Objective To elucidate the application scope and delineate the criteria of dobutamine stress echocardiography (DSE) in assessing surgical risk associated with valvular heart diseases in patients presenting with reduced left ventricular ejection fraction (LVEF). Methods This retrospective analysis encompassed data from patients with reduced LVEF (LVEF<40%) who underwent DSE prior to valvular heart surgery at the Valvular Surgery Center of Beijing Anzhen Hospital between May 2016 and September 2024. Patients were stratified based on the terminal dose of dobutamine into two cohorts: a limited dose group [receiving a maximum dobutamine dose of <5 µg/(kg·min) due to concomitant conditions such as suspected atrial thrombus, aortic dilation, or previous myocardial infarction] and a non-limited dose group (where dosage was adjusted to either achieve the maximum positive standard or the maximal dose tolerable by the patient). Within the non-limited dose group, patients were further classified into positive and negative response groups. The positive response post DSE was defined based on the following criteria: LVEF≥55% (the maximum positive standard), LVEF<55% but with a 5% improvement (the minimum positive standard) from resting situation, aortic maximum velocity (AVmax)≥400 cm/s, or mean pressure gradient (meanPG)≥40 mm Hg, latter two applicable only to patients with aortic stenosis. Clinical indicators were compared in the three groups. Results A total of 99 patients were enrolled, aged 35 to 87 years, with an average age of (61.7±10.1) years. The number of males was significantly higher than that of females (3:1). There were 61 (61.6%) patients undergoing aortic valve surgery, 25 (25.3%) undergoing mitral valve surgery, and 13 (13.1%) undergoing combined aortic and mitral valve surgery. Nineteen (19.2%) patients experienced adverse symptoms such as palpitations, head and face numbness, dizziness, chest tightness post DSE. Additionally, new-onset or aggravated ventricular premature ventricular contractions were in 40 (40.4%) patients. All above symptoms and signs resolved minutes after cessation of the test. No severe adverse events necessitating oxygen therapy or emergency intervention occurred. Among the 93 patients in the non-limited dose group, 86 were classified in the positive response group and 7 in the negative response group. The left ventricular end diastolic diameter, left ventricular end systolic diameter, and LVEF in the positive group all showed significant improvement compared to preoperative values, and were also significantly better than those in the negative group (P<0.05). All 7 patients with negative DSE results underwent interventional surgery, which was significantly different from the positive group (36 patients, 41.9%). In the limited dose group (n=6), 4 patients with a positive result or a positive trend on DSE underwent median sternotomy, 2 received interventional treatment due to a negative response. No significant differences in mortality were observed among the groups (P>0.05). Conclusion Dobutamine stress echocardiography significantly contributes to risk stratification in surgical interventions for patients with valvular heart disease complicated by reduced LVEF. It aids in determining optimal timing and methods for surgery. With comprehensive patient evaluation and controlled dobutamine dosing, the application of DSE can be safely expanded.

With the development of point-of-care testing(POCT)technology,the demand for pre-hospital applications has gradually increased.Blood glucose,troponin,blood gas analysis and other projects have been gradually carried out in pre-hospital.The development of the above projects has played an important role in the timely diagnosis of critical diseases such as pre-hospital stroke,chest pain,and out-of-hospital cardiac arrest.However,due to the shortcomings of trained professionals and standardized equipment in pre-hospital systems,it is challenging to carry out quality control work such as POCT in-house quality control,comparison,ability verification,etc.,and POCT pre-hospital quality management has shortcomings.In order to improve the quality of POCT and eliminate potential safety hazards,the"expert consensus on POCT pre-hospital quality management standards"was formulated after consultation between pre-hospital and in-hospital experts.The consensus focuses on the establishment of POCT pre-hospital quality management system,management organization,quality control plan formulation and implementation path,personnel access,equipment access,digital intelligence integration and other issues,which can be used by pre-hospital medical emergency institutions at all levels to carry out POCT quality management.

Objective:To investigate the impact and clinical value of preoperative intra-aortic balloon pump(IABP)placement on the occurrence of postoperative atrial fibrillation(POAF)in elderly high-risk patients with coronary artery disease undergoing off-pump coronary artery bypass grafting(CABG).Methods:A retrospective cohort study was conducted, selecting 128 elderly(age≥60 years)patients with coronary artery disease who underwent isolated off-pump CABG and met high-risk criteria(≥2 high-risk factors)at Beijing Tongren Hospital.According to the occurrence of POAF, patients were divided into the POAF group(38 cases)and the non-POAF group(90 cases). Preoperative baseline data, preoperative IABP usage, intraoperative and postoperative indicators were collected and compared between the two groups.Univariate analysis was used to screen for differential variables, and multivariate logistic regression analysis was performed to identify the independent risk factors for POAF, focusing on the role and impact of preoperative IABP placement on POAF occurrence.Results:Among the 128 patients included, the incidence of POAF in patients with preoperative IABP placement was lower than that in patients without preoperative IABP placement[12.12%(4/33) vs.35.79%(34/95), χ2=6.512, P=0.011]; the preoperative IABP usage rate in the POAF group was significantly lower than that in the non-POAF group[10.53%(4/38) vs.32.22%(29/90), χ2=5.488, P=0.019]; the proportion of patients with preoperative left ventricular ejection fraction(LVEF)<40% in the POAF group was significantly higher than that in the non-POAF group[23.68%(9/38) vs.10.00%(9/90), χ2=4.140, P=0.042]; and the preoperative creatinine level in the POAF group was also significantly higher than that in the non-POAF group[(90.62±29.45)μmol/L vs.(81.31±20.18)μmol/L, t=2.066, P=0.041]. Multivariate logistic regression analysis showed that preoperative LVEF<40% was an independent risk factor for POAF occurrence( OR=11.862, 95% CI: 1.083-129.875, P=0.043), while preoperative IABP placement was an independent protective factor for POAF occurrence( OR=0.095, 95% CI: 0.016~0.583, P=0.011). The comparison of intraoperative and postoperative indicators between the two groups showed that multiple indicators in the POAF group were significantly worse than those in the non-POAF group.In terms of intraoperative indicators, the mean graft blood flow(mGF)of the graft vessels in the POAF group was lower[(18.25±8.84)ml/min vs.(21.24±7.13)ml/min, t=2.015, P=0.046], while the pulsatility index(PI)was higher(2.64±1.36 vs.2.18±1.07, t=2.045, P=0.043). In terms of postoperative laboratory indicators, the level of cardiac troponin I(cTnI)on the first postoperative day in the POAF group[(15.69±11.32)μg/L vs.(11.46±10.07)μg/L, t=2.092, P=0.038], the highest postoperative creatinine level[(128.23±74.29)μmol/L vs.(96.18±48.32)μmol/L, t=2.897, P=0.004], and the highest blood lactic acid level within 24 hours[(1.78±0.53)mmol/L vs.(1.54±0.62)mmol/L, t=2.085, P=0.039]were all significantly higher.In terms of postoperative recovery indicators, the duration of vasoactive drug use[(46.41±32.08)h vs.(36.21±22.39)h, t=2.058, P=0.042], mechanical ventilation time[(16.72±11.64)h vs.(12.19±9.68)h, t=2.275, P=0.025], and intensive care unit(ICU)stay time[(73.48±60.20)h vs.(54.89±39.29)h, t=2.070, P=0.040]in the POAF group were all significantly longer.The LVEF before discharge in the POAF group was also significantly lower than that in the non-POAF group[(43.08±16.24)% vs.(48.49±13.08)%, t=1.986, P=0.049]. Conclusions:Preoperative LVEF<40% is an independent risk factor for POAF occurrence after off-pump CABG in elderly high-risk patients with coronary artery disease, and preoperative prophylactic IABP placement can significantly reduce the occurrence of POAF in this population.

Objective:To explore the lifestyle pattern of the physical examination population and analyze its association with metabolic associated fatty liver disease (MAFLD).Methods:This was a cross-sectional study. Based on the data of 196 515 physical examination individuals from the Health Management Center of the Third Xiangya Hospital of Central South University from January 2016 to December 2020, the subjects were grouped and characterized by principal component analysis and cluster analysis. Among them, 137 277 cases with MAFLD diagnosis information were included in the association analysis between lifestyle pattern and MAFLD. The differences in lifestyle pattern choice among different age, sex, education level, marital status, occupational category and medical insurance type and their differences with the risk of MAFLD were analyzed. The generalized linear mixed model was used to control confounding factors and then association analysis was conducted.Results:There were 6 types of lifestyle patterns in the physical examination population, which were respectively: indulgent type-both physical and mental damage, remedial type-excessive diet, giving type-unique intensity, comfortable type-natural health, heavy smoking type-sedentary injury, heavy drinking type-attempting to make up, accounting for 7.29%, 9.62%, 7.43%, 52.16%, 9.77%, 13.73% in the population. Among them, the male lifestyle pattern was mainly the indulgent type, the remedial type, the heavy smoking type and the heavy drinking type, showing the characteristics of unhealthy lifestyle pattern; Women tended to have healthier lifestyle patterns. After association analysis with MAFLD, it was found that the prevalence of MAFLD was more than 50% in the people who belonged to the indulgent type, remedial type, the heavy smoking type and the heavy drinking type (53.62%, 57.06%, 51.25% and 50.50%, respectively), and the prevalence of MAFLD in the giving type group was 40.17%. The risk of MAFLD in comfortable group was relatively low (28.25%), and the difference in risk of MAFLD among all modes was statistically significant after controlling for confounding factors ( P<0.001). Conclusion:According to cluster mining, there are 6 types of lifestyle patterns in the physical examination population, and the healthier lifestyle pattern has a lower risk of MAFLD.

The nucleophosmin 1(NPM1)muta-tion is one of the most frequent subtypes in acute myeloid leukemia(AML).Under the conditions of FLT3-internal tandem duplications(FLT3-ITD)and/or DNMT3A co-mutations or adverse cytogenetics,the originally favorable prognosis will deteriorate.In recent years,studies have found that multiple endocrine neoplasia protein(Menin)inhibitors tar-geting Menin-KMT2A complex can downregulate the overexpression of leukemia causing genes HOX(homeotic gene)and MEIS1(myeloid ecotropic vi-ral integration site 1)in NPM1-mutated AML,dem-onstrating remarkable anti-leukemia activity.This article aims to review the mechanism and clinical research of Menin inhibitors,novel small molecule targeted drugs in NPM1-mutated AML,as well as the resistance mechanism of Menin inhibitors,hop-ing to provide promising approaches for the subse-quent treatment of NPM1-mutated AML patients.

Objective:To investigate the neuroprotective effects of ginsenoside Rb1 in neonatal mice with Hypoxic Ischemia(HI)and analyze its potential molecular mechanisms.Methods:Seven-day-old C57BL/6 neonatal mice were randomly assigned to three groups:Sham group,hypoxic-ischemic(HI)model group,and HI model+ginsenoside Rb1 intervention group(HI+Rb1),with 10 mice per group.The modified Rice-Vannucci method was used to establish the HI model,and ginsenoside Rb1(20 mg/kg)was administered via intraperitoneal injection for 7 consecutive days post-surgery(once per day).Brain damage was assessed on days 7 and 14 post-surgery by evaluating cortical neurons and glial cell numbers,as well as the activation status of the ERK signaling pathway.Additionally,in utero electroporation(IUE)was used to overexpress the ERK signaling pathway in the cortical neurons,and the impact of ERK activation on glial cell development was observed.Further,IUE was used to overexpress ERK in the cortex of P0 neonatal mice,fol-lowed by the HI model on day 7 to analyze the effects of enhanced ERK signaling on oligodendrocyte development and myelin regeneration.Results:Compared to the HI group,the HI+Rb1 intervention group showed significant improve-ment in motor ability,reduction in brain injury area,less mature neuron loss,and increased newborn neurons.Addi-tionally,the number of oligodendrocytes in the cortex was increased,and the activation of the ERK signaling pathway was enhanced.In mice with overexpression of the ERK signaling pathway in the cortex,there was a significant increase in oligodendrocytes.In the HI model with ERK overexpression,an increased number of oligodendrocyte precursor cells were found around the brain injury area,consistent with the results of ginsenoside Rb1 intervention.Conclusion:Gin-senoside Rb1 exerts neuroprotective effects in neonatal mice with hypoxic-ischemic brain injury,potentially through the enhancement of ERK signaling,promoting oligodendrocyte proliferation and myelin regeneration.

Objective:To explore the anti-reflux effect of transverse fan-shaped groin formed (TFGF) when the residual stomach is large (the small curvature ≥10 cm).Methods:Twenty-four patients with residual curvature ≥10 cm after PG were treated with TFGF continuously from Nov 2020 to Dec 2023 in this study. The cohort included 20 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction and 4 patients with achalasia of cardia. Reflux disease questionnaire score gastroesophageal reflux disease questionnaire score and gastroscopy Los Angeles score were used to evaluate the anti-reflux effect and postoperative nutritional parameters (hemoglobin, protein and body weight).Results:The reconstructive operation time of adenocarcinoma of the esophago-gastric junction and achalasia of cardia was (20.0±5.1) min and (18.3±4.7) min, respectively. reflux disease questionnaire, gastro-esophageal reflux disease questionnaire and gastroscopy indicated GERD in 3 patients and 8% in 2 patients at 24 months. At follow-up, one patient transitioned from grade B to grade C based on the Los Angeles score at 12 months; 24 months after surgery, one patient's gastroesophageal reflux symptoms resolved and the Los Angeles rating was downgraded from B to A. Nutritional indicators (hemoglobin, protein and body weight levels) all showed a downward trend at 6 months and an upward trend at 24 months.Conclusion:TFGF has the advantages of simple operation, and effective prevention of postoperative gastroesophageal reflux for patients with lesser residual curvature ≥10 cm after PG.

Objective To investigate the impact of nucleophosmin 1-mutated(NPM1m)subtypes,variant allele frequency(VAF)and co-mutations on the survival outcomes of patients with acute myeloid leukemia(AML).Methods Clinical data,mutation status,and outcomes of 86 NPM1m-AML patients admitted in Department of Hematology,First Hospital of Lanzhou University between June 2017 and September 2024 were collected and retrospectively analyzed.Spearman correlation analysis,Kaplan-Meier curve analysis,Log-rank test,and Cox regression analysis was applied for correlation analysis,survival analysis,and factors affecting survival.Results The overall survival(OS)was significantly shorter in the Rares subtype of NPM1m than the ABD subtype(median OS:164 d vs 416 d,P=0.043).The VAF of NPM1m was positively correlated with the initial peripheral blood white blood cell count and lactate dehydrogenase(LDH)level(P<0.05).OS was reduced when VAF was≥0.37(median OS:164 d vs 730 d,P=0.003).The presence of myelodysplasia-related gene(MR)mutations was associated with a poorer prognosis when compared to the MR wild-type(median OS:45 d vs 395 d,P<0.001).The triple mutation of FMS-like tyrosine kinase 3-internal tandem duplication(FLT3-ITD)and DNMT3A also indicated a worse prognosis than the non-triple mutation(median OS:173 d vs 483 d,P=0.007).The presence of PTPN11 mutations was associated with improved OS(median OS:395 d vs 240 d,P=0.027),while the patients with coexistence of N/KRAS mutations trended toward better prognosis than the wild-type patients(median OS:662 d vs 189 d)though no statistical significance(P=0.070).Multivariate analysis revealed that LDH(HR=1.002,95%CI:1.000～1.003,P=0.005),NPM1m VAF(HR=2.415,95%CI:1.208～4.829,P=0.013),Rares subtype(HR=3.037,95%CI:1.134～8.136,P=0.027),and MR mutations(HR=5.283,95%CI:1.991～14.017,P<0.001)were independent risk factors associated with OS in the patients.Conclusion Molecular heterogeneity of NPM1m should be taken into account in prognostic stratification of NPM1m-AML.Factors including the Rares subtype,VAF≥0.37,coexistence of FLT3-ITD and DNMT3A mutations,and MR mutations are associated with poor prognosis of NPM1m-AML.The presence of PTPN11 mutations improves the prognosis,while the presence of N/KRAS mutations shows a trend toward better prognosis.LDH,NPM1m VAF,Rares subtype,and MR mutations are independent risk factors affecting OS of patients with NPM1m-AML.

ObjectiveTo investigate the mechanism of danshenol A （DA） pretreatment in alleviating myocardial ischemia-reperfusion injury （MIRI） by regulating cardiomyocyte ferroptosis by in vivo and in vitro experiments. MethodsA MIRI model was established in SD rats， and an in vitro oxygen-glucose deprivation/reoxygenation （OGD/R） model was constructed with H9C2 cells. Both models were treated with DA. H9C2 cells were allocated into blank， model （OGD/R）， DA， ferroptosis inducer （erastin）， and ferroptosis inhibitor （Fer-1） groups. Cell viability was assessed by the methyl thiazolyl tetrazolium （MTT） assay. Biochemical assays were performed to measure the superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione （GSH）， and ferrous ion （Fe²⁺） levels. Dihydroethidium （DHE） fluorescence assay was adopted to quantify the reactive oxygen species （ROS） level. Real-time PCR and Western blot were employed to quantify the mRNA and protein levels， respectively， of prostaglandin-endoperoxide synthase 2 （PTGS2）， glutathione peroxidase 4 （GPX4）， ferritin heavy chain 1 （FTH1）， and acyl-coA synthetase long-chain family 4 （ACSL4）. Sixty SPF-grade healthy male SD rats were randomly assigned to control， model （MIRI）， DA， erastin， and Fer-1 groups. Enzyme-linked immunosorbent assay （ELISA） was adopted to measure the serum levels of cardiac troponin I （cTnI）， lactate dehydrogenase （LDH）， and creatine kinase （CK）. Histopathological changes in the myocardial tissue were observed by hematoxylin-eosin （HE） staining. Cardiomyocyte apoptosis was detected by terminal deoxynucleotidyl transferase-mediated nick end labeling （TUNEL）. The effect of DA on cardiomyocyte ferroptosis were observed and analyzed by in vivo and in vitro experiments. ResultsIn vitro experiment： compared with the blank group， the OGD/R model group showed reduced cell viability， elevated levels of ROS， MDA， and Fe²⁺， up-regulated mRNA and protein levels of ACSL4， lowered levels of SOD and GSH， and down-regulated mRNA and protein levels of PTGS2， GPX4， and FTH1 （P<0.05，P<0.01）. The DA and Fer-1 groups exhibited consistent trends： cell viability， SOD and GSH levels， and the mRNA and protein levels of PTGS2， GPX4， and FTH1 were significantly restored， while the ROS， MDA， and Fe²⁺ levels， and the mRNA and protein levels of ACSL4 were reduced （P<0.05，P<0.01）. In vivo experiment： Compared with the control group， the MIRI model group showed elevated serum levels of cTnI， LDH， and CK， increased cardiomyocyte apoptosis rate， risen levels of ROS， MDA， and Fe²⁺， and up-regulated mRNA and protein levels of ACSL4. However， both DA and Fer-1 groups exhibited reductions in the indicators above （P<0.05）. Compared with the control group， the MIRI model group demonstrated reduced levels of SOD and GSH and down-regulated mRNA and protein levels of PTGS2， GPX4， and FTH1 （P<0.05）. In contrast， both DA and Fer-1 upregulated these indicators （P<0.05）， effectively reversing the trends in the model group. In addition， the MIRI model group showed swelling of cardiomyocytes， disarrangement of cardiac muscle fibers， and massive inflammatory cell infiltration， which were alleviated in the DA and Fer-1 groups. ConclusionDA alleviates MIRI by inhibiting ferroptosis and inflammation， demonstrating therapeutic potential in acute myocardial infarction.

ObjectiveTo investigate the mechanism of danshenol A （DA） pretreatment in alleviating myocardial ischemia-reperfusion injury （MIRI） by regulating cardiomyocyte ferroptosis by in vivo and in vitro experiments. MethodsA MIRI model was established in SD rats， and an in vitro oxygen-glucose deprivation/reoxygenation （OGD/R） model was constructed with H9C2 cells. Both models were treated with DA. H9C2 cells were allocated into blank， model （OGD/R）， DA， ferroptosis inducer （erastin）， and ferroptosis inhibitor （Fer-1） groups. Cell viability was assessed by the methyl thiazolyl tetrazolium （MTT） assay. Biochemical assays were performed to measure the superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione （GSH）， and ferrous ion （Fe²⁺） levels. Dihydroethidium （DHE） fluorescence assay was adopted to quantify the reactive oxygen species （ROS） level. Real-time PCR and Western blot were employed to quantify the mRNA and protein levels， respectively， of prostaglandin-endoperoxide synthase 2 （PTGS2）， glutathione peroxidase 4 （GPX4）， ferritin heavy chain 1 （FTH1）， and acyl-coA synthetase long-chain family 4 （ACSL4）. Sixty SPF-grade healthy male SD rats were randomly assigned to control， model （MIRI）， DA， erastin， and Fer-1 groups. Enzyme-linked immunosorbent assay （ELISA） was adopted to measure the serum levels of cardiac troponin I （cTnI）， lactate dehydrogenase （LDH）， and creatine kinase （CK）. Histopathological changes in the myocardial tissue were observed by hematoxylin-eosin （HE） staining. Cardiomyocyte apoptosis was detected by terminal deoxynucleotidyl transferase-mediated nick end labeling （TUNEL）. The effect of DA on cardiomyocyte ferroptosis were observed and analyzed by in vivo and in vitro experiments. ResultsIn vitro experiment： compared with the blank group， the OGD/R model group showed reduced cell viability， elevated levels of ROS， MDA， and Fe²⁺， up-regulated mRNA and protein levels of ACSL4， lowered levels of SOD and GSH， and down-regulated mRNA and protein levels of PTGS2， GPX4， and FTH1 （P<0.05，P<0.01）. The DA and Fer-1 groups exhibited consistent trends： cell viability， SOD and GSH levels， and the mRNA and protein levels of PTGS2， GPX4， and FTH1 were significantly restored， while the ROS， MDA， and Fe²⁺ levels， and the mRNA and protein levels of ACSL4 were reduced （P<0.05，P<0.01）. In vivo experiment： Compared with the control group， the MIRI model group showed elevated serum levels of cTnI， LDH， and CK， increased cardiomyocyte apoptosis rate， risen levels of ROS， MDA， and Fe²⁺， and up-regulated mRNA and protein levels of ACSL4. However， both DA and Fer-1 groups exhibited reductions in the indicators above （P<0.05）. Compared with the control group， the MIRI model group demonstrated reduced levels of SOD and GSH and down-regulated mRNA and protein levels of PTGS2， GPX4， and FTH1 （P<0.05）. In contrast， both DA and Fer-1 upregulated these indicators （P<0.05）， effectively reversing the trends in the model group. In addition， the MIRI model group showed swelling of cardiomyocytes， disarrangement of cardiac muscle fibers， and massive inflammatory cell infiltration， which were alleviated in the DA and Fer-1 groups. ConclusionDA alleviates MIRI by inhibiting ferroptosis and inflammation， demonstrating therapeutic potential in acute myocardial infarction.