OBJECTIVE: To study incident and clinical characteristics of the coronary microcirculation dysfunction (CMD) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and to explore the predictive value of CMD for in-hospital acute heart failure event. METHODS: One hundred and forty five patients with AMI who had received PCI and completed MCE during hospitalization in Peking University People' s Hospital from November 2015 to July 2021 were enrolled in our study. The patients were divided into CMD group and normal group according to the coronary microcirculation status detected by MCE. Clinical data and MCE data of the two groups were collected and analyzed. The acute heart failure event during hospitalization was described. A multivariate Logistic regression model was built to analyze the risk of acute heart failure in patients with CMD. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of CMD in predicting acute heart failure event. RESULTS: CMD detected by MCE occurred in 87 patients (60%). Compared with normal group, patients with CMD had higher troponin I (TnI) peak level [52.8 (8.1, 84.0) μg/L vs. 18.9 (5.7, 56.1) μg/L, P=0.005], poorer Killip grade on admission (P=0.030), different culprit vessel (P < 0.001) and more patients had thrombolysis in myocardial infarction (TIMI) flow pre-PCI less than grade 3 in culprit vessel (65.1% vs. 43.1%, P=0.025). Meanwhile, patients with CMD had poorer left ventricular ejection fraction (LVEF) [52% (43%, 58%) vs. 61% (54%, 66%)], poorer global longitudinal strain (GLS) [-11.2% (-8.7%, -14.0%) vs.-13.9% (-10.8%, -17.0%)] and worse wall motion score index (WMSI) (1.58±0.36 vs. 1.25± 0.24) (P all < 0.001). Acute left heart failure happened in 13.8% of the CMD patients, which were significant higher than that in the patients with normal coronary microcirculation perfusion (1.7%, P=0.013). After correcting for the culprit vessel, the TIMI flow pre-PCI in the culprit vessel and the peak TnI value, the risk of acute left heart failure in the patients with CMD was still high (OR=9.120, 95%CI: 1.152-72.192, P=0.036). The area under ROC curve (AUC) was 0.677 (95%CI: 0.551-0.804, P=0.035). CONCLUSION The incidence of CMD detected by MCE in patients with AMI post-PCI was 60%. Patients with CMD have a higher risk of acute left heart failure during hospitalization.
Humans ; Heart Failure/physiopathology* ; Microcirculation ; Percutaneous Coronary Intervention/adverse effects* ; Myocardial Infarction/complications* ; Male ; Female ; Hospitalization ; Middle Aged ; Aged ; Echocardiography ; Coronary Circulation ; Predictive Value of Tests ; Troponin I/blood*

Cholesterol is a crucial lipid in the human body.Elevated levels of cholesterol can result in condi-tions such as hypercholesterolemia.3-hydroxy-3-methylglutaryl coenzyme A reductase(HMGCR)serves as a pivotal en-zyme in the synthesis of cholesterol,acting as a rate-limiting factor.As a result,HMGCR plays a critical role in maintain-ing cholesterol balance,with the regulatory processes being intricate in vivo.This review outlines the advancements in un-derstanding the regulatory mechanisms of HMGCR,encompassing transcriptional control,degradation pathways,and en-zyme activity.

Objective:To investigate the effects of Yangrong Changchun Ointment on serum estradiol (E 2), follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), and on the Kiss peptin/protein one anti-G protein-coupled receptor 54 (GPR54) signaling pathway in rats with menopause syndrome (MPS). Methods:Totally 48 SD female rats were randomly divided into a sham-operation group ( n=8) and a modeling group ( n=40), and the rat model of menopausal syndrome was established by ovariectomy. After successful modeling, the rats were divided into the model group, Kunbao Pills group group, Yangrong Changchun Ointment high-, medium-, low-dosage groups according to random number table method, with eight rats in each group. Yangrong Changchun Ointment high-, medium-, low-dosage groups were orally administered with Yangrong Changchun Ointment suspension at doses of 10.0, 5.0, and 2.5 g/kg, while the Kunbao Pills group was orally administered with Kunbao Pills suspension at a dosage of 1 g/kg. The sham-operation group and model group were orally administered with distilled water of equal volume at a dosage of 1 ml/100 g body weight, once a day, for 28 consecutive days. The organ index of rats was calculated; the behavior of rats was determined by open filed test; HE staining was used to observe the histopathology of the uterus; ELISA was used to detect the levels of E 2, FSH, and AMH in the serum of rats; and qRT-PCR and Western blot were used to detect the mRNA and protein expressions of GPR54, Kiss-1, Phospholipase C (PLC), gonadotropin-releasing hormone (GnRH), and protein kinase C (PKC) in the hypothalamus. Results:Compared with the model group, the uterus, adrenal gland, spleen and thymus indices increased in the Yangrong Changchun Ointment high-dosage group ( P<0.05); serum levels of E 2 and AMH increased ( P<0.05), and the serum level of FSH decreased ( P<0.05); the mRNA and protein expressions of GPR54, Kiss-1, PLC, GnRH and PKC in the hypothalamus decreased ( P<0.05), and the uterine histopathological damage was improved. Conclusion:Yangrong Changchun Ointment can improve the pathological injury and estrogen level disorder in rats with MPS, and its mechanism may be related to inhibiting the activation of kisspeptin/GPR54 pathway.

Objective To construct a graded nursing program for exercise rehabilitation of children with hematopoietic stem cell transplantation(HSCT)and carry out a preliminary application,aiming to provide a basis for healthcare personnel to guide the exercise rehabilitation of children with HSCT.Methods Literature analysis and Delphi expert correspondence were used to construct a graded nursing program of exercise rehabilitation for children with HSCT.Through the convenience sampling method,children with HSCT in the hematology department of a tertiary-level children's hospital in Suzhou City were selected as the study subjects from June-December 2023,of which 26 children with HSCT from September-December 2023 served as an experimental group,and 23 children with HSCT from June-August 2023 as a control group.The experimental group was applied with the graded nursing program of exercise rehabilitation,and the control group was applied with the conventional nursing care.The comparison of cardiorespiratory fitness and adverse events between the 2 groups after 8 weeks of exercise intervention was conducted,and the adherence to the exercise intervention programme in the experimental group was recorded.Results The final constructed graded care program of exercise rehabilitation for children with HSCT included 6 primary indicators,20 secondary indicators,and 44 tertiary indicators.Finally,21 children in the experimental group and 23 children in the control group were included in the study.After the intervention,the 6 min walking distance of the experimental group increased compared with that of the control group,and the difference was statistically significant(P＜0.001).85.71％of children in the experimental group had good exercise compliance,and there was no adverse events in both groups.Conclusion The constructed graded nursing program of exercise rehabilitation for children with HSCT is scientific,reasonable,safe and feasible,which can improve the cardiorespiratory capacity of children with HSCT and provide the basis for their exercise rehabilitation.

Objective To construct a graded nursing program for exercise rehabilitation of children with hematopoietic stem cell transplantation(HSCT)and carry out a preliminary application,aiming to provide a basis for healthcare personnel to guide the exercise rehabilitation of children with HSCT.Methods Literature analysis and Delphi expert correspondence were used to construct a graded nursing program of exercise rehabilitation for children with HSCT.Through the convenience sampling method,children with HSCT in the hematology department of a tertiary-level children's hospital in Suzhou City were selected as the study subjects from June-December 2023,of which 26 children with HSCT from September-December 2023 served as an experimental group,and 23 children with HSCT from June-August 2023 as a control group.The experimental group was applied with the graded nursing program of exercise rehabilitation,and the control group was applied with the conventional nursing care.The comparison of cardiorespiratory fitness and adverse events between the 2 groups after 8 weeks of exercise intervention was conducted,and the adherence to the exercise intervention programme in the experimental group was recorded.Results The final constructed graded care program of exercise rehabilitation for children with HSCT included 6 primary indicators,20 secondary indicators,and 44 tertiary indicators.Finally,21 children in the experimental group and 23 children in the control group were included in the study.After the intervention,the 6 min walking distance of the experimental group increased compared with that of the control group,and the difference was statistically significant(P＜0.001).85.71％of children in the experimental group had good exercise compliance,and there was no adverse events in both groups.Conclusion The constructed graded nursing program of exercise rehabilitation for children with HSCT is scientific,reasonable,safe and feasible,which can improve the cardiorespiratory capacity of children with HSCT and provide the basis for their exercise rehabilitation.

Cholesterol is a crucial lipid in the human body.Elevated levels of cholesterol can result in condi-tions such as hypercholesterolemia.3-hydroxy-3-methylglutaryl coenzyme A reductase(HMGCR)serves as a pivotal en-zyme in the synthesis of cholesterol,acting as a rate-limiting factor.As a result,HMGCR plays a critical role in maintain-ing cholesterol balance,with the regulatory processes being intricate in vivo.This review outlines the advancements in un-derstanding the regulatory mechanisms of HMGCR,encompassing transcriptional control,degradation pathways,and en-zyme activity.

Objective:Based on data mining, the basic acupoint selection rules of allergic rhinitis were discussed, which provided a reference for the clinical treatment of allergic rhinitis.Methods:Computer search for literature on auriculo-sensitive rhinitis in VIP, China National Knowledge Infrastructure, Wanfang, China Biomedical Database, PubMed, Embase, Web of Science, the search period was from establishment of the database until August 29, 2023. The frequency, symptom type and distribution of ear point prescriptions were counted, and the association rules and cluster analysis of ear point prescriptions were carried out.Results:A total of 109 studies were included, and 127 prescriptions for ear points were extracted, involving 33 ear points. The association rules showed that the lungs, inner nose, adrenal glands and wind creek were the core ear points, and the cluster analysis formed six types of combinations: "spleen, kidney, lung, wind creek""subcortical, trachea, liver, throat, shenmen" "large intestine" "internal nose, adrenal gland" "endocrine" "sympathetic, external nose".Conclusions:Auricle therapy for allergic rhinitis mainly involves lungs, inner nose, adrenal glands and wind creeks, and dialectical acupoints are selected according to internal organs and symptoms, providing reference and reference for clinicians.

Objective:To construct an indicator system for the development of nursing disciplines in ClassⅢ Grade A general hospitals.Methods:An initial draft of the indicator system was established through literature research and expert meetings. The Delphi method and purposive sampling were used from January to April 2023 to conduct two rounds of expert consultations with 17 nursing experts from four medical units nationwide and three nursing colleges. The indicators were revised and refined, resulting in the establishment of a nursing discipline construction indicator system for ClassⅢ Grade A general hospitals. The level of expert engagement was represented by the questionnaire recovery rate, expert authority by the expert authority coefficient ( Cr), and the degree of expert opinion coordination by Kendall 's harmony coefficient (Kendall 's W) . Results:The recovery rates for both rounds of expert consultation questionnaires were 100.00% (17/17), with expert Cr of 0.87. The CV values ranged from 0.049 to 0.260 and 0 to 0.140, respectively, while Kendall 's W were 0.221 and 0.257 ( P< 0.01). The final indicator system for the construction of nursing disciplines in ClassⅢ Grade A general hospitals included six primary indicators, 18 secondary indicators, and 63 tertiary indicators. Conclusions:The nursing discipline construction indicator system developed for ClassⅢ Grade A general hospitals in this study is scientific, reliable, and comprehensive. It can provide a reference for the construction of nursing disciplines in Class Ⅲ Grade A general hospitals.

Objective:To investigate the real experience of patients returning to work after total hip and knee arthroplasty, in order to provide a reference for patients to return to work successfully.Methods:We searched for qualitative studies on the real experience of patients after total hip and knee arthroplasty in the returning to work process at home and abroad in the databases such as Cochrane Library, PubMed and Embase, etc, and the search period was from the establishment of the library to May 29, 2023, and the results were integrated by Meta-integration.Results:A total of 6 studies were included, 46 results were extracted, and 9 categories were formed and integrated into 4 themes, patients had different motivations for returning to work, there were many factors influencing patients′ return to work, and patients were eager to be helped in the process of returning to work, and learned from experience to improve their confidence in successfully returning to work.Conclusions:Patients with joint replacement have many obstacles and psychological burden in the process of regression, and hope to receive support from many aspects. Healthcare workers should pay attention to the needs of these populations, provide improved medical support, and actively promote the return of patients to work.

Objectives:To evaluate the impact of global longitudinal strain(GLS)for prognosis in ST-segment elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention(PCI). Methods:We enrolled 156 STEMI patients who underwent PCI and spackle tracking imaging(STI)during hospitalization from September 2020 to August 2023.Patients with Killip Ⅱ-Ⅳ at baseline were excluded,138 patients were finally included.GLS was detected by STI.Patients were divided into more impaired group(GLS>-11.7%,n=57)and less impaired group(GLS≤-11.7%,n=81)according to Youden index.Clinical characteristics and echocardiography data were analyzed.Patients were followed up for a median of 21(13,28)months.Heart failure events were compared between the two groups. Results:The peak troponin I(TnI)was significantly higher in patients with GLS>-11.7%than those with GLS≤-11.7%at admission(85 160[31 297,214 226]pg/ml vs.34 942[13 571,92 713]pg/ml,P<0.001).Culprit vessel was different between the 2 groups(P<0.001).Compared with patients with GLS≤-11.7%,patients with GLS>-11.7%had lower left ventricular ejection fraction(LVEF)([60.1±8.7]%vs.[49.2±8.3]%,P<0.001),higher proportion of regional wall motion abnormality(90.1%vs.100%,P=0.015).Both LVEF and GLS recovered in patients with GLS>-11.7%during follow-up,but remained lower as compared to patients with GLS≤-11.7%(both P<0.001).The median follow-up time was 21(13,28)months.After adjusting age,sex,culprit vessel and peak TnI,the risk of heart failure of patients with GLS>-11.7%was significant higher(HR=9.123,95%CI:1.720-43.394,P=0.009). Conclusions:STEMI patients with more impaired GLS have a higher risk of heart failure post PCI.