OBJECTIVE To compare the antihypertensive efficacy of sacubitril/valsartan versus benazepril in patients with perimenopausal hypertension， as well as their impacts on ventricular remodeling and inflammatory fibrosis. METHODS A total of 206 perimenopausal hypertensive patients in our hospital from January 1， 2023 to December 30， 2024 were retrospectively included.These patients were enrolled and divided into benazepril group （105 cases） and sacubitril/valsartan group （101 cases）. Benazepril group received Benazepril hydrochloride tablet， and sacubitril/valsartan group received Sacubitril valsartan sodium tablet. All patients were treated for 6 months. The blood pressure（systolic blood pressure and diastolic blood pressure） and blood pressure control status before and after treatment， echocardiographic indicators （left ventricular ejection fraction， left ventricular mass index， relative wall thickness， and early-diastolic peak transmitral flow velocity/early-diastolic peak velocity of the mitral annulus）， inflammatory fibrosis related indicators（high-sensitivity C-reactive protein，ratio of monocytes to lymphocytes，and ratio of neutrophils to lymphocytes）， as well as the occurrence of adverse reactions（hypotension，hyperkalemia，and angioedema） were observed in both groups before and after treatment. RESULTS The blood pressure control rate was significantly higher in the sacubitril/valsartan group than in benazepril group （ P ＜0.05）. After treatment， the blood pressure， echocardiographic indicators（except for left ventricular ejection fraction） ，and inflammatory fibrosis related indicators were significantly lower than those before treatment within the same group， and the sacubitril/valsartan group were significantly lower than the benazepril group （ P ＜0.05）. There were no statistically significant differences in the incidence of hypotension， hyperkalemia， angioedema， and overall adverse drug reactions between the two groups （ P ＞0.05）. CONCLUSIONS Compared with benazepril， sacubitril/valsartan provides superior blood-pressure control， reverses ventricular remodeling， attenuates inflammatory fibrosis in perimenopausal hypertensive patients， while maintaining a similar safety profile.

Objective:To explore the factors associated with vascular luminal dilatational remodeling (VLDR) following balloon angioplasty for intracranial atherosclerotic stenosis (ICAS).Methods:A case-control study was conducted to analyze the data of symptomatic severe ICAS patients who received either paclitaxel-coated balloon angioplasty (PCBA) or plain balloon angioplasty (POBA) at our center from January 2019 to January 2022 and completed the six-month follow-up. The patients were divided into VLDR group and non-VLDR group according to whether VLDR occurred on follow-up digital subtraction angiography (DSA). The baseline data, preoperative and postoperative lesion characteristics (DSA), and perioperative related information were collected. The definition of VLDR was a decrease in luminal stenosis rate by more than 10% at the time of follow-up compared to the immediate postoperative period. Multivariate logistic regression was performed to analyze possible factors affecting VLDR such as balloon type, balloon length, and expansion time.Results:A total of 88 patients were included in this study, with 16 in the VLDR group and 72 in the non-VLDR group. The follow-up time for all included patients was 6.00 (5.00, 7.00) months. VLDR occurred in 18.2% (16/88) of cases, with a VLDR incidence of 30.4% (14/46) after PCBA and 4.8% (2/42) after POBA. Univariate logistic regression analysis revealed that treatment balloon type, balloon length, inflated time, immediate postoperative stenosis rate, follow-up time and Mori classification may affect the occurrence of VLDR. Multivariate logistic regression analysis showed that the use of paclitaxel-coated balloon (PCB) ( OR=9.82, 95% CI 1.99-48.49, P=0.005) and postoperative immediate stenosis rate ( OR=1.07, 95% CI 1.00-1.14, P=0.042) were independently associated with VLDR. Conclusion:The occurrence of VLDR following balloon angioplasty in ICAS was associated with the use of PCB and immediate postoperative stenosis rates, which will provide guidance for the clinical application of PCB.

Humans ; Muscular Dystrophy, Duchenne/epidemiology* ; Prevalence ; Myocardium

Objective: To explore the relationship between adolescents physical fitness and depressive symptoms, and to provide reference for the early prevention and intervention of depressive symptoms and improvement of physical fitness in Chinese adolescents. Methods: From September to December 2021, a total of 8 102 adolescents were selected by random cluster sampling method in Shanghai, Urumqi, Changsha and Kunming. The Center for Epidemiologic Studies Depression Scale(CES-D) was used to investigate the depressive symptoms, and completed grip strength, standing long jump, 50 m running, modified sitting forward flexion, 20 s repeated traverse, 30 s sit ups, 20 m round trip running (20 m SRT) test. χ 2 test, Goodman Kruskal Gamma and Logistic regression analysis were used to analyze the relationship between physical fitness index(PFI) and depressive symptoms. Results: The overall detection rate of depressive symptoms in adolescents with high level PFI was 23.4%, and the detection rate of low level adolescents was 26.3%, with a statistically significant difference ( χ 2=6.73, P =0.01). There was a significant positive correlation between PFI and depressive symptoms in the high school group ( G=0.09, P <0.05) and the boy group ( G=0.12, P < 0.05 ), and there was no significant association between PFI and depressive symptoms in the junior high school group and the girl group ( P >0.05). After adjusting for gender and age in the Logistic regression model, compared with those with high PFI, the risk of depressive symptoms in those with low PFI was 1.18 times (95% CI =1.05-1.33). Conclusion There is a correlation between physical fitness and depressive symptoms in adolescents. Adolescents with low PFI are at higher risk of developing depressive symptoms than those with high PFI.

Humans ; Child ; Risk Factors ; Adipose Tissue

Objective:To explore the diagnostic accuracy and application value of 3.0 T non-contrast coronary magnetic resonance angiography (CMRA) in evaluating coronary artery in children with Kawasaki disease (KD).Methods:From May 2019 to January 2022, 75 children diagnosed with KD in our hospital were enrolled. All the patients underwent CMRA and transthoracic echocardiography (TTE) in one week, twenty-six of whom underwent coronary CT angiography (CCTA) or invasive coronary angiography (ICA) within two weeks. The diagnostic performance of CMRA and TTE was evaluated with CCTA/ICA as reference standard by per-patient basis, per-vessel basis, per-segment basis. Sensitivity and specificity of CMRA and TTE was compared by paired chi square test.The distribution of coronary artery aneurysm (CAA), thrombosis and other pathological changes of coronary artery were recorded and compared between two methods. The patients′ height and weight were collected to calculate the Z value. Z value>2.5 was defined as CAA.Results:All patients successfully completed CMRA examinations. Among the 26 patients, the sensitivity of CMRA was significantly higher than that of TTE by per coronary artery[97.7%(43/44)vs.84.1%(37/44), χ2=4.17, P<0.05]. CMRA showed a higher sensitivity than that of TTE both by proximal segments and middle/distal segments [97.7%(43/44)vs. 84.1%(37/44), 100%(21/21) vs. 52.4%(11/21), χ2=10.08, 7.11, both P<0.05). A total of 115 CAAs was found by CMRA, while only 87 (75.7%) CAAs were observed by TTE. Of the 28 (24.3%) CAAs missed by TTE, 16 (57.1%) were located in right coronary artery (RCA), 2(7.1%) in left main coronary artery, 7(25.0%) in left anterior ascending coronary artery (LAD) and 3(10.7%) in left circumflex coronary artery (LCX). Eleven (39.3%) missed CAAs by TTE were located in the proximal segment of RCA, LMCA, LAD and LCX, and 17 (60.7%) missed CAAs were located in the middle and distal segments. TTE missed coronary thrombosis in 5 patients compared with CMRA. Conclusions:3.0 T non-contrast CMRA is non-invasive and non-radiation, and the image quality can meet the needs of diagnosis, especially for detection of CAAs in RCA or in middle and distal segments of coronary artery in KD patients.

Objective:To investigate the effect of thrombus burden on the clinical outcome of endovascular recanalization in large vessel occlusive stroke.Methods:Patients with acute anterior circulation occlusion who underwent endovascular treatment within 24 hours after onset in Zhengzhou University People′s Hospital from January 2018 to December 2019 were retrospectively collected. According to the clot burden score (CBS) of DSA, total objectives were divided into CBS≥6 group (24 cases) and CBS<6 group (38 cases). Clinical data of the two groups were collected and the modified Rankin scale (mRS) was used to evaluate the clinical outcome at 90 days after surgery. Independent sample t-test, Wilcoxon rank sum test and χ 2 test were used to compare the clinical data between the two groups. Independent risk factors affecting the clinical outcome were analyzed by binary logistic regression. Results:There were no statistically significant differences in basic demographic data, stroke risk factors and other factors between the CBS≥6 group and CBS<6 group ( P>0.05).The proportion of using tirofiban after surgery in the CBS≥6 group (63.2%, 24/38) was lower than that in the CBS<6 group (87.5%, 21/24) (χ2=4.380, P=0.044). The discharge NIHSS score of the CBS≥6 group was [5.0 (3.3, 7.8) points] lower than CBS<6 group [8.5 (1.8, 14.5) points] ( Z=5.221, P=0.022). The proportion of postoperative mRS 0-2 was (91.7%, 22/24) in the CBS≥6 group higher than CBS<6 group(39.5%, 15/38) (χ2=20.486, P=0.001), there were no statistically significant differences between the two groups ( P<0.05). The results of binary logistics regression analysis showed the CBS groups (OR=0.042, 95%CI 0.007-0.244 , P=0.001) was an independent risk factor affecting good outcome. Subgroup analysis of whether tirofiban was used or not showed there was no statistically significant difference in clinical prognosis between the two groups ( P>0.05). Conclusions:The clinical outcome of CBS≥6 group is significantly better than that of CBS<6 group, and patients with small thrombus burden are more likely to get a good clinical outcome of 90 days.

Objective:To explore the predictive ability of apparent diffusion coefficient (ADC) value in magnetic resonance imaging (MRI) mapping sequences in outcomes of brain tissues in patients with acute ischemic stroke (AIS) who had successful recanalization after endovascular treatment.Methods:A total of 45 patients with AIS who received endovascular treatment and successful recanalization in our hospital from January 2019 to December 2019 were selected. Post-processing software was used to analyze the images of these patients by MRI before surgery and one week after surgery, and the differences of ADC value in the core area of cerebral infarction, lesion reversal area and increased cerebral infarction area displayed by diffusion weighted imaging (DWI) before surgery were measured and compared. Receiver operating characteristic (ROC) curve was used to analyze the predictive ability of preoperative ADC value in the reversal of lesions showed by DWI.Results:Lesion reversal area and increased cerebral infarction area indicated by preoperative DWI existed in all patients after successful recanalization. The preoperative ADC values of the infarct core, lesion reversal area and increased cerebral infarction area were 0.555×10 -3 mm 2/s (0.462, 0.648), 0.637×10 -3 mm 2/s (0.509, 0.765) and 0.948×10 -3 mm 2/s (0.905, 0.991), respectively, with significant differences ( P<0.05). The optimal cut-off point to predict DWI lesion reversal after successful recanalization was 0.57×10 -3mm 2/s, and the accuracy was 87.1% (area under curve=0.871; 95%CI: 0.868-0.875, P=0.000), with sensitivity of 97.2% and specificity of 68.3%. Conclusion:In patients with AIS after successful recanalization, the preoperative ADC values are obviously different in brain tissues with different outcomes, which can be used to predict the final imaging outcomes of the brain tissues.

Objective:To investigate the safety and efficacy of endovascular treatment in acute anterior circulation massive cerebral infarction and its prognostic factors.Methods:A retrospective analysis was performed on clinical data of 34 patients with acute anterior circulatory massive cerebral infarction who received intravascular treatment in our hospital from February 2018 to December 2019. The perioperative hemorrhage rate and mortality rate were analyzed in these patients. Modified Rankin scale (mRS) scores were taken as the evaluation standard in the prognoses of these patients during the 90 d of follow up, and the influencing factors affecting the prognoses of patients with massive cerebral infarction were analyzed.Results:The operation was successful in 30 patients (88.2%); the operation time was (97.41±54.58) min, and the number of thrombolysis was (1.91±0.75) times. Distal embolization occurred in 4 patients (11.8%); there were 3 patients with non-symptomatic hemorrhage (8.8%) and 3 patients with symptomatic hemorrhage (8.8%). Cerebral hernia occurred in 7 patients (20.6%); there were 5 deaths (14.4%). During the 90 d of follow up, 13 patients (38.2%) had good prognosis, and 21 (61.8%) had poor prognosis; there were statistically significant differences in NIHSS scores at admission, infarction locations in diffusion weighted imaging, vascular occlusion locations in DSA, pecentages of patients accepted preoperative intravenous thrombolysis and patients with cerebral hernia between the two groups ( P<0.05). NIHSS scores at admission ( OR=0.817, 95% CI: 0.682-0.980, P=0.029), thrombus load scale scores ( OR=5.981, 95%CI: 1.827-19.575, P=0.003), vascular occlusion locations in DSA ( OR=0.031, 95% CI: 0.003-0.311, P=0.003) and pecentage of patients accepted preoperative intravenous thrombolysis ( OR=0.092, 95% CI: 0.010-0.838, P=0.034) were independent factors influencing the prognoses of emergency intravascular treatment. Conclusions:Endovascular recanalization can achieve a relatively good prognosis in patients with massive cerebral infarction. Patients with low NIHSS scores, high thrombotic load scale scores, and middle cerebral artery occlusion, and patients accepted direct intravascular treatment have relatively good prognosis.

Objective:To explore the characteristics of high-density sign of flat-panel CT (FDCT) after endovascular treatment in patients with acute ischemic stroke (AIS) in the anterior circulation of large vessels and their relation with hemorrhagic transformation.Methods:Seventy-eight patients with AIS in the anterior circulation of large vessels accepted endovascular treatment in our hospital from March 2018 to June 2019 were chosen in our study. All patients underwent FDCT, and they were grouped according to the presence of local high-density sign and occurrence of hemorrhagic transformation. The baseline and clinical data of patients from high-density sign group and non-high-density sign group, and from hemorrhagic transformation group and non-hemorrhagic transformation group were compared and analyzed. The correlation between high-density sign and hemorrhagic transformation was analyzed. The morphological characteristics and distribution of FDCT high-density sign in patients from high-density sign group were analyzed, and univariate and multivariate Logistic regression analyses were used to screen the influencing factors for post-operative hemorrhagic transformation in patients from the high-density sign group.Results:(1) The incidence of high-density sign in these patients after endovascular treatment was 41.0% (32/78); as compared with patients in the non-high-density sign group, patients in the high-density sign group had significantly higher rate of hemorrhagic transformation (6.5% vs. 53.1%, P<0.05) and significantly higher 3-month modified Rankin scale (mRS) scores (2.0 [1.0, 3.0] vs. 3.9 [3.0, 5.3], P<0.05). (2) The incidence of hemorrhagic transformation after endovascular treatment was 25.6% (20/78); as compared with those in the non-hemorrhagic transformation group, patients in the hemorrhage transformation group had statistically higher incidence of high-density sign in FDCT (31% vs. 70%, P<0.05); multivariate Logistic regression analysis showed that FDCT high density sign was an independent risk factor for hemorrhage transformation after endovascular treatment ( OR=1.823, 95%CI: 1.125-2.358, P=0.000). (3) In the 32 patients with FDCT high-density sign, 4 (12.5%), 13 (40.6%) and 7 (21.9%) had high-density sign in the cortex and subcortex, basal ganglia, and subarachnoid space, whose hemorrhagic transformation incidences were 75% (3/4), 53.8% (7/13), and 57.1% (4/7), respectively, and mean 3-month mRS scores were 4.5, 3.0 and 4.0, respectively; another 8 patients (25%) had endovascular FDCT high-density sign, whose hemorrhagic transformation incidence was 87.5% (7/8), and 3-month mRS scores were ≥4. (4) Multivariate Logistic regression analysis showed that the vascular opening time ≤6 h was a protective factor for hemorrhage transformation in patients with FDCT high-density sign ( OR=0.687, 95%CI: 0.193-0.936, P=0.044). Conclusions:In patients with AIS in the anterior circulation of large vessels accepted endovascular treatment, FDCT high-density sign indicates high risk of hemorrhage transformation and poor prognosis, especially in patients having high-density sign in the cerebral cortex, subcortical area and intravascular area. Minimizing the vascular opening time may reduce the risk of hemorrhagic transformation in patients with FDCT high-density sign.