Objective To analyze the relationship between fragmented QRS(fQRS)and microalbuminuria(MAU)and serum uric acid(SUA)in patients with type 2 diabetes mellitus(T2DM).Methods From October 2022 to June 2023,245 T2DM patients diagnosed by The Department of Endocrinology,Jinhua Hospital Affiliated to Zhejiang University School of Medicine were selected and divided into fQRS group(fQRS,n=111)and T2DM group(n=134)according to ECG results.The general data,biochemical indexes,left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),interventricular septum(IVS),left ventricular posterior wall(LVPW),left ventricular ejection fraction(LVEF),left atrial diameter(LAd),peak value ratio of mitral orifice blood flow velocity in early and late diastole(E/A)and mitral orifice blood flow velocity in early diastole were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between fQRS wave and other indexes in T2DM patients,and Logistic regression analysis was used to analyze the influencing factors of fQRS.Results The prevalence rates of UACR,SUA,HbA1c and MAU in fQRS group were higher than in T2DM group(P＜0.05 or P＜0.01).LVEDd,LAd,E,E/e'and E/A>1.5 in QRS group were higher than in T2DM group(P＜0.05 or P＜0.01).Pearson correlation analysis showed that fQRS wave was positively correlated with smoking history,BMI,HbA1c,UACR,MAU,SUA,LVEDd,LAd,E/A and E/e'(P＜0.05).Logistic regression analysis showed that MAU was the influencing factor of fQRS wave in T2DM patients.Conclusions The fQRS in ECG in patients with T2DM is associated with MAU and SUA and may be an important evidence of myocardial fibrosis associated with subclinical cardiac diastolic dysfunction.

Objective: To explore the differential expression profiles of DNA methylation sites/regions and potential molecular mechanisms in the peripheral blood of coronary heart disease (CHD)-induced unstable angina pectoris patients with or without Qi deficiency and blood stasis syndrome, and to provide scientific evidence for the conbination of disease and syndrome. Methods: According to the pre-determined inclusion and exclusion criteria, the study subjects were enrolled and divided into two groups namely CHD-induced unstable angina group (G group) and healthy control group (J group) to conduct “disease” analysis, while G group was further divided into Qi deficiency and blood stasis syndrome group (case group) and non-Qi deficiency blood stasis syndrome group (control group) to perform “syndrome” analysis. The general data and clinical information of the study subjects were collected. The peripheral venous blood was extracted on an empty stomach, and the Illumina Infinium MethylationEPIC BeadChip (850K methylation chip) was used to detect the differential expressionprofiles of DNA methylation in each group, ChAMP software (V 2.14.0) was used for the differential methylation data analysis, with a threshold of the adjusted P value (adj.P.val) < 0.01. Gene Ontology (GO) and Kyoto Encyclopedia of Genomes (KEGG) were employed for the functional and pathway enrichment analyses of related mapped genes. Results: A total of 263 differentially methylated CpG positions (DMPs) were screened out between G and J groups, including 191 hypermethylated positions such as cg05845204 and cg08906898, and 72 hypomethylated positions such as cg26919182 and cg13149459. These positions were mainly mapped to 148 genes encompassing RNA binding motif protein 39 (RBM39), acetyl-CoA acyltransferase 2 (ACAA2), protein phosphatase 1 regulatory subunit 12B (PPP1R12B), and the dual-specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2). GO functional enrichment analysis revealed that the genes of the DMPs were primarily enriched in protein localization to chromosomes, regulation of cell morphogenesis, negative regulation of calcium-mediated signals, etc. KEGG pathway analysis suggested that the genes were mainly enriched in fatty acid metabolism and endocytosis pathways. In addition, a total of 23 differential methylation regions (DMRs) were identified, with overlapping genes such as transmembrane protein 232 (TMEM232), ribosomal protein large P1 (RPLP1), peroxisomal biogenesis factor 10 (PEX10), and forkhead box N3 (FOXN3) recognized. It was found that GO functions were mainly enriched in the negative regulation of Ras protein signal transduction, small GTPase-mediated signal transduction, negative regulation, etc. A total of 1 703 differential methylation sites were screened out between case and control groups, including 444 increased methylation positions such as cg05573767 and 1 259 decreased methylationpositions such as cg19938535, and cg03893872. These positions were mapped to 1 108 genes such as ribosomal protein S6 kinase A2 (RPS6KA2), leucine rich repeat containing 16A (LRRC16A), and hedgehog acyltransferase (HHAT). According to the GO functional enrichment analysis, the genes relating to the DMPs were mainly enriched in biological functions such as transmembrane receptor protein serine/threonine kinase signaling pathway and axonogenesis. The KEGG pathway enrichment analysis suggested the involvement of Rap1 signaling pathway, adenosine 5’-monophosphate-activated protein kinase (AMPK) signaling pathway, etc. A total of 21 DMRs were identified, including 22 overlapping genes such as mucin 4 (MUC4), three prime repair exonuclease 1 (TREX1), and LIM homeobox 6 (LHX6). GO analysis demonstrated that the genes primarily participated in molecular functions such as positive regulation of transmembrane transport, regulation of fatty acid metabolism, and copper ion binding. Conclusion This study reveals the methylation patterns of DMPs and DMRs in patients with Qi deficiency and blood stasis syndrome caused by CHD-induced unstable angina pectoris. Potential epigenetic regulation of fatty acid metabolism, Rap1 signaling, and other molecular functions are involved in the development of CHD between the "disease" and "syndrome".

Objective This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials(RCTs)assessing the clinical efficacy of acupuncture for chronic stable angina(CSA).Methods PubMed,The Cochrane Library,Embase,CNKI,VIP,WanFang Data,CBM databases,ClinicalTrial.gov and Chinese Clinical Trial Registry were electronically searched to collect randomized controlled trials(RCTs)of acupuncture for CSA and only RCTs that included acupuncture as the sole or combination of acupuncture in the treatment of CSA.The retrieval period was from the establishment of the database to May 19,2022.The primary outcome measure was the frequency of angina attacks,and the secondary outcome measures were angina efficacy,total effective rate of ECG improvement,nitroglycerin use after treatment,patient-perceived overall effectiveness,performance on the Six-Minute Walk Test(6-MWT),depression as measured by the anxiety as measured by the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),adverse effects.Results Twelve studies with a total of 1605 case subjects were included and grade quality of evidence reviews had 1 outcomes as medium quality evidence,5 outcomes as low quality evidence and 4 outcomes as very low quality evidence.Acupuncture treatment resulted in significantly greater reductions in angina attacks,visual analog scale(VAS),6-minute walk test,angina efficacy,electrocardiogram improvement rate,angina efficacy,total clinical response rate.Conclusion The efficacy of acupuncture combined with western medicine in treating CSA is better than that of Western medicine alone,thanks to restricted by the number and quality of included researchs,higher quality studies are required to prove above conclusions.

Objective:This study aims to summarize the construction and operation results of a clinical research support platform in a large grade A tertiary hospital in Beijing, and to explore the top-level design, functional positioning, and operation management based on research wards, thereby providing a reference for improving the clinical research support system in China.Methods:Guided by the needs of clinical research, the clinical research support platform consisted of seven core functional units, including the clinical trial platform, medical ethical review platform, medical experiment and clinical testing platform, clinical research big data platform, clinical research methodology platform, scientific and technological achievements transformation platform, and biobank.Results:The clinical research support platform with perfect functions, scientific management, and efficient operation can provide strong technical support for efficient operation of research wards, high-quality development of clinical trials, and rapid transformation of innovative results.Conclusions:A high-level clinical research support platform can effectively integrate medical resources, promote resource sharing and cooperation, promote the deep integration of industry, academia, research, and medicine, and enhance the collaboration and scientific level of clinical research.

Objective:To solve international students' problems of learning difficulties and passive learning caused by language barriers in the process of biochemistry learning from the perspective of teachers in this specialty.Methods:Eighty international students were randomly divided into experimental group and control group. In the experimental group, the regional management mode was introduced in teaching, allowing students to speak mother tongues or English for group discussions on well-designed questions, and at the same time, classroom quizzes and stage tests were given, introducing formative evaluation to supervise students' learning and assess their learning performance. The control group received conventional teaching. The learning effects were assessed through a final exam and questionnaire survey. SPSS 25.0 was used to perform the Kruskal-Wallis H test and Nemenyi test. Results:Twenty-seven (75.00%) students believed that group discussion by region could deepen the discussion of questions; 27 (75.00%) no longer felt difficult, or even felt easy, to learn biochemistry; and nearly 90.00% of the students affirmed the formative evaluation mode, believing that it had positive effects on their learning attitude and behavior. In addition, the median exam score of the experimental group was 36.94% higher than that of the control class in the same year.Conclusions:Regional management combined with formative evaluation can promote international students' learning enthusiasm, improve their comprehensive achievement, and positively affect their learning behavior.

Objective:This study aims to summarize the achievements of the research wards in a large grade A tertiary hospital in Beijing, discuss the important role of pharmacists, and provide a reference for improving the functions and responsibilities of pharmacists in the research ward construction.Methods:Combining the practice of research ward construction in a grade A tertiary hospital in Beijing, the important role of pharmacists in the construction and operation of research wards were analyzed in system construction, information construction, analysis laboratory construction, and project management.Results:The participation of pharmacists with professional pharmaceutical knowledge and familiarity with the relevant policies and regulations of clinical research can greatly improve the quality and efficiency of research ward construction and operation.Conclusions:Pharmacists' participation in the construction of research wards is beneficial to improving clinical research ability and quality, and is of great significance to the development of China′s pharmaceutical health industry.

Objective:To investigate the effect of nurse-led multiple disciplinary team-based intervention in the prevention of venous thromboembolism in paitents undergoing general surgery.Methods:A total of 118 patients who underwent general surgery in the Tianjin First Central Hospital from May 2017 to October 2018 were divided into study group and control group by random digits table method, with 59 cases in each group. The control group received routine thrombosis prevention nursing, the study group carried out nurse-led multiple disciplinary team-based intervention. The condition of lower limbs deep venous hemodynamic was detected by color Doppler ultrasonography at 3 days after surgery, the levels of D-dimer, thrombelastograph coagulation analyzer (TEG) coagulation parameters were also measured at after 24 hours of admission and postoperative day 3, respectively.Results:The vein blood stasis rate was 94.9% (3/59) in the study group, 79.7% (12/59) in the control group, the venous blood flow of the lower 1imbs in the study group was better than that in the control group ( Z value was 2.477, P<0.05). At 3 days after surgery, the levels of D-dimer were (5.26±1.42) mg/L in the study group, (6.36±1.58) mg/L in the control group, D-dimer was decreased in study group compared to the control group, the difference was statistically significant ( t value was 3.991, P<0.05). Coagulation reaction time(R) value and solidification angle(Angel), maximum thrombus intensity(MA), composite coagulation index(CI) levels were (5.30±0.91) min, (69.64±21.93) deg, (65.40±13.76) mm and (1.23±0.20) in the study group, those index were (4.41±0.75) min, (76.64±16.02) deg, (70.98±13.39) mm, (2.09±0.36) in the control group, R value were increased and Angel, MA, CI levels were decreased in the study group compared to the control group ( t value was 2.001-15.997, P<0.05). Conclusions:Nurse-led multiple disciplinary team-based intervention improves the lower limbs deep venous hemodynamic and coagulation function, as well as reduce the incidence of venous thromboembolism.

Objective To investigate the first decompression time of TR Band hemostasis after transradial percutaneous coronary intervention (TRI), provide evidence to support and guidance for clinical nursing practice. Methods By searching Cochrane Library, OVID, PubMed, Chinese biomedical literature service system(CBM),China National Knowledge Infrastructure(CNKI), VIP database(VIP), Wanfang database, the randomized controlled trials (RCTs),controlled clinical trials (CCT) and historical cohort study(HCT) of TR Band hemostasis after coronary artery intervention were collected and analyzed. Two reviewers used bias risk assessment tool according to Cochrane recommendation Handbook 5.0 to evaluate, Meta-analysis was carried out using RevMan 5.1.5 software. Results A total of 1 881 patients in 2 RCTs and 3 CCTs were included.Compared with the first decompression time 30 min, patients in 1 h group with limb swelling and pain incidence were statistically significant difference [ (OR=2.22, 95%CI 1.25-3.93, P<0.01) vs. (OR=1.63,95%CI 1.02-2.59, P < 0.05)], bleeding at the puncture sites or the operative limbnumbness or ecchymosis there was no significant difference [(OR=0.77,95%CI 0.35-1.71, P>0.05) vs.(OR=2.14, 95%CI 0.75-6.12, P>0.05)vs.(OR=11.73, 95%CI 0.64-215.74, P>0.05)];1h compared with 2 h patients with limbs, pain, hemorrhage rate had significant difference [(OR=0.09, 95%CI-0.13--0.05, P<0.01) vs. (OR=2.07, 95%CI 1.24-3.46, P<0.01)]; a comparison between 90 min and 2h, the limb pain and swelling incidence were statistically significant difference [(OR=2.77, 95%CI 1.82-4.23, P<0.01)vs.(OR=2.73,95%CI 1.41-5.28, P<0.01)], the puncture site bleeding, hematoma, ecchymosis rate and the operative limb numbness extent differences were no statistical significance [(OR=0.97,95%CI 0.61-1.54, P>0.05) vs. (OR=0.95, 95%CI 0.52-1.75, P>0.05)vs. (OR=0.96,95%CI 0.54-1.73, P>0.05)]. Conclusions 30 min decompression after TRI can reduce operative limb swelling and pain incidence rate. There is no obvious influence between puncture site bleeding and operative limb numbness.

Objective To evaluate the effectiveness of TR Band hemostat in trans-radial coronary intervention patients.Methods The randomized controlled trials (RCTs) on the application of TR Band hemostat in trans-radial coronary intervention patients were collected through the databases such as the Cochrane Library,OVID,PubMed,CBM,VIP and Wanfang Data.The quality of studies was critically appraised and data were extracted by two reviewers independently,and Meta-analysis was conducted for the included studies.Results Five RCTs involving 5 028 patients were included.Meta-analysis showed that the application of TR Band hemostat in trans-radial coronary intervention patients could shorten the time of hemostasis by compression,reduce the incidence rate of skin lesions,improve the postoperative patients with comfort,but the efficacy was not significant in puncture site bleeding,hematoma and incidence of radial artery occlusion (RAO).Conclusions The application of TR Band hemostat in trans-radial coronary intervention patients can significantly decrease the incidence of oppression hemostasis time and reduce the incidence rate of skin lesions,improve the postoperative patients with comfort.It is worth being popularized.

Objective To explore the effect of atorvastatin on high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in unstable angina pectoris (UAP) patients after intervention.Methods Eighty cases with UAP who underwent percutaneous coronary intervention (PCI) were divided into group A and group B by random digits table method with 40 cases each after PCI.The patients in group A were given regular heart treatment and atorvastatin 20 mg treatment.The patients in group B were given regular heart treatment and atorvastatin 40 mg treatment.The serum hs-CRP and IL-6 was determined before treatment and 24 h,3 weeks after treatment and compared between two groups.Results There was no significant difference in the serum hs-CRP and IL-6 before treatment between group A and group B [(5.6 ± 1.2) mg/L vs.(5.6 ± 1.1) mg/L and (211.9 ± 21.2) ng/L vs.(209.6 ± 19.9) ng/L,P ＞ 0.05].The serum hs-CRP and IL-6 24 h after treatment in group A and group B were increased compared with that before treatment,and there was significant difference(P ＜ 0.05),but there was no significant difference between group A and group B[(8.1 ± 1.1) mg/L vs.(8.5 ± 1.2) mg/L and (311.1 ± 20.9) ng/L vs.(313.3 ± 18.5) ng/L,P＞ 0.05].The serum hs-CRP and IL-6 3 weeks after treatment in group A and group B were decreased compared with that before treatment,there were significant difference (P ＜ 0.05),and there were significant difference between group A and group B [(3.1 ± 1.1) mg/L vs.(1.9 ±0.8) mg/L and (163.3± 18.5) ng/L vs.(123.3± 19.5)ng/L,P ＜ 0.05].No obvious adverse reaction was observed in two groups after treatment and liver function was not seen obvious anomaly.Conclusions Atorvastatin treatment in UAP patients after PCI can significantly reduce the serum hs-CRP and IL-6,and the 40 mg treatment is better than the 20 mg treatment.It is worth of clinical application.