Objective:To investigate the endocardial myocardial biopsy and ultrastructural features of heart failure patients with reduced ejection fraction, to determine their histopathologic phenotype, and to explore the diagnostic utility of endomyocardial biopsy in such patients.Methods:A total of 35 patients with heart failure with reduced ejection fraction diagnosed at Beijing Anzhen Hospital and underwent endomyocardial biopsy were collected between January 2022 and December 2023. The clinical features, histopathological, and ultrastructural characteristics were analyzed and compared with 11 patients with heart failure with preserved ejection fraction.Results:The age ranged from 35-58 years, with median age of 51 years; there were 26 males and 9 females. Myocardial fibrosis and myocardial fiber disorders were the most common histopathologic changes [97.1% (34/35) and 74.3% (26/35), respectively]. Myocardial fibrosis was not statistically different between the heart failure with reduced ejection fraction group and the heart failure with preserved ejection fraction group [13.3% (5.7%-21.4%) vs. 13.2% (9.3%-34.2%), P=0.279]. Significant ultrastructural changes were dense mitochondrial proliferation, vacuolar degeneration, and disorganized arrangement of myocardial fibers with localized lysis and fracture. After endomyocardial biopsy, the etiology was identified in 11 patients (31.4%,11/35), with a prevalence of cardiac amyloidosis of 17.1% (6/35). Conclusions:Endomyocardial biopsy is useful for early diagnosis and precise treatment in patients presenting with heart failure with reduced ejection fraction. Histopathological and ultrastructural analyses can uncover potential treatments, and predict and improve prognosis by providing relevant information for understanding the pathogenesis and clinical evolution.

ObjectiveTo clarify the repair effect of Mume Fructus on the intestinal mucosal epithelial barrier in the mouse model of inflammatory bowel disease （IBD） and explore the repair mechanism. MethodsThirty-six male C57BL/6 mice were randomly assigned into six groups： normal， model， low-， medium-， and high-dose （200， 400， and 800 mg·kg^-1） Mume Fructus， and sulfasalazine （300 mg·kg^-1）. Except the normal group， the rest groups had free access to 2% dextran sulfate sodium （DSS） solution for seven days to establish the IBD model， followed by a seven-day drug intervention. The body weight change and disease activity index （DAI） were recorded. After the last administration， spleen and colon tissue samples were collected to analyze the differences in colon length and spleen index. Hematoxylin-eosin staining was used to observe the morphology of the colon tissue. The level of diamine oxidase （DAO） in the serum was measured by the DAO assay kit. Immunohistochemistry was employed to determine the expression of tight junction proteins such as Claudin-1， Occludin， and zonula occludens-1 （ZO-1） in the colon tissue. Real-time PCR was performed to measure the mRNA levels of tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in the colon tissue. Finally， Western blot was employed to determine the protein levels of mitogen-activated protein kinase kinase （MEK）， extracellular signal-regulated kinase （ERK）， phosphorylated （p）-MEK， and phosphorylated ERK in the colon tissue. ResultsCompared with the normal group， the model group exhibited decreases in body weight and colon length （P<0.01）， increases in DAI， spleen index， and serum DAO level （P<0.01）， damaged colonic epithelium and goblet cells， and obvious infiltration of inflammatory cells. In addition， the model group exhibited higher positive expression of Claudin-1， Occludin， and ZO-1 （P<0.01）， higher mRNA levels of TNF-α and IL-1β （P<0.01）， and higher protein levels of p-MEK and p-ERK （P<0.05， P<0.01） than the normal group. However， sulfasalazine and three doses of Mume Fructus markedly decreased the body weight and DAI （P<0.05）， recovered the colon length and spleen index， alleviated colon tissue damage， lowered the level of DAO in the serum （P<0.01）， and down-regulated the mRNA levels of TNF-α and IL-1β （P<0.01） and the protein levels of p-MEK and p-ERK （P<0.05）. Sulfasalazine and low- and medium-dose Mume Fructus increased the positive expression of Occludin， Claudin-1， and ZO-1 （P<0.05， P<0.01）. Furthermore， high-dose Mume Fructus elevated the protein expression of Occludin （P<0.05）. ConclusionMume Fructus can restore the expression of intestinal epithelial tight junction proteins by inhibiting the phosphorylation of proteins in the MEK/ERK signaling pathway and down-regulating the levels of TNF-α and IL-1β， thus repairing the intestinal mucosal barrier in the mouse model of IBD.

ObjectiveTo explore the evolution of medication patterns and syndrome-herb associations of traditional Chinese medicine （TCM） in treating inflammatory bowel disease （IBD）， providing a theoretical foundation for precise syndrome differentiation and treatment in clinical practice. MethodsMedical case literature on TCM treatment of IBD from 1960 to 2024 was retrieved to establish a database. Frequency statistics， cluster analysis， change point detection， and association rule mining were employed to comprehensively analyze the syndrome distribution， therapeutic methods， medication patterns， and their temporal variations. ResultsA total of 685 medical cases were included. Common syndromes were dampness-heat （66.42%） and spleen deficiency （56.20%）. Primary therapeutic methods included heat clearing （63.65%）， spleen invigorating （47.45%）， and dampness draining （36.79%）. High-frequency herbs included Coptidis Rhizoma （354）， Paeoniae Radix Alba （303）， Aucklandiae Radix （292）， Codonopsis Radix （253）， and Glycyrrhizae Radix et Rhizoma （244）. Initial prescription clustering revealed three core therapeutic method combinations： heat clearing and detoxifying （represented by Baitouweng Tang）， spleen invigorating and Qi reinforcing （represented by Shenling Baizhusan）， and cold-heat regulation （represented by Wumeiwan combined with Shaoyao tang）. Temporal analysis identified 2008 as a key transition point in TCM treatment of IBD， with significantly increased usage frequency of heat-clearing and dampness-drying herbs such as Fraxini Cortex， Phellodendri Chinensis Cortex， Sophorae Flavescentis Radix， and Scutellariae Radix as well as hemostatic herbs such as carbonized Sanguisorbae Radix， Bletillae Rhizoma， Agrimoniae Herba， and Notoginseng Radix et Rhizoma. Follow-up efficacy analysis showed median improvement rates of 64.0% at the first follow-up， 76.0% at the second follow-up， and 78.7% at the third follow-up. Syndrome-drug association analysis revealed specific herb pairs with significant therapeutic advantages， including Notoginseng Radix et Rhizoma + Coicis Semen， Sanguisorbae Radix + Coptidis Rhizoma， and Codonopsis Radix + Aconii Lateralis Radix Praeparaia. ConclusionTCM medication patterns for treating IBD demonstrate distinct temporal evolution characteristics， with significantly increased usage frequency of herbs such as Fraxini Cortex， Notoginseng Radix et Rhizoma， and Agrimoniae Herba. Significant therapeutic method-herb associations and syndrome-herb association patterns exist， with the formation of specific herb pairs， providing evidence-based support for precise syndrome differentiation and treatment of IBD.

Objective To construct a LASSO-logistic regression model for the risk of complications of cardiopulmonary resuscitation(CPR)based on clinical data and relevant parameters of external chest compression and to provide a reference for the prevention of com-plications of cardiopulmonary resuscitation.Methods One hundred cardiac arrest survivor patients admitted to Shijiazhuang Circular Chemical Industrial Park Hospital from April 2020 to May 2023 were selected and divided into complication and non-complication groups according to complications.The clinical data,chest compression-related parameters of the 2 groups were compared,and LASSO regression was used to initially screen the influencing factors of CPR complications.Logistic regression was used to analyze the influencing factors of CPR complications,and Nomogram was drawn to predict the risk of CPR complications.Results LASSO regression screening showed that the coefficients of body mass index,thoracic anteroposterior diameter,rescuer education level,and rescuer gender were compressed.When λ was 1.786,the number of influencing factors was minimized,and the model performance was excellent.At this time,seven predic-tive variables including rescuer identity,rescuer CPR training,application of air mattress,application of decompression pad,compression depth,compression duration,and strict control of fluid volume were selected to achieve the best selection of influencing factors.Logistic regression analysis showed that rescuer being a nurse,rescuer having received CPR training,application of air mattress bed,application of decompression pad,and strict control of fluid volume were related protective factors for CPR complications,while compression depth and compression duration were related risk factors for CPR complications(P＜0.05).The nomogram diagram of the logistic prediction model for CPR complication risk showed that its C-index was 0.932,indicating good discrimination,and the calibration curve fitted well with the ideal curve.The constructed prediction model had good consistency with the actual observed results.Conclusion CPR complications included sternal fractures,lung contusions,and rib fractures.The risk closely relates to the rescuer,the rescuer's CPR training,the appli-cation of air mattress bed,the application of decompression pad,the depth of compression,the duration of compression,and the strict con-trol of fluid volume.

Objective To construct a LASSO-logistic regression model for the risk of complications of cardiopulmonary resuscitation(CPR)based on clinical data and relevant parameters of external chest compression and to provide a reference for the prevention of com-plications of cardiopulmonary resuscitation.Methods One hundred cardiac arrest survivor patients admitted to Shijiazhuang Circular Chemical Industrial Park Hospital from April 2020 to May 2023 were selected and divided into complication and non-complication groups according to complications.The clinical data,chest compression-related parameters of the 2 groups were compared,and LASSO regression was used to initially screen the influencing factors of CPR complications.Logistic regression was used to analyze the influencing factors of CPR complications,and Nomogram was drawn to predict the risk of CPR complications.Results LASSO regression screening showed that the coefficients of body mass index,thoracic anteroposterior diameter,rescuer education level,and rescuer gender were compressed.When λ was 1.786,the number of influencing factors was minimized,and the model performance was excellent.At this time,seven predic-tive variables including rescuer identity,rescuer CPR training,application of air mattress,application of decompression pad,compression depth,compression duration,and strict control of fluid volume were selected to achieve the best selection of influencing factors.Logistic regression analysis showed that rescuer being a nurse,rescuer having received CPR training,application of air mattress bed,application of decompression pad,and strict control of fluid volume were related protective factors for CPR complications,while compression depth and compression duration were related risk factors for CPR complications(P＜0.05).The nomogram diagram of the logistic prediction model for CPR complication risk showed that its C-index was 0.932,indicating good discrimination,and the calibration curve fitted well with the ideal curve.The constructed prediction model had good consistency with the actual observed results.Conclusion CPR complications included sternal fractures,lung contusions,and rib fractures.The risk closely relates to the rescuer,the rescuer's CPR training,the appli-cation of air mattress bed,the application of decompression pad,the depth of compression,the duration of compression,and the strict con-trol of fluid volume.

Objective:To investigate the endocardial myocardial biopsy and ultrastructural features of heart failure patients with reduced ejection fraction, to determine their histopathologic phenotype, and to explore the diagnostic utility of endomyocardial biopsy in such patients.Methods:A total of 35 patients with heart failure with reduced ejection fraction diagnosed at Beijing Anzhen Hospital and underwent endomyocardial biopsy were collected between January 2022 and December 2023. The clinical features, histopathological, and ultrastructural characteristics were analyzed and compared with 11 patients with heart failure with preserved ejection fraction.Results:The age ranged from 35-58 years, with median age of 51 years; there were 26 males and 9 females. Myocardial fibrosis and myocardial fiber disorders were the most common histopathologic changes [97.1% (34/35) and 74.3% (26/35), respectively]. Myocardial fibrosis was not statistically different between the heart failure with reduced ejection fraction group and the heart failure with preserved ejection fraction group [13.3% (5.7%-21.4%) vs. 13.2% (9.3%-34.2%), P=0.279]. Significant ultrastructural changes were dense mitochondrial proliferation, vacuolar degeneration, and disorganized arrangement of myocardial fibers with localized lysis and fracture. After endomyocardial biopsy, the etiology was identified in 11 patients (31.4%,11/35), with a prevalence of cardiac amyloidosis of 17.1% (6/35). Conclusions:Endomyocardial biopsy is useful for early diagnosis and precise treatment in patients presenting with heart failure with reduced ejection fraction. Histopathological and ultrastructural analyses can uncover potential treatments, and predict and improve prognosis by providing relevant information for understanding the pathogenesis and clinical evolution.

Amniotic fluid embolism (AFE) is a rare but extremely dangerous obstetric catastrophic disease, with coagulation dysfunction being a common clinical manifestation. This article reports a case of AFE with disseminated intravascular coagulation as the initial presentation, and conducts literature review. In order to increase the attention of clinical physicians to obstetric coagulation dysfunction and provide a basis for early identification and treatment of AFE.

Objective To retrospectively analyze of factors influencing early preterm birth(EPB)and late preterm birth(LPB)in pregnancy women with placenta previa complicated by placenta accreta spectrum disorders(PAS),and assess maternal and infant outcomes.Methods We included 590 cases of pregnancy women with placenta previa complicated by PAS who underwent cesarean sections at five hospitals in Wuhan and Xianning cities between January 2018 and June 2021.These patients were divided into three groups based on delivery gesta-tional age:EPB,LPB,and term birth(TB).A multiple logistic regression model was employed to analyze the risk factors associated with EPB and LPB.Additionally,differences in early maternal and infant outcomes among these groups were examined.Results Among 590 pregnancy women with placenta previa complicated by PAS,the proportions of EPB and LPB were 9.7%and 54.4%.The use of uterine contraction inhibitors prior to cesarean section,vaginal bleeding,and previous cesarean sections history were identified as risk factors for both EPB and LPB.The proportion of severe postpartum hemorrhage was comparable between the EPB group and the LPB group;however,the incidence of neonatal asphyxia,low birth weight infants,and the rate of newborns transferred to the Neonatal Intensive Care Unit(NICU)within 24 hours after cesarean delivery were significantly higher in the EPB group compared to the LPB group.Conclusions Placenta previa complicated by PAS predominantly leads to LPB.The history of prior cesarean sections,uterine contractions,and vaginal bleeding prior to cesarean section,are sig-nificantly associated with both EPB and LPB.During the perinatal period,efforts should be made to extend gesta-tional weeks under close monitoring to minimize the incidence of premature births and thereby improve early mater-nal and infant outcomes.

Objective:To investigate the impact of short-term exposure to atmospheric pollutants on the number of acute stroke daily admissions in Taiyuan, China.Methods:The case data of patients with stroke from three large hospitals in different regions of Taiyuan, Shanxi Province from January 1, 2018 to December 31, 2019 were collected. The daily average concentrations of atmospheric pollutants and meteorological data in Taiyuan during the same period were collected. Spearman rank correlation was used to analyze the correlation between meteorological factors and atmospheric pollutants, and a generalized additive model (GAM) based on time series research and analysis was used to investigate the impact and lag effect of air pollutants on the number of stroke daily admissions. Stratified analysis was performed based on different genders and ages (≤64 years, 65-74 years, and ≥75 years).Results:Between 2018 and 2019, a total of 4 921 patients with acute stroke were collected from three large hospitals, with a daily average of 6.74 stroke admissions. Among them, 4 310 patients (87.6%) had ischemic stroke, 521 (10.6%) had cerebral hemorrhage, and 90 (1.8%) had subarachnoid hemorrhage. GAM analysis showed that there was a significant correlation between short-term exposure to PM 2.5, PM 10, and SO 2 and the number of stroke daily admissions. All three had a significant impact on the number of stroke daily admissions on the day of onset and 3 days later. The maximum effect value was reached on the day of onset, and when the average concentrations of PM 2.5, PM 10, and SO 2 increase by 10 μg/m 3, the number of stroke daily admissions increased by 1.48% (95% confidence interval [ CI] 0.46%-2.53%), 0.80% (95% CI 0.25%-1.36%), and 2.80% (95% CI 0.76%-4.88%), respectively. Stratified analysis showed that exposure to PM 2.5, PM 10, SO 2, and CO had a more significant impact on the number of stroke daily admissions in male patients, while only PM 10 showed positive results in females. Age stratified analysis showed that PM 2.5 significantly increased the number of stroke daily admissions in individuals aged ≥75 years. Conclusion:Short-term exposure to atmospheric pollutants (PM 2.5, PM 10, SO 2, and CO) will to some extent increase the number of stroke daily admissions among residents of Taiyuan, especially among males and those aged ≥75 years.

Amniotic fluid embolism (AFE) is a rare but extremely dangerous obstetric catastrophic disease, with coagulation dysfunction being a common clinical manifestation. This article reports a case of AFE with disseminated intravascular coagulation as the initial presentation, and conducts literature review. In order to increase the attention of clinical physicians to obstetric coagulation dysfunction and provide a basis for early identification and treatment of AFE.