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 explore the relationship between retinol-binding protein (RBP) levels and disease severity in patients with transthyretin cardiac amyloidosis (ATTR-CA), as well as its impact on therapeutic response to tafamidis.Methods:This retrospective study utilized data from the China National Rare Disease Registry System and included ATTR-CA patients treated with tafamidis between January 2018 and September 2022. Patients were stratified into two groups based on baseline RBP levels: the normal RBP group (≥36 mg/L) and the reduced RBP group (<36 mg/L). Baseline characteristics and clinical data after one year of treatment were collected and compared between the groups. Within the reduced RBP group, patients were further subclassified by changes in RBP levels after treatment (ΔRBP=post-treatment RBP-baseline RBP) into ΔRBP>0 and ΔRBP<0 subgroups. Worsening of global longitudinal strain (GLS) after treatment was defined as the primary outcome, logistic regression analysis was used to identify risk factors influencing therapeutic response to tafamidis in ATTR-CA patients.Results:A total of 52 ATTR-CA patients were included (aged (58.5±12.0) years, 46 males (88%)). Among 39 patients who completed one-year tafamidis treatment, no statistically significant difference was observed in RBP levels post-treatment versus baseline ((27.0±14.3) mg/L vs. (25.9±15.4) mg/L, P=0.261). Compared to the normal RBP group, the reduced RBP group had significantly higher estimated glomerular filtration rate-adjusted N-terminal pro-B-type natriuretic peptide levels (2 316.0 (1 161.5, 6 027.8) ng/L vs. 806.2 (349.5, 1 735.8) ng/L), higher left ventricular mass index ((164.4±46.5) g/m2 vs. (123.9±31.8) g/m2), and lower left ventricular ejection fraction ((50.8±11.3)% vs. (58.8±6.2)%) (all P<0.05). Among 31 patients in the reduced RBP group who completed one-year tafamidis treatment, 23 were classified as ΔRBP>0 and 8 as ΔRBP<0. The ΔRBP<0 group exhibited greater GLS worsening than the ΔRBP>0 group (0.7 (-0.1, 1.4)% vs. -0.4 (-1.4, 0.2)%, P=0.027). Multivariate logistic regression analysis revealed that ΔRBP<0 was an independent risk factor for GLS worsening ( OR=8.584, 95%CI 1.186-62.150, P=0.033) in ATTR-CA patients. Conclusion:ATTR-CA patients with reduced RBP levels exhibit more severe left ventricular structural and functional impairment compared to those with normal RBP levels. Decline in RBP during treatment (ΔRBP<0) is associated with poorer response to tafamidis treatment. Monitoring RBP dynamics may assist clinicians in assessing disease severity and therapeutic response in ATTR-CA patients.

In recent years, non-invasive brain stimulation has been widely used in clinical rehabilitation due to its safe and non-invasive features.Particularly for stroke patients, this technique has become a new type of rehabilitation by virtue of its role in improving gait disorders, aphasia, dysphagia, and other complications. Previous research on stroke rehabilitation mainly focused on the cerebral cortex, while the recent evidences suggest that the cerebellum, with its rich synaptic plasticity and extensive structural and functional connectivity with the brain, has emerged as a promising target for non-invasive intervention in stroke rehabilitation. Non-invasive stimulation of the cerebellum is expected to improve patients' impaired function and quality of life. This review discusses the possible mechanisms and clinical applications of non-invasive cerebellar stimulation technology in regulating stroke rehabilitation, aiming to provide new treatment directions and application value for individualized stroke rehabilitation.

In recent years, non-invasive brain stimulation has been widely used in clinical rehabilitation due to its safe and non-invasive features.Particularly for stroke patients, this technique has become a new type of rehabilitation by virtue of its role in improving gait disorders, aphasia, dysphagia, and other complications. Previous research on stroke rehabilitation mainly focused on the cerebral cortex, while the recent evidences suggest that the cerebellum, with its rich synaptic plasticity and extensive structural and functional connectivity with the brain, has emerged as a promising target for non-invasive intervention in stroke rehabilitation. Non-invasive stimulation of the cerebellum is expected to improve patients' impaired function and quality of life. This review discusses the possible mechanisms and clinical applications of non-invasive cerebellar stimulation technology in regulating stroke rehabilitation, aiming to provide new treatment directions and application value for individualized stroke rehabilitation.

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 explore the relationship between retinol-binding protein (RBP) levels and disease severity in patients with transthyretin cardiac amyloidosis (ATTR-CA), as well as its impact on therapeutic response to tafamidis.Methods:This retrospective study utilized data from the China National Rare Disease Registry System and included ATTR-CA patients treated with tafamidis between January 2018 and September 2022. Patients were stratified into two groups based on baseline RBP levels: the normal RBP group (≥36 mg/L) and the reduced RBP group (<36 mg/L). Baseline characteristics and clinical data after one year of treatment were collected and compared between the groups. Within the reduced RBP group, patients were further subclassified by changes in RBP levels after treatment (ΔRBP=post-treatment RBP-baseline RBP) into ΔRBP>0 and ΔRBP<0 subgroups. Worsening of global longitudinal strain (GLS) after treatment was defined as the primary outcome, logistic regression analysis was used to identify risk factors influencing therapeutic response to tafamidis in ATTR-CA patients.Results:A total of 52 ATTR-CA patients were included (aged (58.5±12.0) years, 46 males (88%)). Among 39 patients who completed one-year tafamidis treatment, no statistically significant difference was observed in RBP levels post-treatment versus baseline ((27.0±14.3) mg/L vs. (25.9±15.4) mg/L, P=0.261). Compared to the normal RBP group, the reduced RBP group had significantly higher estimated glomerular filtration rate-adjusted N-terminal pro-B-type natriuretic peptide levels (2 316.0 (1 161.5, 6 027.8) ng/L vs. 806.2 (349.5, 1 735.8) ng/L), higher left ventricular mass index ((164.4±46.5) g/m2 vs. (123.9±31.8) g/m2), and lower left ventricular ejection fraction ((50.8±11.3)% vs. (58.8±6.2)%) (all P<0.05). Among 31 patients in the reduced RBP group who completed one-year tafamidis treatment, 23 were classified as ΔRBP>0 and 8 as ΔRBP<0. The ΔRBP<0 group exhibited greater GLS worsening than the ΔRBP>0 group (0.7 (-0.1, 1.4)% vs. -0.4 (-1.4, 0.2)%, P=0.027). Multivariate logistic regression analysis revealed that ΔRBP<0 was an independent risk factor for GLS worsening ( OR=8.584, 95%CI 1.186-62.150, P=0.033) in ATTR-CA patients. Conclusion:ATTR-CA patients with reduced RBP levels exhibit more severe left ventricular structural and functional impairment compared to those with normal RBP levels. Decline in RBP during treatment (ΔRBP<0) is associated with poorer response to tafamidis treatment. Monitoring RBP dynamics may assist clinicians in assessing disease severity and therapeutic response in ATTR-CA patients.

Objective:To investigate the risk factors and long-term prognosis of major adverse cardiovascular events(MACEs) in patients with dilated cardiomyopathy (DCM).Methods:This study was a single-center retrospective cohort study. Clinical information from 300 patients with DCM hospitalized in Peking Union Medical College Hospital from April 2013 to April 2023 was collected. Based on echocardiography results, the patients were divided into two groups: isolated DCM and DCM with left ventricular non-compaction cardiomyopathy (LVNC). The MACEs, including major heart failure events, severe ventricular arrhythmias, and cardiovascular death, were recorded by outpatient or telephone follow-up. Univariate and multivariate Cox proportional hazard regression models were used to analyze the risk factors affecting the prognosis of patients with DCM. Kaplan-Meier curve and log-rank were used for survival analysis to compare the difference in the incidence of cardiovascular events between the two groups.Results:The included 300 DCM patients were (47.8±16.8) years old, with 197 males (65.7%), of which 237 (79.0%) were isolated DCM and 63 (21.0%) were DCM with LVNC. The follow-up time was 4.0 (1.9, 6.2) years. A total of 142 (47.3%) MACEs occurred, including 117 (39.0%) major heart failure events, 20 (6.7%) severe ventricular arrhythmia events, and 53 (17.7%) cardiovascular death events. Multivariate Cox proportional hazard regression analysis showed that increased left ventricular end-diastolic diameter ( HR=1.21, 95% CI: 1.01-1.44, P=0.042), moderate or severe mitral regurgitation ( HR=1.71, 95% CI: 1.19-2.47, P=0.004), increased ln (N-terminal pro-B-type natriuretic peptide) ( HR=1.30, 95% CI: 1.10-1.54, P=0.002) were independent risk factors for dverse cardiovascular events in DCM patients, and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI) treatment ( HR=0.45, 95% CI: 0.26-0.78, P=0.004) was independent protective factor. Kaplan-Meier survival analysis found no significant difference in the risk of MACEs between isolated DCM and DCM with LVNC ( P=0.22). Similarly, there were no significant differences in the incidence of major heart failure, severe ventricular arrhythmia, and cardiovascular death between the two groups (all P>0.05). Conclusion:An increase in left ventricular end-diastolic diameter, moderate or severe mitral regurgitation, elevated N-terminal pro-B-type natriuretic peptide, and non use of ACEI/ARB/ARNI are independent predictors of cardiovascular events in DCM patients. There was no significant risk of MACEs in patients with isolated DCM and DCM with LVNC, and suggested that LVNC may be a unique phenotype and should be accurately managed in combination with genetic background.

Objective:To explore the clinical characteristics and prognostic value in hereditary transthyretin amyloidosis cardiomyopathy (hATTR-CM) patients based on cluster analysis, and to explore the risk factors for cardiovascular composite events.Methods:This retrospective cohort study included hATTR-CM patients who were admitted to Peking Union Medical College Hospital from January 2000 to January 2024. These patients were divided into two clusters using cluster analysis, based on genetic information, demographic information and clinical information. During the follow-up period, cardiovascular composite events were defined as all-cause death and hospitalization for heart failure. Both cardiovascular composite events and all-cause death were the endpoints. Kaplan-Meier survival curves and log-rank method were used to compare the prognostic significance of cluster analysis subgroups. Univariate and multivariate Cox proportional hazard regression models were used to analyze the risk factors affecting the incidence of cardiovascular composite events.Results:A total of 43 patients were included in this study, 30 were male (69.8%). In cluster 1 ( n=27), whose age of onset was (49.9±13.9) years old, 24(88.9%) of them started with neuropathy or gastrointestinal symptoms, and all clinical phenotypes were mixed type (neurological and cardiac). In cluster 2 ( n=16), whose age of onset was (59.0±10.6) years old, 15(93.8%) of them started with heart failure symptoms, and 13(81.3%) were pure cardiomyopathy. During the median follow-up time of 2.6 years, a total of 16 patients (37.2%) experienced composite cardiovascular events, and a total of 12 patients (27.9%) died. Kaplan-Meier survival curves showed a significantly lower cumulative survival rate for cardiovascular composite endpoint events (log-rank P=0.04) and all-cause death (log-rank P=0.04) in cluster 2 than in cluster 1. Univariate Cox proportional hazard regression model analysis showed that hATTR-CM patients with reduced estimated glomerular filtration rate, left ventricular ejection fraction≤40%, and moderate to severe mitral regurgitation were risk factors for vascular composite events (all P<0.05). Multivariate Cox proportional hazard regression analysis showed that left ventricular ejection fraction≤40% was an independent risk factor ( P<0.01). Conclusions:Cluster analysis is a valuable prediction tool on the prognostic stratification of hATTR-CM. Cluster 2, which is late-onset with onset of heart failure symptoms has a worse prognosis during follow-up period. The occurrence of composite cardiovascular events in hATTR-CM is related to left ventricular ejection fraction≤40%. Cluster analysis is helpful for clinical identification of high-risk groups.

Objective To investigate the relationship between symptom burden and rehabilitation self-efficacy of patients after fragility fracture surgery,and to study the chain mediating role of social support and perceived stress in the influence of symptom burden on rehabilitation self-efficacy of such patients.Methods Approved by the Ethics Committee of the hospital,168 patients who met the admission criteria after fragility fracture surgery admitted to the Second Affiliated Hospital of Inner Mongolia Medical University from July 2020 to December 2023 were included in the study by convenient sampling method,and general data of the patients were collected.M.D.Anderson Symptom Inventor(MDASI),Self-Efficacy for Managing Chronic Disease 6-Item Scale(SECD6),Social Support Rating Scale(SSRS)and Perceived Stress Scale(CPSS)were used to investigate the above patients,and multiple sets of quantitative data were analyzed for attribution association profile and mediation effect.Results After removing invalid questionnaires,a total of 160 valid questionnaires were collected,with an effective response rate of 95.24％.Correlation analysis showed that symptom burden was negatively correlated with rehabilitation self-efficacy(r=-0.405,P＜0.05);social support was significantly positively correlated with rehabilitation self-efficacy(r=0.558,P＜0.05);perceived stress was negatively correlated with rehabilitation self-efficacy(r=-0.330,P＜0.05);symptom burden was negatively correlated with social support(r=-0.191,P＜0.05);social support was negatively correlated with perceived stress(r=-0.280,P＜0.05);symptom burden was positively correlated with perceived stress(r=0.376,P＜0.05).Mediating effect test showed that the symptom burden of patients after fragility fracture surgery had a direct impact on rehabilitation self-efficacy(β=-0.402,t=0.148,P＜0.05),and had an impact on rehabilitation self-efficacy through 3 mediating pathways:first,the mediating effect of social support alone(β=-0.098,95％CI:-0.112～-0.074);the second was the mediating effect of stress perception alone(β=-0.081,95％CI:-0.104～-0.061);the third is the chain mediating effect of social support and stress perception(β=-0.056,95％CI:-0.074～-0.030).Conclusion The burden of symptoms after fragility fracture surgery has a direct effect on rehabilitation self-efficacy.Symptom burden influences postoperative self-efficacy of patients with fragility fractures through the chain mediation of social support and perceived stress.Early and accurate assessment of symptom burden,stress perception and social support should be conducted.According to needs,the multidisciplinary medical team provides individualized and diversified health education support to actively help and guide the self-regulation of patients'stress perception,so as to reduce patients'symptom burden and promote the improvement of their self-efficacy in the process of rehabilitation.

Objective To investigate the relationship between symptom burden and rehabilitation self-efficacy of patients after fragility fracture surgery,and to study the chain mediating role of social support and perceived stress in the influence of symptom burden on rehabilitation self-efficacy of such patients.Methods Approved by the Ethics Committee of the hospital,168 patients who met the admission criteria after fragility fracture surgery admitted to the Second Affiliated Hospital of Inner Mongolia Medical University from July 2020 to December 2023 were included in the study by convenient sampling method,and general data of the patients were collected.M.D.Anderson Symptom Inventor(MDASI),Self-Efficacy for Managing Chronic Disease 6-Item Scale(SECD6),Social Support Rating Scale(SSRS)and Perceived Stress Scale(CPSS)were used to investigate the above patients,and multiple sets of quantitative data were analyzed for attribution association profile and mediation effect.Results After removing invalid questionnaires,a total of 160 valid questionnaires were collected,with an effective response rate of 95.24％.Correlation analysis showed that symptom burden was negatively correlated with rehabilitation self-efficacy(r=-0.405,P＜0.05);social support was significantly positively correlated with rehabilitation self-efficacy(r=0.558,P＜0.05);perceived stress was negatively correlated with rehabilitation self-efficacy(r=-0.330,P＜0.05);symptom burden was negatively correlated with social support(r=-0.191,P＜0.05);social support was negatively correlated with perceived stress(r=-0.280,P＜0.05);symptom burden was positively correlated with perceived stress(r=0.376,P＜0.05).Mediating effect test showed that the symptom burden of patients after fragility fracture surgery had a direct impact on rehabilitation self-efficacy(β=-0.402,t=0.148,P＜0.05),and had an impact on rehabilitation self-efficacy through 3 mediating pathways:first,the mediating effect of social support alone(β=-0.098,95％CI:-0.112～-0.074);the second was the mediating effect of stress perception alone(β=-0.081,95％CI:-0.104～-0.061);the third is the chain mediating effect of social support and stress perception(β=-0.056,95％CI:-0.074～-0.030).Conclusion The burden of symptoms after fragility fracture surgery has a direct effect on rehabilitation self-efficacy.Symptom burden influences postoperative self-efficacy of patients with fragility fractures through the chain mediation of social support and perceived stress.Early and accurate assessment of symptom burden,stress perception and social support should be conducted.According to needs,the multidisciplinary medical team provides individualized and diversified health education support to actively help and guide the self-regulation of patients'stress perception,so as to reduce patients'symptom burden and promote the improvement of their self-efficacy in the process of rehabilitation.