Objective To assess the correlation between the body mass index(BMI)and short-term prognosis in the patients with acute myocardial infarction complicating cardiogenic shock(AMI-CS).Methods A total of 262 patients with diagnosed AMI-CS hospitalized in this hospital from January 2013 to February 2022 were selected as the study subjects,and a total of 255 patients with AMI-CS were included after excluding the patients with incomplete clinical data,no coronary angiography,loss to follow-up and low BMI(<18.5 kg/m2).Among them,those with BMI of 18.5-<24.0 kg/m2 were included in the normal BMI group(n=150),and those with BMI of≥24.0 kg/m2 were included in the overweight or obese group(n=105).The baseline data,auxiliary examinations and treatment measures of the patients were collected,and the patients who did not die at the time of discharge were followed up by telephone on 30 d after AMI onset,and the survival status of the patients,whether having major adverse cardiovascular events(MACE)occurrence and the occurrence time were obtained.The correlation between BMI and endpoint events was assessed by the COX regression model.Results The proportion of complicating atrial fibrillation,BNP and urea levels in the overweight or obesity group were lower than those in the normal BMI group,the BMI and Hb levels were higher than those in the normal BMI group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the results of cardiovascular examination between the two groups(P>0.05).The use rate of β-receptor blockers in the overweight or obese group was higher than that in the normal BMI group,and the difference was statistically significant(P<0.05).On 30 d of follow-up,the all-cause mortality rate in the overweight or obese group was 39.0%,which was lower than 44.0%in the normal BMI group,but the difference was not statistically significant(P=0.430);there was no statistically signifi-cant difference in the incidence rate of each MACE event and the total incidence rate of MACE between the two groups(P>0.05).The BMI normal group served as the control,the risk of death and the occurrence risk of MACE events in the overweight or obese group had no significant increase(P>0.05).The short-term prognosis had no significant interaction between BMI and the patients in different subgroups(P>0.05).Con-clusion The short-term prognosis has no significant difference between the overweight/obese AMI-CS pa-tients and normal BMI AMI-Cs patients.

Objective To investigate the protective effect of colchicine against myocardial ischemia-reperfusion injury(I/R)and explore the underlying mechanism.Methods H9C2 cells exposed to hypoxia/reoxygenation(H/R)were treated with 3 nmol/L colchicine,after which the changes in cell viability were assessed using MTT assay,and AMPK phosphorylation,the expressions of NOX4,NRF2,SOD2,BAX,Bcl-2,and cleaved caspase-3 were detected with Western blotting.Male C57BL/6 mice were randomized into sham operation,I/R,I/R+colchicine,and I/R+colchicine+dorsomorphin(DSMP)groups.After the treatments,myocardial expressions of p-AMPK/AMPK,8-OHdG,cleaved caspase-3,mitochondrial BAX(Mito-BAX),and cytoplasmic cytochrome C(Cyt-Cyto C)were examined and cardiac functions,infarct area,ATP content,and serum levels of lactic dehydrogenase(LDH)and cardiac troponin T(cTnT)levels were assessed.Results In H9C2 cells,H/R exposure significantly reduced AMPK phosphorylation and expressions of NRF2,SOD2,and Bcl-2,lowered cell viability,and up-regulated the expressions of NOX4,BAX,and cleaved caspase-3(P<0.05),and these changes were obviously alleviated by colchicine treatment(P<0.05).In the mouse models,myocardial I/R injury significantly reduced myocardial AMPK phosphorylation level,ATP content,and expressions of NRF2,SOD2 and Bcl-2,caused cardiac function impairment,enhanced NOX4,Mito-BAX,Cyt-Cyto C,BAX,8-OHdG,and cleaved caspase-3 expressions,and increased infarct area and serum LDH and cTnT levels(P<0.05).Colchicine treatment significantly reversed the damaging effects of I/R(P<0.05),but its protective effects was obviously antagonized by DSMP(P<0.05).Conclusion Colchicine alleviates myocardial I/R injury and protects cardiac function in mice by reducing myocardial oxidative stress and apoptosis via activating AMPK.

Objective To investigate the protective effect of colchicine against myocardial ischemia-reperfusion injury(I/R)and explore the underlying mechanism.Methods H9C2 cells exposed to hypoxia/reoxygenation(H/R)were treated with 3 nmol/L colchicine,after which the changes in cell viability were assessed using MTT assay,and AMPK phosphorylation,the expressions of NOX4,NRF2,SOD2,BAX,Bcl-2,and cleaved caspase-3 were detected with Western blotting.Male C57BL/6 mice were randomized into sham operation,I/R,I/R+colchicine,and I/R+colchicine+dorsomorphin(DSMP)groups.After the treatments,myocardial expressions of p-AMPK/AMPK,8-OHdG,cleaved caspase-3,mitochondrial BAX(Mito-BAX),and cytoplasmic cytochrome C(Cyt-Cyto C)were examined and cardiac functions,infarct area,ATP content,and serum levels of lactic dehydrogenase(LDH)and cardiac troponin T(cTnT)levels were assessed.Results In H9C2 cells,H/R exposure significantly reduced AMPK phosphorylation and expressions of NRF2,SOD2,and Bcl-2,lowered cell viability,and up-regulated the expressions of NOX4,BAX,and cleaved caspase-3(P<0.05),and these changes were obviously alleviated by colchicine treatment(P<0.05).In the mouse models,myocardial I/R injury significantly reduced myocardial AMPK phosphorylation level,ATP content,and expressions of NRF2,SOD2 and Bcl-2,caused cardiac function impairment,enhanced NOX4,Mito-BAX,Cyt-Cyto C,BAX,8-OHdG,and cleaved caspase-3 expressions,and increased infarct area and serum LDH and cTnT levels(P<0.05).Colchicine treatment significantly reversed the damaging effects of I/R(P<0.05),but its protective effects was obviously antagonized by DSMP(P<0.05).Conclusion Colchicine alleviates myocardial I/R injury and protects cardiac function in mice by reducing myocardial oxidative stress and apoptosis via activating AMPK.

Transcatheter adrenal artery embolization(TAAE)is a minimally-invasive interventional treatment for adrenal diseases.Perioperative pain occurs mainly during and after operation.The standardized management of perioperative pain can reduce the occurrence of intraoperative adverse reactions,improve the degree of intraoperative cooperation,better the postoperative quality of life,thus,to improve patient satisfaction with interventional surgery.However,current researches among the healthcare staff mainly focus on the safety and efficacy of TAAE while neglect the standardized pain management during the perioperative period.Therefore,in order to improve the surgical efficacy of TAAE and optimize the perioperative surgical experience of patients,it is necessary to formulate a standardized pain management strategy and to apply this strategy in clinical practice.This paper aims to make a comprehensive review about the current situation of perioperative pain occurrence and pain management strategies in TAAE therapy,so as to provide reference for standardizing the perioperative pain management of interventional surgery,and improving the success rate of interventional surgery as well as the patient satisfaction with the treatment.(J Intervent Radiol,2024,33:679-683)

Transthyretin cardiac amyloidosis myocardiopathy （ATTR-CM） is an infiltrative cardiomyopathy characterized by the deposition of amyloidogenic material in the myocardial interstitium due to the misfolding of monomers following the dissociation of unstable transthyretin （TTR） tetramers. Previous treatments for ATTR-CM lacked specificity，primarily targeting symptomatic management of heart failure and arrhythmias. In recent years，researchers have developed two major classes of drugs addressing the pathogenesis of ATTR-CM. The first class stabilizes TTR tetramer structure （such as tafamidis and acoramidis）， while the second class interferes with TTR synthesis （such as patisiran）. Among these，tafamidis has been confirmed as the only currently effective treatment for ATTR-CM，while other drugs are still in clinical trial stages with limited clinical evidence. Concerning the management of comorbidities in ATTR-CM，treatment mainly focuses on common cardiac comorbidities （such as heart failure and arrhythmias）. Traditional drugs used to improve heart failure prognosis （such as β-blockers and renin-angiotensin- receptor blocker），have not demonstrated prognosis improvement in ATTR-CM patients and may even lead to adverse reactions. For ATTR-CM patients with concurrent atrial fibrillation，anticoagulation therapy is recommended to prevent thrombus formation，and amiodarone can be used for rhythm control. Despite significant advancements in pharmaceutical treatments for ATTR-CM，the overall prognosis remains poor，necessitating further research into the pathogenesis and target development to enhance the prognosis of ATTR-CM patients.

Objective:To evaluate the effect of three teaching methods of case-based learning (CBL), problem-based learning (PBL) and blended learning (CBL+PBL) on the teaching of clinical clerkship of cardiovascular internal medicine among medical students.Methods:A total of 175 third-year medical students were divided into three groups (CBL, PBL and CBL+PBL). They entered the clinical clerkship in batches, and then received written examination and questionnaire survey after the teaching. The data were processed by SPSS 19.0 and were compared by one-way ANOVA or chi-square test (R × C) among groups.Results:The total average scores of students in CBL, PBL and CBL+PBL groups were 15.34±2.88, 14.67±2.98 and 17.13±2.82, respectively ( P<0.05), and the proportion of students with "excellent" scores were 27.4%(17/62), 14.5%(9/62) and 58.1%(36/162), respectively. Most students in CBL group did not agree that CBL helped to train literature access skills [70.7%(41/58)] or teamwork ability [82.8%(48/58)], compared with which 70.9%(39/55) in PBL group thought it helped to train literature access skills but only 7.3%(4/55) well accepted PBL. In addition, majority of students in CBL+PBL group believed it was helpful to gain learning interest [64.3%(36/56)] and train team cooperation ability [62.5%(35/56)], and [53.6%(30/56)] favored this teaching method. Conclusion:Compared with traditional CBL, PBL fails to attract students or improve teaching performance; while blended learning is benefited for the students and can improve teaching quality.

Objective To evaluate the efficacy and safety of donepezil combined with memantine in the treatment of Alzheimer′s disease and provide a guidance for the proper clinical use of those medications.Methods The literatures published from 2014 to 2016 in CNKI/VIP/WanFang Med-online/CBM and other databases were collected.Screening and quality evalua-tion were carried out with include and exclude standard.The software RevMan 5.3 was used for data analysis.Results Eight-een studies included are randomized controlled trials with 900 cases in study group and 896 cases in control group.The com-bined results showed that MMSE,NPI and BEHAVE-AD of the combination therapy were superior to those of monotherapy group.There is no significant difference in ADL and ADAS-Cog.Conclusion The combination therapy was better than mono-therapy both in mental state and pathological behavior.The clinical application of those medications should be based on the spe-cific conditions of individual patient.

There are some problems in clinical teaching of cardiovascular medicine, such as insuf-ficient attention to the "three bases" skills, not teaching trainees in accordance with their aptitude ade-quately, monotonous instructional mode, and assessment becoming a mere formality. Aiming at these prob-lems, we have explored the training methods of medical talents adapted to the modern medical model, and improved the clinical basic skills and thinking of the students and the quality of teaching through such measures as paying close attention to basic skills training, standardizing ward rounds, paying attention to teaching students in accordance with their aptitude, and reforming teaching methods and assessment modes.

Objective To investigate the impact of body mass index (BMI) on short-term and long-term prognosis in the patients with ST-segment elevation myocardial infarction (STEMI).Methods The clinical data of inpatients with STEMI in our hospital during 2014 were retrospectively collected.The patients conforming to the inclusion and exclusion criteria were divided into 4 groups according to BMI,low BMI group (n=31),normal BMI group (n=139),overweight group (n=71) and obesity group(n=26).The clinical baseline data were analyzed and compared among 4 groups,and the all-cause mortality on 7 d and within 1 year after myocardial infarction(MI) was followed up.Results The higher the BMI increased,the younger the patient's onset age (P＜0.01),the smaller the female proportion(P=0.001),among them,the albumin and hemoglobin levels in the obesity group were relatively higher(P=0.004;P =0.006);the all-cause mortality at 1 year after MI was significantly decreased with BMI increasing (P =0.003),while which on 7 d after MI had no statistical difference (P=0.287).Conclusion BMI is correlated with the long-term prognosis in the patients with STEMI,and "obesity contradiction" phenomenon exists in the patients with STEMI.However,the influence of BMI on the prognosis in the patients with STEMI should be comprehensively evaluated by combining with the multiple factors such as the patient's age,sex,complications and medication therapy.

Objective To investigate does intracellular protein degradation pathway play an important role in decrease of endothelial nitric oxide synthase (eNOS) in human umbilical vein endothelial cells (HUVECs).MethodsTo establish a primary HUVECs culture methods,the HUVECs were incubated with concentration gradient group of TNF-α(0.01,0.1,1 and 10 ng/mL) in different time periods (24,48 and 72 h).The HUVECs were pretreated with NH4Cl or treated with caspase inhibitor or MG-132 1.5 h prior to incubation for an additional 24 h with TNF-α.The expression of eNOS was detected via Western blot assay.Results Treatment of the HUVECs with TNF-α(0.01-10 ng/mL) led to a dose-dependent reduction of eNOS expression.And treatment with TNF-α(1 ng/mL) reduced the eNOS expression in a time-depended manner.Compared with the TNF-α group,the protein expression level of eNOS was obviously increased in the co-working group of MG-123 and TNF-α.Conclusions TNF-α induces degradation of eNOS through a ubiquitin-proteasome pathway.