrequency catheter ablation can improve procedural efficiency in the treatment of persistent atrial fibrillation.Its efficacy and safety are similar to those of the low-power,long-duration technique.

Objective:To investigate the distribution of GP.Mur antigen in blood donors in Jiangsu Province.Methods:Genomic DNA was extracted from 1114 blood donors in Jiangsu region.PCR-SSP was performed to amplify GP.Mur,and gene analysis was conducted by direct sequencing of the PCR products.The frequency of GP.Mur in the blood donor population of Jiangsu region was calculated.Results:Out of 1 114 randomly selected blood samples,11 positive bands were detected during amplification.Direct sequencing analysis revealed that among the 11 positive samples,4 were homozygous for GYP.Mur genotype,3 were heterozygous for GYP.Mur genotype,and the remaining 4 samples were identified as GYP.HF genotype.Conclusion:This study analyzed the distribution of the GP.Mur antigen and preliminary obtained the frequency data in the blood donor population in Jiangsu region.Further in-depth research on this blood group is of great importance in guiding clinical blood transfusion practices and ensuring transfusion safety.

Objective:To investigate the predictive value of serum soluble interleukin-2 receptor(sIL-2R),tumor necrosis factor alpha(TNF-α),IgG and IgA for the recurrence in patients with multiple myeloma(MM).Methods:A total of 108 MM patients who were initially diagnosed and treated in our hospital from January 2017 to March 2019,and 72 patients who met the diagnostic criteria and had complete follow-up data were selected as the study subjects.MM recurrence was the endpoint event,and follow-up was conducted until the occurrence of the endpoint event or the deadline of this study.MM patients were divided into recurrent group(RG)and non-recurrent group(NRG)based on whether they have relapsed or not.Venous blood was collected from patients at the first diagnosis and follow-up(at the occurrence of endpoint events or termination of the study),and enzyme-linked immunosorbent assay(ELISA)was used to detect sIL-2R and TNF-α levels in the patient's serum.An automatic immune analyzer was used to detect the levels of IgG and IgA in the patient's serum.The differences in expression levels of the factors between two groups were compared and the correlations between sIL-2R and TNF-α,IgG and IgA at the first diagnosis and follow-up were analyzed.At the same time,venous blood was collected from patients during complete remission,and their serum sIL-2R levels were measured to compare the differences in sIL-2R expression levels at the first diagnosis,complete remission and recurrence.Receiver operating characteristic(ROC)curves was used to determine the optimal cutoff values for serum sIL-2R,TNF-α,IgG and IgA,and the predictive value of sIL-2R,TNF-α,IgG and IgA in the recurrence of MM patients were analyzed based on the area under the curve(AUC).Results:The serum sIL-2R levels of MM patients at the first diagnosis and recurrence were significantly higher than at complete remission(P＜0.05).At the first diagnosis,the hemoglobin content of RG was lower than that of NRG,while the β 2-microglobulin content was higher than that of NRG(P＜0.001).There was no significant difference in other clinical parameters between the two groups(P＞0.05).The levels of sIL-2R,TNF-α,IgG and IgA at the first diagnosis and follow-up of RG were higher than those of NRG(P＜0.05).There was a significant correlation between sIL-2R and TNF-α,IgG and IgA at the first diagnosis and follow-up(P＜0.001).The ROC curve showed that,at the first diagnosis,sIL-2R,TNF-α,IgG and IgA predicted the AUC of MM patients were 0.919,0.850,0.766 and 0.795,respectively,after follow-up,they predicted AUC of MM were 0.890,0.815,0.760 and 0.794,respectively(P＜0.001).Conclusion:The serum sIL-2R has the highest predictive value for MM patient's recurrence,and it is possible to detect the TNF-α,IgG and IgA levels at specific times to infer changes in sIL-2R levels and evaluate the patient's prognosis.

Objective This study aimed to investigate the potential relationship between urinary metals copper (Cu), arsenic (As), strontium (Sr), barium (Ba), iron (Fe), lead (Pb) and manganese (Mn) and grip strength. Methods We used linear regression models, quantile g-computation and Bayesian kernel machine regression (BKMR) to assess the relationship between metals and grip strength.Results In the multimetal linear regression, Cu (β=-2.119), As (β=-1.318), Sr (β=-2.480), Ba (β=0.781), Fe (β= 1.130) and Mn (β=-0.404) were significantly correlated with grip strength (P < 0.05). The results of the quantile g-computation showed that the risk of occurrence of grip strength reduction was -1.007 (95％ confidence interval:-1.362, -0.652; P < 0.001) when each quartile of the mixture of the seven metals was increased. Bayesian kernel function regression model analysis showed that mixtures of the seven metals had a negative overall effect on grip strength, with Cu, As and Sr being negatively associated with grip strength levels. In the total population, potential interactions were observed between As and Mn and between Cu and Mn (Pinteractions of 0.003 and 0.018, respectively).Conclusion In summary, this study suggests that combined exposure to metal mixtures is negatively associated with grip strength. Cu, Sr and As were negatively correlated with grip strength levels, and there were potential interactions between As and Mn and between Cu and Mn.

Objective To establish a dynamic prediction model of fatal massive hemorrhage in trauma based on the vital signs time series data and machine learning algorithms.Methods Retrospectively analyze the vital signs time series data of 7522 patients with trauma in the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ)database from 2008 to 2019.According to the occurrence of posttraumatic fatal massive hemorrhage,the patients were divided into two groups:fatal massive hemorrhage group(n=283)and non-fatal massive hemorrhage group(n=7239).Six machine learning algorithms,including logistic regression(LR),support vector machine(SVM),random forests(RF),adaptive boosting(AdaBoost),gated recurrent unit(GRU),and GRU-D were used to develop a dynamic prediction models of fatal massive hemorrhage in trauma.The probability of fatal massive hemorrhage in the following 1,2,and 3 h was dynamically predicted.The performance of the models was evaluated by accuracy,sensitivity,specificity,positive predictive value,negative predictive value,Youden index,and area under receiver operating characteristic curve(AUC).The models were externally validated based on the trauma database of the Chinese PLA General Hospital.Results In the MIMIC-Ⅳ database,the set of dynamic prediction models based on the GRU-D algorithm was the best.The AUC for predicting fatal major bleeding in the next 1,2,and 3 h were 0.946±0.029,0.940±0.032,and 0.943±0.034,respectively,and there was no significant difference(P=0.905).In the trauma dataset,GRU-D model achieved the best external validation effect.The AUC for predicting fatal major bleeding in the next 1,2,and 3 h were 0.779±0.013,0.780±0.008,and 0.778±0.009,respectively,and there was no significant difference(P=0.181).This set of models was deployed in a public web calculator and hospital emergency department information system,which is convenient for the public and medical staff to use and validate the model.Conclusion A set of dynamic prediction models has been successfully developed and validated,which is greatly significant for the early diagnosis and dynamic prediction of fatal massive hemorrhage in trauma.

Objective:To compare the short-term effect and adverse reaction of venetoclax(VEN)combined with azacitidine(AZA)versus"7+3"regimen in newly diagnosed elder patients with acute myeloid leukemia(AML).Methods:From January 2021 to January 2022,the clinical data of seventy-nine newly diagnosed elder patients with AML at the Second Hospital of Shanxi Medical University and the Shanxi Bethune Hospital were retrospectively analyzed,including VEN+AZA group(41 cases)and"7+3"group(38 cases).The propensity score matching(PSM)method was used to balance confounding factors,then response,overall survival(OS),progression-free survival(PFS)and adverse reactions between the two groups were compared.Results:The ORR of VEN+AZA group and"7+3"group was 68％and 84％,respectively,and the CRc was 64％and 72％,respectively,the differents were not statistically significant(P＞0.05).In the VEN+AZA group,there were 5 non-remission(NR)patients,4 with chromosome 7 abnormality(7q-/-7),and 1 with ETV6 gene mutation.Median followed-up time between the two groups was 8 months and 12 months,respectively,and the 6-months OS was 84％vs 92％(P=0.389),while 6-months PFS was 84％vs 92％(P=0.258).The main hematological adverse reactions in two groups were stage Ⅲ-Ⅳmyelosuppression,and the incidence rate was not statistically different(P＞0.05).The median time of neutrophil recovery in two groups was 27(11-70)d,25(14-61)d(P=0.161),and platelet recovery was 27(11-75)d,25(16-50)d(P=0.270),respectively.The infection rate of VEN+AZA group was lower than that of"7+3"group(56％vs 88％,P=0.012).The rate of lung infections of two groups was 36％and 64％,respectively,the difference was statistically significant(P=0.048).Conclusion:The short-term effect of VEN+AZA group and"7+3"regimens in eldrly AML patients are similar,but the VEN+AZA regimen had a lower incidence of infection.The presence of chromosome 7 abnormality(7q-/-7)may be a poor prognostic factor for elderly AML patients treated with VEN+AZA.