Objective To investigate the risk factors associated with mortality in patients undergoing surgical treatment for myocardial infarction complicated by ventricular septal rupture, and to establish a prediction model. Methods A retrospective analysis was conducted on clinical data of patients who underwent surgical treatment of myocardial infarction with ventricular septal rupture at Beijing Anzhen Hospital from 2008 to 2022. Patients were followed up and divided into a survival group and a death group based on perioperative and follow-up outcomes. Univariate analysis was performed for all variables, followed by least absolute shrinkage and selection operator (LASSO) regression to screen risk factors affecting postoperative mortality. A Cox regression model was constructed and a Nomogram was developed. Results A total of 83 surgical patients were included, comprising 49 males and 34 females, with a mean age of (64.4±7.7) years. There were 13 perioperative deaths, and among the 70 surviving patients, 6 additional deaths occurred during follow-up. Consequently, 64 patients were assigned to the survival group and 19 to the death group. Univariate analysis revealed statistically significant differences between groups in age, culprit vessel patency status, intra-aortic balloon pump use, Killip classification, time from myocardial infarction to surgery, and time from perforation to surgery (all P<0.05). LASSO regression identified three independent predictors: age [HR=1.092, 95%CI (1.005, 1.187), P=0.039], Killip classification [HR=2.024, 95%CI (1.009, 4.059), P=0.047], and culprit vessel patency [HR=0.110, 95%CI (0.014, 0.869), P=0.036]. The Nomogram based on these variables demonstrated good discriminative ability, with area under the receiver operating characteristic curve of 0.907 at 1 month and 0.876 at 1 year postoperatively. Follow-up revealed cumulative survival rates of 78.2%, 78.2%, 74.6%, and 74.6% at 2, 5, 8, and 10 years postoperatively for all patients, and 92.7%, 92.7%, 88.5%, and 88.5% for perioperative survivors. Conclusion Patients with myocardial infarction complicated by ventricular septal rupture demonstrate favorable mid-to-long-term prognosis after surgical repair. Age, Killip classification, and culprit vessel patency are independent predictors of postoperative mortality, and the established prediction model shows satisfactory prognostic performance.

Objective To investigate and analyze epidemiological characteristics of patients with mycoplasma pneumoniae pneumonia (MPP) from 2020 to 2023, and the risk factors for plastic bronchitis (PB), To provide data support for developing preventive measures. Methods The medical records of 2 257 patients with respiratory tract infection treated at Huai'an Hospital Affiliated to Xuzhou Medical University from 2020 to 2023 were collected. Count the number of MPP patients and analyze the MP detection rate. Multivariate logistic regression analysis and ROC curve was used to screen the risk factors for PB. Results A total of 858 cases were positive for MP antibodies, and the detection rate was 38.02%. There are statistically significant differences in MP detection rates among different genders, age groups, and years (P<0.05). Among the 286 patients diagnosed with MPP and undergoing bronchoscopy, 68 (23.78%) patients had PB. According to univariate and multivariate logistic regression analysis, small age, higher N%, D-D, LDH and AST levels were independent risk factors for PB (P<0.05). ROC curve analysis shows that age and combined detection are the most effective indicators for PB prediction, with areas under the curve of 0.998 and 0.961, respectively. Conclusion MP is the main pathogen of respiratory tract infections in the area from 2020 to 2023. Women and children are more susceptible to MP infection. Small age, high N%, DD, LDH and AST levels are independent risk factors for PB in patients with MPP. Targeted preventive measures should be taken for MP susceptible population, and close attention should be paid to PB related risk factors to prevent disease progression and the occurrence of PB.

Objective:To investigate the application value of cardiac magnetic resonance imaging(CMR) in evaluating the perioperative risk of surgical treatment in patients of coronary artery disease and heart failure with reduced ejection fraction.Methods:A total of 78 patients diagnosed with CAD and HFrEF who underwent CABG in Beijing Anzhen Hospital from January 2018 to October 2021 were retrospectively enrolled. All patients underwent CMR examination before CABG. The perioperative data of the two groups were compared, and the risk factors that may lead to perioperative MACCE were analyzed by LASSO regression. Then, logistic regression was used to establish a prediction model and internal validation was performed to evaluate the diagnostic efficiency and accuracy of the model by Bootstrap method. Results:There were 24 patients(30.8%) with perioperative MACCE and 54 patients(69.2%) without perioperative MACCE. LASSO regression was used to screen out three factors related to the outcome. Multivariate logistic regression analysis showed that LGE in the third and eighth segment of left ventricle and diastolic radial strain rate were independent risk factors for perioperative MACCE. The area under the curve of the prediction model constructed with CMR was 0.799(95% CI: 0.696-0.901), so the discrimination was good. The calibration curve showed that the prediction curve was basically fit to the standard curve, and the Hosmer- Lemeshow test P=0.797, indicating high prediction accuracy. Conclusion:CMR is a valuable test for evaluating perioperative risk in patients with coronary heart disease complicated with HFrEF. To establish the risk prediction model combined with CMR can provide some reference for the assessment of perioperative risk in these patients undergoing surgical treatment.

Objective:To investigate the application value of cardiac magnetic resonance imaging(CMR) in evaluating the perioperative risk of surgical treatment in patients of coronary artery disease and heart failure with reduced ejection fraction.Methods:A total of 78 patients diagnosed with CAD and HFrEF who underwent CABG in Beijing Anzhen Hospital from January 2018 to October 2021 were retrospectively enrolled. All patients underwent CMR examination before CABG. The perioperative data of the two groups were compared, and the risk factors that may lead to perioperative MACCE were analyzed by LASSO regression. Then, logistic regression was used to establish a prediction model and internal validation was performed to evaluate the diagnostic efficiency and accuracy of the model by Bootstrap method. Results:There were 24 patients(30.8%) with perioperative MACCE and 54 patients(69.2%) without perioperative MACCE. LASSO regression was used to screen out three factors related to the outcome. Multivariate logistic regression analysis showed that LGE in the third and eighth segment of left ventricle and diastolic radial strain rate were independent risk factors for perioperative MACCE. The area under the curve of the prediction model constructed with CMR was 0.799(95% CI: 0.696-0.901), so the discrimination was good. The calibration curve showed that the prediction curve was basically fit to the standard curve, and the Hosmer- Lemeshow test P=0.797, indicating high prediction accuracy. Conclusion:CMR is a valuable test for evaluating perioperative risk in patients with coronary heart disease complicated with HFrEF. To establish the risk prediction model combined with CMR can provide some reference for the assessment of perioperative risk in these patients undergoing surgical treatment.

Objective:To investigate the risk factors and prognosis of mitral regurgitation (MR) in patients with chronic kidney disease (CKD).Methods:Clinical data were collected from CKD patients who were hospitalized at the Department of Nephrology, Xuanwu Hospital, Capital Medical University, from January 1, 2018, to December 31, 2019, and underwent echocardiography. Patients were followed up until November 1, 2021, with the endpoint being all-cause mortality.Logistic regression was used to analyze the risk factors of MR in CKD patients. Kaplan-Meier survival analysis was performed to plot the survival curve, with the Log-rank test comparing the survival rate. Multivariate Cox regression analysis was used to identify the risk factors of death in CKD patients.Results:It was a retrospective single-center study. A total of 555 CKD patients were included, with 262 patients developing MR. Of whom, 212 patients had mild MR (80.9%), 44 patients had modreate MR (16.8%), 6 patients had severe MR (2.3%). The prevalence of MR among patients with CKD stages 1 to 5 was 21.9%, 33.0%, 45.9%, 51.9%, and 64.6%, and the prevalence of moderate to severe MR was 0, 5.6%, 7.4%, 10.1%, and 15.9%. Multivariate logistic regression analysis revealed that male sex ( OR=1.579, 95% CI 1.008-2.476, P=0.046), presence of chronic heart disease ( OR=2.263, 95% CI 1.398-3.662, P=0.001), CKD stage 4-5 (with CKD stage 1-3 as reference, OR=1.744, 95% CI 1.007-3.019, P=0.047), and decreasing hemoglobin levels ( OR=0.985, 95% CI 0.975-0.996, P=0.006) were the associated factors for MR in CKD patients. Kaplan-Meier survival analysis indicated higher all-cause mortality (Log-rank, χ2=8.094, P=0.004) in the MR group compared to the non-MR group. Multivariate Cox regression analysis showed that increasing age ( HR=1.072, 95% CI 1.042-1.104, P<0.001), elevating blood phosphorus ( HR=2.782, 95% CI 1.122-6.895, P=0.027), MR ( HR=1.962, 95% CI 1.002-3.839, P=0.049) and decreasing albumin ( HR=0.927, 95% CI 0.886-0.970, P=0.001) were independent associated factors for all-cause death in CKD patients. Conclusions:The overall prevalence of MR and the prevalence of moderate to severe MR are increasing with the progression of CKD. Male sex, presence of chronic heart disease, CKD stage 4-5 and decreasing hemoglobin levels are risk factors for MR in CKD patients. MR is an independent risk factor for all-cause mortality in CKD patients.

Objective:To investigate the value of myocardium scar area in predicting adverse cardiovascular events (MACEs) after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICM).Methods:The first part of this study was a retrospective study. Patients diagnosed with ICM and undergoing CABG surgery at Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2022 were enrolled as the discovery cohort. All patients underwent cardiac magnetic resonance-late gadolinium enhancement (CMR-LGE) before surgery. According to the occurrence of postoperative MACEs, the patients were divided into MACEs group and MACEs-free group. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. The primary endpoint was postoperative MACEs. Univariate and multifactor regression analyses were used to analyze the risk factors for MACEs. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive efficacy and optimal cut-off value of myocardial scar area for endpoint events. The second part of this study was a prospective study. Patients with ICM who received CABG at Beijing Anzhen Hospital, Capital Medical University from January 2023 to June 2023 were enrolled as a validation cohort, and were divided into MACEs group and MACEs-free group according to whether MACEs occurred after surgery. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. Verify the reliability of the cut-off value obtained by ROC curve in the validation cohort.Results:A total of 120 patients with ICM (30 patients in MACEs group and 90 patients in MACEs-free group), aged (61.6±8.7) years, including 93 males, were included in the discovery cohort. A total of 22 ICM patients (5 patients in MACEs group and 17 patients in MACEs-free group), aged (59.5±8.2) years, including 18 males, were included in the validation cohort. Multivariate Cox regression showed that myocardial scar area ( HR=1.258, 95% CI 1.096-1.444, P=0.001) was an independent risk factor for the primary endpoint event. The area under ROC curve of myocardial scar area for predicting postoperative MACEs was 0.90 (95% CI 0.83-0.95), and myocardial scar area≥36.0% was the optimal cut-off value for predicting postoperative MACEs, and its sensitivity, specificity and accuracy were 96.7%, 72.2% and 78.3%, respectively. In the validation cohort, the sensitivity, specificity and accuracy of myocardial scar area in predicting postoperative MACEs in patients with ICM after CABG were 80.0%, 82.4% and 81.8%, respectively. Conclusion:Myocardial scar area is an independent risk factor for MACEs after CABG in patients with ICM, and myocardial scar area≥36.0% is the optimal cut-off value for predicting MACEs after CABG. Myocardial scar area can help to identify patients at high risk of surgery and provide a basis for risk stratification of patients.

Objective:To investigate the risk factors and prognosis of mitral regurgitation (MR) in patients with chronic kidney disease (CKD).Methods:Clinical data were collected from CKD patients who were hospitalized at the Department of Nephrology, Xuanwu Hospital, Capital Medical University, from January 1, 2018, to December 31, 2019, and underwent echocardiography. Patients were followed up until November 1, 2021, with the endpoint being all-cause mortality.Logistic regression was used to analyze the risk factors of MR in CKD patients. Kaplan-Meier survival analysis was performed to plot the survival curve, with the Log-rank test comparing the survival rate. Multivariate Cox regression analysis was used to identify the risk factors of death in CKD patients.Results:It was a retrospective single-center study. A total of 555 CKD patients were included, with 262 patients developing MR. Of whom, 212 patients had mild MR (80.9%), 44 patients had modreate MR (16.8%), 6 patients had severe MR (2.3%). The prevalence of MR among patients with CKD stages 1 to 5 was 21.9%, 33.0%, 45.9%, 51.9%, and 64.6%, and the prevalence of moderate to severe MR was 0, 5.6%, 7.4%, 10.1%, and 15.9%. Multivariate logistic regression analysis revealed that male sex ( OR=1.579, 95% CI 1.008-2.476, P=0.046), presence of chronic heart disease ( OR=2.263, 95% CI 1.398-3.662, P=0.001), CKD stage 4-5 (with CKD stage 1-3 as reference, OR=1.744, 95% CI 1.007-3.019, P=0.047), and decreasing hemoglobin levels ( OR=0.985, 95% CI 0.975-0.996, P=0.006) were the associated factors for MR in CKD patients. Kaplan-Meier survival analysis indicated higher all-cause mortality (Log-rank, χ2=8.094, P=0.004) in the MR group compared to the non-MR group. Multivariate Cox regression analysis showed that increasing age ( HR=1.072, 95% CI 1.042-1.104, P<0.001), elevating blood phosphorus ( HR=2.782, 95% CI 1.122-6.895, P=0.027), MR ( HR=1.962, 95% CI 1.002-3.839, P=0.049) and decreasing albumin ( HR=0.927, 95% CI 0.886-0.970, P=0.001) were independent associated factors for all-cause death in CKD patients. Conclusions:The overall prevalence of MR and the prevalence of moderate to severe MR are increasing with the progression of CKD. Male sex, presence of chronic heart disease, CKD stage 4-5 and decreasing hemoglobin levels are risk factors for MR in CKD patients. MR is an independent risk factor for all-cause mortality in CKD patients.

Objective: To analyze the efficacy and safety of the sodium channel blockers (SCB) antiseizure medication in the treatment of focal epilepsy in infants under 6 months of age. Methods: This was a case series study. Infants with focal epilepsy with onset within 6 months of age and treated with SCB attending the Department of Neurology of Beijing Children's Hospital from June 2016 to April 2022 were collected. The clinical data, auxiliary examinations, SCB application, efficacy, adverse reactions, and prognosis were analyzed retrospectively. Patients were grouped according to type of seizure and epileptic syndrome, age of onset and etiology. Chi square test and Fisher exact test were used to analyze the differences between groups statistically. Results: A total of 118 infants were enrolled, 65 males and 53 females, with an age of epilepsy onset of 56 (4, 114) days. Developmental and epileptic encephalopathy was diagnosed in 60 infants, 39 had self-limited neonatal and (or) infantile epilepsy, and 19 had non-syndromic focal epilepsy. Application of SCB: 106 used oxcarbazepine, 2 used lacosamide, 9 switched from oxcarbazepine to lacosamide or a combination of 2 SCB, and 1 used oxcarbazepine, lacosamide, and lamotrigine successively; oxcarbazepine was the first choice in 46 cases. The age at which SCB was applied was 103 (53, 144) days. The children were followed up for 6 months to 6 years. SCB was effective in 89 cases (75.4%), including 70 cases (59.3%) who achieved seizure freedom. The seizure-free rate was higher in the focal epilepsy only group than in the group with other seizure types (64.4% (65/101) vs. 4/17, χ²=9.99, P<0.05). The responder and seizure-free rates were all higher in the group with the onset age of >3-6 months than the group >1-3 months (84.4% (38/45) vs. 62.5% (20/32), 73.3% (33/45) vs. 46.9% (15/32), χ²=4.85 and 5.58, both P<0.05). With the exception of variants in the PRRT2 gene, those with variants in sodium or potassium channels had higher responder and seizure-free rates than those with variants in other genes(86.2% (25/29) vs. 45.5% (10/22), 62.1% (18/29) vs. 22.7% (5/22), χ²=9.65 and 7.82,both P<0.05). The most common adverse event was transient hyponatremia, which happened in 66 cases (55.9%). There were 9 cases of rash, which subsided in 6 cases after discontinuing oxcarbazepine and switching to lacosamide, and 7 cases of electrocardiogram abnormalities, which improved after withdrawing oxcarbazepine and changing to lacosamide in 1 case. Conclusion: SCB are effective and tolerable in the treatment of focal epilepsy in infants under 6 months of age, with better efficacy in patients with genetic variants of the sodium or potassium channel, focal seizures only, and seizure onset >3-6 months of age.
Child ; Female ; Male ; Infant, Newborn ; Humans ; Infant ; Sodium Channel Blockers/adverse effects* ; Oxcarbazepine ; Lacosamide ; Retrospective Studies ; Epilepsies, Partial/drug therapy* ; Seizures ; Sodium ; Anticonvulsants/adverse effects*

OBJECTIVE To establish the quality standard of Lixieling tablets. METHODS Thin layer chromatography was used to identify Bistortae Rhizoma, Andrographis Herba and Sophorae Flavescentis Radix in Lixieling tablets. The components of andrographolium and matrine were determined by HPLC. RESULTS The thin layer spots of Bistortae Rhizoma, Andrographis Herba and Sophorae Flavescentis Radix were clear, with good separation effect and repeatability. The linear relationship between andrographolide, neoandrographolide, 14-deoxygenated andrographolide, dehydrated andrographolide, sophorine, oxymatrine, sophorine and oxysophorine and their respective concentration ranges was good. The RSDs of instrument precision, repeatability, stability and recovery all met the requirements. CONCLUSION The method is simple and reproducible, and can be used for the quality control of Lixieling tablets.

Objective: To explore the metabolite profile and metabolic pathways of newly diagnosed multiple myeloma (MM). Methods: Gas chromatography-mass spectrometry (GC-MS) was employed for the high-throughput detection and identification of serum samples from 55 patients with MM and 37 healthy controls matched for age and sex from 2016 to 2017 collected at the First Affiliated Hospital of Soochow University. The relative standard deviation (RSD) of quality control (QC) samples was employed to validate the reproducibility of GC-MS approach. The differential metabolites between patients with MM and healthy controls were detected by partial least squares discrimination analysis (PLS-DA), and t-test with false discovery rate (FDR) correction. Metabolomics pathway analysis (MetPA) was employed to construct metabolic pathways. Results: There were 55 MM patients, including 34 males and 21 females. The median age was 60 years old (42-73 years old). There were 30 cases of IgG type, 9 cases of IgA type, 1 case of IgM type, 2 cases of non-secreted type, 1 case of double clone type and 12 cases of light chain type, including 3 cases of kappa light chain type and 9 cases of lambda light chain type. The result of QC sample test showed that the proportion of compounds with the RSD of the relative content of metabolites < 15% was 70.21% obtained by the reproducibility of GC-MS experimental data, which implied that the experimental data were reliable. A total of 17 metabolites were screened differently with the healthy control group, including myristic acid, hydroxyproline, cysteine, palmitic acid, L-leucine, stearic acid, methionine, phenylalanine, glycerin, serine, isoleucine, tyrosine, valine, citric acid, inositol, threonine, and oxalic acid (VIP>1, P<0.05). Metabolic pathway analysis suggested that metabolic disorders in MM patients comprised mainly phenylalanine metabolism, glyoxylic acid and dicarboxylic acid metabolism, phosphoinositide metabolism, cysteine and methionine metabolism, glycerolipid metabolism, glycine, serine, and threonine metabolism. Conclusion: Compared with normal people, patients with newly diagnosed MM have obvious differences in metabolic profiles and metabolic pathways.
Male ; Female ; Humans ; Middle Aged ; Adult ; Aged ; Cysteine ; Multiple Myeloma/diagnosis* ; Reproducibility of Results ; Metabolome ; Metabolomics/methods* ; Metabolic Networks and Pathways ; Methionine ; Serine ; Phenylalanine ; Threonine ; Biomarkers