Free fatty acids, as important energy metabolism substrates for the heart, play an important role in various cardiovascular diseases; ω-3 PUFA, as an important branch of free fatty acids, has been confirmed by more and more researches to be closely related to cardiovascular diseases. Heart failure, as a common cardiovascular problem, seriously affects people's quality of life. Studies have shown that ω-3 PUFA plays a significant role in the development of heart failure. In this paper, we try to review the metabolism, pathogenesis and therapeutic significance of ω-3 PUFA in heart failure.

Objective:To explore the predictive value of Epinephrine (EPI) level for Major adverse cardiovascular events (MACE) in patients with ST segment elevation myocardial infarction (STEMI) after emergency Percutaneous coronary intervention (PCI).Methods:A total of 107 patients with STEMI after emergency PCI in Northern Jiangsu People's Hospital of Jiangsu Province from September 2020 to November 2021 were selected. Baseline data, biochemical test data and coronary angiography data were collected. EPI level was measured by enzyme-linked immunosorbent assay. The following analysis was planned: ① Patients were divided into MACE group and non-MACE group, and various indicators of the two groups were compared; ② According to Receiver operating characteristic curve (ROC), the best cut-off values of EPI level which predict the occurrence of MACE were calculated respectively. Patients were respectively divided into high EPI level group and low EPI level group according to the best cut-off values, and the occurrence of MACE between the groups was compared respectively.③ Survival analysis (Kaplan-Meier method and log-rank test) was used to investigate the relationship between EPI level and MACE in patients with STEMI after emergency PCI. ④COX proportional hazard regression model was used to investigate the risk factors for MACE in patients with STEMI after emergency PCI.Results:①According to the inclusion and exclusion criteria, 107 patients with STEMI after emergency PCI were selected for the study, of which 19 patients had MACE and 88 patients did not have MACE. Compared with the non-MACE group, the patients in the MACE group were older, the proportion of Killip Ⅱ and above, NT-proBNP and EPI were higher, while FT3 was lower, and the differences were statistically significant ( P<0.05). The Gensini score of MACE group was significantly higher than that of non-MACE group ( P<0.01). ② According to ROC analysis, the Area under the curve (AUC) of EPI level for predicting MACE in patients with STEMI after emergency PCI was 0.699 (95% CI: 0.579-0.819, P=0.007), the best cut-off value of EPI level was 528.54, the sensitivity was 78.9%, and the specificity was 56.8%. The incidence of MACE in the high EPI level group was significantly higher than that in the low EPI group ( P=0.005).③ Kaplan-Meier survival curve showed that the higher the EPI level value, the higher the risk of MACE (log-rank test P=0.004). ④Multivariate COX regression analysis showed that age ( P=0.042), FT3 ( P<0.001), EPI level ( P<0.001) and Gensini score ( P=0.004) were independent risk factors for MACE. Conclusions:①EPI level significantly correlates with the occurrence of MACE in patients with STEMI after emergency PCI. EPI level has predictive value for MACE in patients with STEMI after emergency PCI. The higher the EPI value, the higher the risk of MACE. ②Multivariate COX regression analysis show that EPI level is independent risk factor for MACE in patients with STEMI after emergency PCI.

Osteonecrosis of the femoral head (ONFH) is one of the common and difficult-to-treat orthopedic diseases caused by a variety of factors that lead to abnormal blood flow to the femoral head, which in turn leads to deformation and collapse of the femoral head and eventually results in severe hip joint dysfunction. The key to the treatment is early diagnosis and correct treatment according to the stage classification and active prevention of further aggravation of ONFH aiming to delay or avoid hip replacement surgery in young and middle-aged patients. At present, there are various non-surgical and surgical hip-preserving modalities for early ONFH, designed to slow down the progression of the disease, prevent the femoral head from collapsing and stop the mild collapse. In recent years, with the emergence and development of bone reconstruction biomaterials, artificial bone reconstruction after scraping of ONFH lesions has shown great potential in the treatment of early ONFH. The authors review the research progress in hip-preserving modalities for early ONFH in young and middle-aged patients from non-surgical and surgical perspectives, hoping to provide a reference for clinical treatment of early ONFH.

Objective To investigate the distribution differences of cytochrome P4502C19(CYP2C19)gene polymorphisms and its impact on antiplatelet therapy in patients with coronary arter-y disease undergoing percutaneous coronary intervention(PCI)in Yangzhou region.Methods A to-tal of 215 patients diagnosed with coronary heart disease who underwent PCI from January 2021 to De-cember 2022 in Yangzhou region were retrospectively selected as study objects.The age of the pa-tients ranged from 37 to 93 years,with 152 males and 63 females.Polymerase chain reaction-sequen-cing was used to detect the CYP2C19 genotypes in the patients.The relationships of gender and age with distribution of CYP2C19 gene polymorphism were observed.Based on the metabolic types of CYP2C19 and the antiplatelet drugs used post-operatively,the patients were divided into fast-metabo-lizing clopidogrel group,medium-slow metabolizing clopidogrel group,fast-metabolizing ticagrelor group,medium-slow metabolizing ticagrelor group.After 6 months of follow-up,the incidence rates and severity of adverse events of cardiovascular ischemia and bleeding were compared among groups.Results The CYP2C19 genotypes of 215 patients were distributed as follows:81 cases of CYP2C19*1/*1 genotype,93 cases of CYP2C19*1/*2,10 cases of CYP2C19*1/*3,25 cases of CYP2C19*2/*2,6 cases of CYP2C19*2/*3.CYP2C19 metabolite types were fast metabolizers in 81 cases(37.67％),intermediate metabolizers in 103 cases(47.91％)and slow metabolizers in 31 cases(14.42％).The proportion of extensive metabolizers of CYP2C19 in the study patients was 37.67％,intermediate metabolizers accounted for 47.91％,and poor metabolizers accounted for 14.42％.There was no significant difference in the distribution of CYP2C19 genotype between different genders(x2=0.346,P=0.987).There was no significant difference in the distribution of metabolic type between different genders(x2=0.342,P=0.843).There was no significant differ-ence in the distribution frequency of metabolic type among different age groups(x2=1.098,P=0.895).The incidence of cardiovascular ischemia of adverse events in the fast-metabolizing clopi-dogrel group and the fast-metabolizing ticagrelor group was 16.67％and 14.29％,respectively,no significant difference was observed(P＞0.05).The incidence of cardiovascular ischemia of adverse events in the medium-slow metabolized clopidogrel group was higher than that in the medium-slow metabolized ticagrelor group,and the difference was statistically significant(P＜0.05).There was no significant between-group difference in the incidence of bleeding of adverse events among groups(P＞0.05).Conclusion In patients undergoing PCI for coronary heart disease in Yangzhou re-gion,there is a polymorphism in the CYP2C19 gene with no significant differences between genders and age groups.The intermediate and fast metabolizers are more prevalent.It is clinically significant to perform CYP2C19 gene testing and adopt precise antiplatelet therapy for such patients.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective To investigate the distribution differences of cytochrome P4502C19(CYP2C19)gene polymorphisms and its impact on antiplatelet therapy in patients with coronary arter-y disease undergoing percutaneous coronary intervention(PCI)in Yangzhou region.Methods A to-tal of 215 patients diagnosed with coronary heart disease who underwent PCI from January 2021 to De-cember 2022 in Yangzhou region were retrospectively selected as study objects.The age of the pa-tients ranged from 37 to 93 years,with 152 males and 63 females.Polymerase chain reaction-sequen-cing was used to detect the CYP2C19 genotypes in the patients.The relationships of gender and age with distribution of CYP2C19 gene polymorphism were observed.Based on the metabolic types of CYP2C19 and the antiplatelet drugs used post-operatively,the patients were divided into fast-metabo-lizing clopidogrel group,medium-slow metabolizing clopidogrel group,fast-metabolizing ticagrelor group,medium-slow metabolizing ticagrelor group.After 6 months of follow-up,the incidence rates and severity of adverse events of cardiovascular ischemia and bleeding were compared among groups.Results The CYP2C19 genotypes of 215 patients were distributed as follows:81 cases of CYP2C19*1/*1 genotype,93 cases of CYP2C19*1/*2,10 cases of CYP2C19*1/*3,25 cases of CYP2C19*2/*2,6 cases of CYP2C19*2/*3.CYP2C19 metabolite types were fast metabolizers in 81 cases(37.67％),intermediate metabolizers in 103 cases(47.91％)and slow metabolizers in 31 cases(14.42％).The proportion of extensive metabolizers of CYP2C19 in the study patients was 37.67％,intermediate metabolizers accounted for 47.91％,and poor metabolizers accounted for 14.42％.There was no significant difference in the distribution of CYP2C19 genotype between different genders(x2=0.346,P=0.987).There was no significant difference in the distribution of metabolic type between different genders(x2=0.342,P=0.843).There was no significant differ-ence in the distribution frequency of metabolic type among different age groups(x2=1.098,P=0.895).The incidence of cardiovascular ischemia of adverse events in the fast-metabolizing clopi-dogrel group and the fast-metabolizing ticagrelor group was 16.67％and 14.29％,respectively,no significant difference was observed(P＞0.05).The incidence of cardiovascular ischemia of adverse events in the medium-slow metabolized clopidogrel group was higher than that in the medium-slow metabolized ticagrelor group,and the difference was statistically significant(P＜0.05).There was no significant between-group difference in the incidence of bleeding of adverse events among groups(P＞0.05).Conclusion In patients undergoing PCI for coronary heart disease in Yangzhou re-gion,there is a polymorphism in the CYP2C19 gene with no significant differences between genders and age groups.The intermediate and fast metabolizers are more prevalent.It is clinically significant to perform CYP2C19 gene testing and adopt precise antiplatelet therapy for such patients.

Trollius chinensis has a wide range of pharmacological effects ，including anti-oxidative ，antibacterial，antiviral， anti-inflammatory，anti-tumor，anti-aging，antipyretic and analgesic effects ，relieving cough and removing phlegm ，viscera protection，and so on. Flavonoids and phenolic acids are the main medicinal components of it ，especially three monomers have a wide range of efficacy and have been studied more ，such as orientin ，vitexin and 2″-O-galactopyranosyl orientin. T. chinensis is mostly used in clinical practice in the form of Chinese patent medicines ，such as Jinlianhua granules ，Jinlianhua capsules ， Jinlianhua tablets and Jinlianhua oral liquid. These medicines are used to treatment of upper respiratory tract infection ，pharyngitis， tonsillitis，periodontitis，mumps，oral ulcer ，and hand-foot-mouth disease. They are usually used by combining with Western medicine. Due to its definite curative effect and less adverse drug reactions ，T. chinensis related preparations are more suitable for pediatric population ，and they can be used for the treatment of upper respiratory tract infection in children ，acute suppurative tonsillitis in children ，epidemic mumps in children ，hand-foot-mouth disease in children ，which is also one of its drug characteristics. This paper review the relevant literatures in recent 20 years from the respective of pharmacological effects and clinical applicationin order to provide reference for further promoting rational clinical application of T. chinensis and new drug research and development.

Anomalous aortic origin of a coronary artery is a rare abnormal coronary artery development disease, which affects myocardial blood perfusion in the absence of significant coronary artery stenosis. Such patients have a high risk of sudden death, and their disease progresses rapidly, and their clinical manifestations are easily confused with myocardial diseases. We report a case of a 13-year-old young patient whose diagnosis was confirmed, the condition was stabilized at an early stage, and the abnormal coronary structure was corrected by coronary decapitation through a multidisciplinary combination of cardiology, cardiac surgery, ICU, and imaging. This article focuses on the diagnosis and treatment of these patients.

Objective:To investigate the efficacy of single locked-plate internal fixation combined with autologous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femural fracture (PDFF) after total knee arthroplasty (TKA).Methods:A retrospective case series study was made on 13 patients suffering from Rorabeck type II PDFF after primary TKA together with severe osteoporosis (T value≤ -2.5 SD) admitted to 940th Hospital of Joint Logistics Support Force of PLA from January 2016 to December 2020, including 4 males and 9 females, aged 65-85 years [(75.2±6.5)years]. All patients were treated with single locked-plate internal fixation combined with autologous iliac bone graft. Anti-osteoporosis and early standardized joint function rehabilitation were undertaken postoperatively. The operation time and intraoperative blood loss were recorded. The range of motion of knee joint was compared before operation, at postoperative 3, 6 and 12 months and at the last follow-up. The Hospital for Special Surgery (HSS) knee score was assessed at postoperative 3, 6 and 12 months and at the last follow-up to evaluate the recovery of knee joint function. The bone mineral density was reexamined at postoperative 6 months and 12 months to evaluate the therapeutic effect of anti-osteoporosis. Complications were detected as well.Results:All patients were followed up for 12-72 months [(43.2±19.9)months]. The operation time was 90-135 minutes [(103.8±12.6)minutes], with the intraoperative blood loss of 100-250 ml [(150.0±45.6)ml]. The range of motion of knee joint was (114.6±7.8)°, (90.4±8.0)°, (97.3±4.8)° and (98.1±6.3)° before operation and at postoperative 3, 6 and 12 months (all P<0.05). The HSS knee score was (80.2±2.2)points, (84.6±2.9)points and (87.3±3.3)points at postoperative 3, 6 and 12 months (all P<0.05). The knee joint function was excellent in 10 patients and good in 3 at postoperative12 months, and the excellent and good rate was 100%. The T value of bone mineral density was (-3.8±0.6)SD, (-3.4±0.6)SD and (-2.9±0.6)SD preoperatively and at postoperative 6 months and 12 months (all P<0.05). One patient experienced nonunion and was cured after secondary autologous iliac bone grafting combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) bone grafting. Three patients developed venous thrombosis of lower limbs and were cured with oral administration of rivaroxaban. One patient had mild knee flexion and extension limitation and was improved after manual release under femoral nerve block anesthesia and subsequent functional rehabilitation. Conclusion:For patients with Rorabeck type II PDFF after TKA, single locked-plate internal fixation combined with autologous iliac bone graft has advantages of short operation time, few intraoperative bleeding, satisfactory knee range of motion and functional recovery as well as significant improvement of bone mineral density.

AIM: To observe the clinical efficacy of antiplatelet therapy with ticagrelor monotherapy after short-term double antibody therapy in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). METHODS: A total of 172 patients with ACS who had undergone PCI from October 2018 to April 2022 in our hospital and Subei People's Hospital of Jiangsu Province were selected and divided into three groups according to the patients' medication status: 50 patients in group A (tegretol alone group); 62 patients in group B (aspirin enteric coated tablets + tegretol group); and 60 patients in group C (aspirin enteric coated tablets + clopidogrel hydrogen sulfate group). The patients were observed for postoperative recurrent angina pectoris, in-stent restenosis, revascularization, heart failure, and bleeding. RESULTS: There were no significant differences in postoperative recurrent angina, in-stent restenosis, re-hematologic reconstruction, heart failure, and bleeding between the 3 groups. CONCLUSION: There is no increase in ischemic events, heart failure in patients treated with tegretol antiplatelet therapy alone after a short course of dual antibiotics after PCI and it reduces risk of bleeding.