Objective: To investigate factors influencing perioperative blood transfusion in patients with scarred uterus during pregnancy undergoing cesarean section, construct and validate a transfusion risk prediction model, and provide evidence for preoperative assessment and blood management. Methods: Clinical data of 405 patients undergoing cesarean section for scarred uterus during pregnancy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to December 2024 were retrospectively collected. The dataset was randomly divided into a training set (n=284) and a validation set (n=121) at a 7∶3 ratio. Within the training set, Firth-penalized logistic regression was employed for multivariate analysis to identify independent factors influencing perioperative blood transfusion and construct a predictive model. Model performance was evaluated in the validation set. Results: Multivariate Firth regression analysis showed that severe placenta previa (OR=75.566, 95%CI: 8.603-9979.174) and placenta accreta (OR=4.591, 95%CI: 1.120-19.416) were independent risk factors for perioperative blood transfusion, while preoperative red blood cell count (OR=0.189, 95%CI: 0.083-0.405) and fibrinogen levels (OR=0.588, 95%CI: 0.395-0.855) were protective factors. The predictive model constructed based on these four variables demonstrated good discriminatory performance, with areas under the receiver operating characteristic curves of 0.803 (95%CI: 0.740-0.867) and 0.753 (95%CI: 0.644-0.862) in the training and validation sets, respectively. Conclusion: For patients with scarred uterus during pregnancy undergoing cesarean section, severe placenta previa and placenta accreta significantly increase the risk of transfusion, while higher preoperative red blood cell count and fibrinogen levels exert a protective effect. The predictive model established in this study facilitates the identification of patients requiring transfusion, thereby enabling preoperative blood preparation and optimized blood management.

Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.

Objective:To investigate the protective effects of p53/glucose transporter 4 (GLUT4) regulation on cardiomyocyte injury induced by high glucose combined with hypoxia/reoxygenation.Methods:Human myocardial AC16 cells were treated with 33 mmol/L glucose and a hypoxic chamber to establish an in vitro model of high glucose combined with hypoxia/reoxygenation. Based on the glucose concentration in the medium and hypoxia/reoxygenation conditions, AC16 cells were divided into control group, high glucose group, hypoxia/reoxygenation group and high glucose combined with hypoxia/reoxygenation group. On the basis of high glucose combined with hypoxia/reoxygenation group, cells were transfected with empty vector, p53 small interfering RNA (siRNA), and co-transfected with p53 and GLUT4 siRNA to establish negative control group, sip53 transfection group, and sip53+siGLUT4 transfection group, respectively. Western blotting was used to detect the levels of hypoxia-inducible factor-1α (HIF-1α), p53, GLUT4, dynamin-related protein 1 (Drp1), mitofusin 2 (Mfn2), B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax) and cysteine aspartic acid specific protease-3 (Caspase-3). The levels of reactive oxygen species were detected using the 2′,7′-dichlorodihydrofluorescein diacetate fluorescent probe. Mitochondria were labeled with the Mito-Tracker Deep Red FM fluorescent probe to assess mitochondrial morphology and their related parameters. Mitochondrial membrance potential was meausred using the JC-1 detection kit. Adenosine triphosphate (ATP) content was determined using an ATP assay kit. Glucose uptake ability was evaluated by measuring the fluorescence intensity of 2-[ N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy- D-glucose (2-NBDG) using a multifunctional microplate reader. Apoptosis was assessed by TUNEL assay. Results:The relative expression of HIF-1α protein in the high glucose combined with hypoxia/reoxygenation group was 1.189±0.185, higher than that in the control group (0.086±0.071) ( P<0.05). The relative expression of p53 protein in the high glucose combined with hypoxia/reoxygenation group was 1.248±0.194, higher than those in the control group (0.730±0.184), high glucose group (0.932±0.161) and hypoxia/reoxygenation group (1.109±0.151) (all P<0.05). The relative expression of GLUT4 protein in the high glucose combined with hypoxia/reoxygenation group was 0.407±0.140, lower than those in the control group (1.061±0.060) and hypoxia/reoxygenation group (0.781±0.092) (both P<0.05). The fluorescence intensity of reactive oxygen species in the high glucose combined with hypoxia/reoxygenation group was 38.31±1.66, higher than that in the control group (11.59±1.02) ( P<0.05). The number of mitochondria in the high glucose combined with hypoxia/reoxygenation group was (62.00±15.26), lower than those in the control group (136.20±23.55) and high glucose group (96.55±13.72) (both P<0.05). The average mitochondrial area in the high glucose combined with hypoxia/reoxygenation group was (7.02±1.38) μm 2, lower than those in the control group [(13.74±0.67) μm 2], high glucose group [(9.27±1.99) μm 2] and hypoxia/reoxygenation group [(9.64±2.36) μm 2] (all P<0.05). The average perimeter of mitochondria in the high glucose combined with hypoxia/reoxygenation group was (9.10±1.14) μm, lower than those in the control group [(13.35±0.69) μm] and the hypoxia/reoxygenation group [(10.83±1.58) μm] (all P<0.05). The number of mitochondrial branches was 53.73±9.49, lower than those in the control group (147.10±25.99), high glucose group (97.08±13.65) and hypoxia/reoxygenation group (104.80±24.92) (all P<0.05). The average branch length of mitochondria in the high glucose combined with hypoxia/reoxygenation group was (1.45±0.26) μm, lower than that in the control group [(2.29±0.52) μm] ( P<0.05). The red-green fluorescence intensity ratio in the high glucose combined with hypoxia/reoxygenation group was 0.580±0.133, lower than those in the control group (2.379±0.242), high glucose group (1.200±0.112) and hypoxia/reoxygenation group (0.883±0.076) (all P<0.05). The ATP content of the high glucose combined with hypoxia/ reoxygenation group was (0.025±0.003) μmol/10 5 cells, lower than those of the control group [(0.137±0.012) μmol/10 5 cells], high glucose group [(0.078±0.003) μmol/10 5 cells] and hypoxia/reoxygenation group [(0.073±0.010) μmol/10 5 cells] (all P<0.05). The fluorescence intensity of 2-NBDG in the high glucose combined with hypoxia/reoxygenation group was 257 315±7 951, lower than those in the control group (339 597±10 165), high glucose group (317 293±8 876) and hypoxia/reoxygenation group (314 611±12 228) (all P<0.05). The relative expression of Drp1 protein in high glucose combined with hypoxia/reoxygenation group was 1.203±0.090, higher than those in the control group (0.705±0.170), high glucose group (0.910±0.106) and hypoxia/reoxygenation group (1.002±0.112) (all P<0.05). The relative expression of Mfn2 protein in the high glucose combined with hypoxia/reoxygenation group was 0.706±0.285, lower than those in the control group (1.988±0.139), high glucose group (1.305±0.076) and hypoxia/reoxygenation group (1.131±0.236) (all P<0.05). The relative expression levels of Bax/Bcl-2 and Caspase-3 proteins in the high glucose combined with hypoxia/reoxygenation group were 2.318±0.216 and 1.076±0.076, respectively, higher than those in the control group (0.281±0.046 and 0.442±0.084), high glucose group (0.673±0.043 and 0.662±0.159) and hypoxia/reoxygenation group (0.807±0.293 and 0.835±0.058), respectively (all P<0.05). The TUNEL fluorescence intensity of the high glucose combined with hypoxia/reoxygenation group was 70.55±7.22, higher than those of the control group (14.10±5.93), high glucose group (36.59±2.56) and hypoxia/reoxygenation group (39.04±6.016) (all P<0.05). The relative expression levels of p53 protein in the sip53 transfection group and sip53+siGLUT4 transfection group were 0.322±0.147 and 0.391±0.149, respectively, lower than that in the high glucose combined with negative control group (1.002±0.035) (both P<0.05). The relative expression of GLUT4 protein in the sip53 transfection group was 1.871±0.123, higher than that in the negative control group (1.281±0.232) ( P<0.05). The relative expression of GLUT4 protein in the sip53+siGLUT4 transfection group (0.951±0.193) was lower than that in the sip53 transfection group ( P<0.05). The fluorescence intensity of reactive oxygen species in the sip53 transfection group (27.73±0.74) was lower than that in the negative control group (38.83±0.83) ( P<0.05). The fluorescence intensity of reactive oxygen species in the sip53+siGLUT4 transfection group (43.12±5.08) was higher than that in the sip53 transfection group ( P<0.05). The number of mitochondria, the average area of mitochondria, the average perimeter of mitochondria, the number of mitochondrial branches and the average branch length of mitochondria in the sip53 transfection group were (92.27±10.10), (9.25±0.42) μm 2, (10.86±0.58) μm, (83.27±13.57), and (1.81±0.21) μm, respectively. They were higher than (52.36±16.87), (7.44±1.49) μm 2, (9.22±1.11) μm, (52.36±16.87), and (1.22±0.26) μm in the negative control group (all P<0.05). The number of mitochondria, the average area of mitochondria, the average perimeter of mitochondria, the number of mitochondrial branches and the average branch length of mitochondria in the sip53+siGLUT4 transfection group were (53.73±9.49), (6.89±0.61) μm 2, (8.88±0.47) μm, (53.73±9.49), and (1.22±0.17) μm, respectively, lower than those in the sip53 transfection group (all P<0.05). The red-green fluorescence intensity ratio, ATP content, 2-NBDG fluorescence intensity and relative expression of Mfn2 protein in the sip53 transfection group were 1.27±0.23, (0.048±0.021) μmol/10 5 cells, 275 923±10 447 and 2.608±0.581, respectively, higher than those in the negative control group [0.53±0.21, (0.020±0.007) μmol/10 5 cells, 254 875±8 078, and 0.687±0.146, respectively] (all P<0.05). The red-green fluorescence intensity ratio, ATP content, 2-NBDG fluorescence intensity and relative expression of Mfn2 protein in the sip53+siGLUT4 transfection group were 0.40±0.08, (0.011±0.012) μmol/10 5 cells, 199 511±6 855, and 0.649±0.070, respectively, lower than those in the sip53 transfection group (all P<0.05). The relative expression levels of Drp1, Bax/Bcl-2, Caspase-3 proteins and TUNEL fluorescence intensity in the sip53 transfection group were 0.759±0.063, 0.446±0.161, 1.048±0.300, and 48.93±1.48 respectively, lower than those (1.065±0.149, 1.197±0.133, 1.847±0.201, and 67.61±9.99) in the negative control group (all P<0.05). The relative expression levels of Drp1, Bax/Bcl-2, Caspase-3 proteins and TUNEL fluorescence intensity in the sip53+siGLUT4 transfection group were 0.958±0.166, 2.660±0.135, 1.587±0.220, and 63.39±12.84, respectively, higher than those in the sip53 transfection group (all P<0.05). Conclusions:Under the condition of high glucose combined with hypoxia/reoxygenation, p53 induces cardiomyocyte injury by down-regulating GLUT4. Inhibition of p53 can increase the expression of GLUT4, thereby reducing cardiomyocyte injury induced by high glucose combined with hypoxia/reoxygenation.

Objective In response to the practical issues of pilot ground simulation ejection training relying on subjective evaluation,which requires high professionalism and lacks objectivity and systematicity,an objective evaluation system and method for ejection training based on pressure detection has been designed.Methods According to the rules of ejection training about posture,maneuver and time,and utilizing technologies such as pressure detection,infrared detection,and time-triggered detection,this paper designed separate modules for ejection posture detection,ejection timing detection,and comprehensive analysis and evaluation.These modules are closely integrated with the ejection training process,achieving objective evaluation of the ejection training.Results This system and method can provide a scientific and real-time objective evaluation of the posture,movements,and time in ejection training without affecting the normal organization and process.Conclusion The objective evaluation system can provide a new approach that is highly objective and easy to operate for comprehensively evaluating and enhancing the effectiveness of ejection training,as well as for scientifically conducting ejection training and assessment.

Objective To investigate the short-term efficacy of CT-guided microwave ablation(MWA)combined with percutaneous vertebroplasty(PVP)for spinal metastases,and to analyze the risk factors for postoperative cement leakage.Methods The clinical data of 50 patients with spinal metastases(74 diseased vertebrae in total),who were treated with CT-guided MW A combined with PVP at the authors'hospital from January 2020 to June 2023,were retrospectively analyzed.Numerical Pain Rating Scale(NRS),daily morphine consumption(DMC)and Activity of Daily Living Scale(ADL)were used to evaluate the short-term efficacy.Regular postoperative CT reexamination was carried out to assess the condition of local tumor control and bone cement leakage.Univariate analysis and multivariate binary logistic analysis of gender,age,maximum diameter of metastatic lesion,type of metastasis,Tomita classification of primary tumor,level of affected vertebrae,injected volume of bone cement,injection side,pathological fracture,and posterior vertebral wall rupture were performed to determine the risk factors for postoperative occurrence of bone cement leakage.Results The preoperative,and the postoperative one-day,one-week,one-month,3-month and 6-month NRS were(7.24±1.41),(4.76±1.45),(3.42±1.34),(2.86±0.90),(2.20±0.57),(1.66±0.72)points respectively.The preoperative,and the postoperative one-day,one-week,one-month,3-month and 6-month DMC were(110.40±94.61),(66.10±51.23),(47.30±37.49),(32.90±22.84),(25.60±18.97),(15.36±13.43)mg respectively.The preoperative,and the postoperative one-week,one-month,3-month and 6-month ADL were(40.80±11.45),(53.20±6.68),(60.40±5.14),(62.90±4.75),(64.80±4.51)points respectively.The differences in NRS,DMC,ADL between their preoperative values and postoperative 6-month values were statistically significant(all P＜0.05).Postoperative 6-month imaging follow-up check revealed that tumor was controlled in 46 patients and the tumor recurrence rate was 8％(4/50),and mild bone cement leakage occurred in 17 of 74 vertebrae(22.97％).Multivariate regression analysis indicated that pathological fracture(OR=9.581,95％CI=2.292-40.055,P=0.002)and rupture of posterior wall of vertebra(OR=5.105,95％CI=1.041-25.022,P=0.044)were the independent risk factors for bone cement leakage,the pathological fracture(OR=35.333,95％CI=4.029-309.840,P=0.001)was the independent risk factor for cortical bone cement leakage.No independent risk factor for vascular bone cement leakage was observed.The rupture of posterior wall of vertebra(OR=48.400,95％CI=4.725-495.753,P=0.001)was the independent risk factor for leakage of bone cement in spinal canal.Conclusion MW A combined with PVP can rapidly relieve pain,improve the ability of daily activity and quality of life of patients with spinal metastases,which can be further improved within 6 months after treatment.The combination use of MW A and PVP carries lower incidence of bone cement leakage.The pathological fracture and posterior wall rupture of vertebra are the independent risk factors for bone cement leakage.

Breast cancer(BC)is one of the most prevalent malignant tumors affecting women worldwide,with its incidence rate continuously increasing.As a result,treatment strategies for this disease have received considerable attention.Research has highlighted the crucial role of the Hedgehog(Hh)signaling pathway in the initiation and progression of BC,particularly in promoting tumor growth and metastasis.There-fore,molecular targets within this pathway represent promising opportunities for the development of novel BC therapies.This study aims to elucidate the therapeutic mechanisms by which natural com-pounds modulate the Hh signaling pathway in BC.By conducting a comprehensive review of various natural compounds,including polyphenols,terpenes,and alkaloids,we reveal both common and unique regulatory mechanisms that influence this pathway.This investigation represents the first comprehen-sive analysis of five distinct mechanisms through which natural compounds modulate key molecules within the Hh pathway and their impact on the aggressive behaviors of BC.Furthermore,by exploring the structure-activity relationships between these compounds and their molecular targets,we shed light on the specific structural features that enable natural compounds to interact with various components of the Hh pathway.These novel insights contribute to advancing the development and clinical application of natural compound-based therapeutics.Our thorough review not only lays the groundwork for exploring innovative BC treatments but also opens new avenues for leveraging natural compounds in cancer therapy.

Objective To observe the clinical,CT and MRI manifestations of CIC-rear ranged sarcoma(CRS).Methods Eight patients with single CRS lesion ranged from 3.79 to 98.81 cm and the median of 21.37 cm were retrospectively enrolled,6 lesions located in deep soft tissue and 2 located in the femur.The clinical and imaging data were observed.Results All 8 CRS lesions presented as rapidly growing local masses,including 6 solid cystic soft tissue lesions and 2 non enlarged bone lesions with osteolytic bone destruction,which were all lobulated lesions with uneven equal-low density/slightly high T1 and slightly high T2 signals,with multiple focal map like necrosis.Diffusion weighted imaging showed lesions with limited diffusion and invasion of adjacent tissue,and"ice melting sign"was observed in 4 cases.After administration of contrast agents,the solid components of lesions enhanced unevenly and moderately or significantly and sustainedly,with slightly more pronounced enhancement at the edges,abundant blood vessels were visible inside and at the edges."Vascular floating sign"was noticed in 2 cases.Conclusion The clinical,CT and MRI manifestations of CRS had certain characteristics.

Objectives:To investigate the clinical value of cardiac magnetic resonance imaging(CMR)feature-tracking strain analysis in risk stratification of diabetic heart failure with preserved ejection fraction(HFpEF).Methods:In this retrospective study,a total of 215 patients with diabetic HFpEF who underwent CMR at Chinese Academy of Medical Sciences Fuwai Hospital from January 2012 to December 2018 were included.Myocardial strain parameters were calculated using CMR feature-tracking technology.Patients were followed up by medical records or telephone calls.Composite endpoint event,all-cause death or heart failure hospitalization during follow-up were recorded.Patients were divided into event group and event-free group.Univariable and multivariable Cox proportional hazard regression analyses were performed to determine the risk factors for the outcomes in diabetic HFpEF.The effects of hypertension and obesity on the prognosis of diabetic HFpEF patients and whether they affect the prognostic value of CMR feature-tracking strain analysis were also analyzed.Results:During a follow-up of(7.1±1.8)years,93(43.3%)patients had endpoint events(event group),including 28 all-cause deaths and 65 heart failure hospitalization.Compared with the event-free group(n=122),patients in the event group had significantly lower left ventricular ejection fraction,higher prevalence and extent of late gadolinium enhancement,and significantly reduced global longitudinal strain(GLS),global circumferential strain,global radial strain,and global systolic longitudinal strain rate(all P<0.05).The absolute GLS value was significantly lower in event group than in event-free group,regardless of the presence of hypertension and obesity.Multivariate Cox regression analysis showed that estimated glomerular filtration rate(HR=0.983,95%CI:0.972-0.993,P=0.001),left atrial volume index(HR=1.015,95%CI:1.005-1.026,P=0.004),and GLS(HR=1.142,95%CI:1.060-1.231,P<0.001)were independent risk factors for adverse cardiovascular events in diabetic HFpEF patients.However,adjusted N-terminal pro-brain natriuretic peptide was not an independent prognostic factor.The cut-offvalue of GLS to predict outcome was-14.09%from ROC curve analysis.The Kaplan-Meier curve showed that in patients with and without hypertension and obesity,patients with the GLS>-14.09%had lower event-free survival compared to patients with GLS≤-14.09%(all P<0.05),and the ability of GLS to predict adverse outcomes was not affected by hypertension and obesity.Conclusions:GLS obtained by CMR feature-tracking strain analysis is an independent predictor of adverse outcomes in diabetic HFpEF,and its ability to predict adverse outcomes is independent of hypertension and obesity.

Objective:To explore the impact of phosphatase and tensin homologue deleted on chromosome 10 (PTEN)/tumor protein 53 (TP53) expression on the 68Ga-prostate specific membrane antigen (PSMA)-11 and 18F-FDG molecular imaging phenotypes in primary prostate cancer. Methods:A retrospective study was conducted on 75 prostate cancer patients (age (67.9±6.3) years) who received both 68Ga-PSMA-11 and 18F-FDG PET/CT imaging on initial diagnosis and subsequent radical prostatectomy at Renji Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, between Auguest 2018 and July 2022. The correlation between PTEN and TP53 expression in prostate cancer and molecular imaging phenotype was analyzed by χ2 test, Kruskal-Wallis rank sum test and Bonferroni method based on the uptake of imaging agents in primary lesions and the results of immunohistochemical analysis of surgical specimens. Results:In prostate cancer tissues with PTEN expression loss, the positive rates of 18F-FDG uptake and 68Ga-PSMA uptake were 14/14 and 11/14, with the SUV max of 7.70(6.15, 11.05) and 15.55(6.75, 23.49) respectively. In prostate cancer tissues with TP53 expression loss, the positive rates of 18F-FDG uptake and 68Ga-PSMA uptake were 10/10 and 6/10, with the SUV max of 7.70(6.95, 8.05) and 9.50(5.38, 19.89) respectively. In prostate cancer tissues with different expression patterns of PTEN and TP53, there were significant differences in the positive rates of 18F-FDG uptake ( χ2=20.45, P< 0.001), 68Ga-PSMA-11 uptake ( χ2=14.97, P=0.002), and the SUV max of 68Ga-PSMA-11 uptake ( H=9.62, P=0.022). Additionally, patients with concurrent loss of PTEN and TP53 expression in the primary tumor had significantly lower SUV max of 68Ga-PSMA-11 uptake compared to those with expression of both PTEN and TP53 (5.70(4.40, 11.70) vs 20.95(13.73, 37.58); P=0.003 (Bonferroni method corrected)). Conclusion:PTEN/TP53 expression is associated with the 68Ga-PSMA-11 and 18F-FDG molecular imaging phenotype in primary prostate cancer.

Objective:To investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and the long-term prognosis in patients with acute myocardial infarction (AMI).Methods:It was a retrospective cohort study. A total of 712 patients diagnosed with AMI who were admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were continuously included as subjects. The fatty liver index (FLI) was used to evaluate the degree of hepatic steatosis. Subjects were divided into No NAFLD group (FLI?30), grade 1 NAFLD group (30≤FLI?60), and grade 2 NAFLD group (FLI≥60). The endpoint event was defined as the occurrence of major cardiovascular adverse events (MACEs). The Cox proportional risk model was used to assess the risk of MACEs. The Kaplan-Meier curve was used to analyze the survival differences between the groups, and subgroup analysis was performed for age, gender, and complicity with hypertension, diabetes, dyslipidemia, and abdominal obesity.Results:During the follow-up period, the incidence of MACEs was 10.92% (26/238) in the No NAFLD group, it was 18.01% (47/261) in the grade 1 NAFLD group, and 24.41% (52/213) in the grade 2 NAFLD group, there was significant difference in the incidence of adverse events among the groups ( χ2=9.136, P?0.05). After adjusting for confounding factors, compared with the No NAFLD group, the risk of MACEs in grade 1 NAFLD group was increased by 69.0%( HR=1.690, 95% CI: 1.026-2.783, P=0.039) and 131.2%( HR=2.312, 95% CI: 1.415-3.773, P=0.001), respectively. Kaplan-Meier curve analysis indicated that the cumulative incidence of MACEs was significantly increased and the prognosis was worse in grade 2 NAFLD group (Log-rank test χ2=13.500, P=0.001). The results of subgroup analysis suggested that grade 2 NAFLD could significantly increase the risk of MACEs in all age groups, women, dyslipidemia, normal body type, and people with or without hypertension or diabetes. In particular, it had higher predictive value in women and normal-size people (interaction P?0.05). Conclusion:The degree of NAFLD is closely related to the long-term prognosis of AMI patients, the more severe the NAFLD, the higher the risk of adverse events in AMI patients.