Objective To investigate the correlation between serum basic helix-loop-helix transcription fac-tor family member E40(BHLHE40)levels and subclinical atherosclerosis(SAS)in patients with type 2 dia-betes mellitus(T2DM).Methods A total of 145 T2DM patients admitted to the Department of General Prac-tice of Suzhou Municipal Hospital from January 2021 to January 2023 were selected as the study objects.Pa-tients were divided into SAS group(n=80)and non-SAS group(n=65)according to whether SAS occurred.Serum BHLHE40 level and clinical data of the two groups were compared.The correlation between serum BHLHE40 level and carotid intima media thickness(CIMT)was analyzed by Pearson correlation.The risk factors of SAS in T2DM patients were analyzed by multi-factor Logistic regression.The value of serum BHL-HE40 level in the diagnosis of SAS in T2DM patients was analyzed by receiver operating characteristic(ROC)curve.Results The age,duration of diabetes,low-density lipoprotein cholesterol(LDL-C),CIMT and serum BHLHE40 levels in SAS group were significantly higher than those in non-SAS group,with statistical differ-ence(P＜0.001).Correlation analysis showed that serum BHLHE40 level was positively correlated with CI-MT(r=0.671,P＜0.001).Multivariate Logistic regression analysis showed that duration of diabetes,age,CIMT,LDL-C and serum BHLHE40 level were all risk factors for SAS in T2DM patients(P＜0.05).ROC curve analysis indicated that the area under the curve(AUC)of serum BHLHE40 for the diagnosis of SAS in T2DM patients was 0.742,the sensitivity was 75.0％,and the specificity was 73.9％.Conclusion Serum BHLHE40 expression level is closely related to the occurrence of SAS in T2DM patients,and is of great diag-nostic value for the occurrence of SAS in T2DM patients.

Objective:To survey the post competency of general practitioners who completed residency training in Suzhou Municipal Hospital.Methods:A questionnaire survey on post competency of general practitioners was conducted from January to March 2022. General practitioners who completed standardized residential training in Suzhou Municipal Hospital from 2009 to 2021 were randomly selected for the survey. The self-designed questionnaire included the basic information and post competency in terms of clinical, public health, research and teaching abilities as well as medical ethics and humanism. A self-evaluation was also performed and the abilities were graded (A 86-100, B 70-85, C 55-69, D 0-54), and grade A was classified as excellent.Results:A total of 163 questionnaires were distributed and 157 valid ones were collected with a recovery rate of 96.3%. Among 157 respondents 62 (39.5%) were males. The participants mainly worked in urban community health service institutions (78 (49.7%)), and most of them worked as general practice (119 (75.8%)). For the self-assessment of clinical skills, the proportion of respondents with excellent abilities in history taking, basic drug use, diagnosis and treatment of common diseases, and chronic disease management was 58.8% (70/119), 57.1% (68/119), 54.6% (65/119) and 54.6% (65/119), respectively. The proportion of respondents with excellent abilities in evidence-based clinical decision making, physical examination, tests interpretation, referral services, family medical services, rehabilitation services, first aid, and psychological counseling and treatment was 43.7% (70/119), 42.9% (52/119), 38.7% (46/119), 37.8% (45/119), 33.6% (40/119), 22.7% (27/119), 21.0% (25/119), and 16.8% (20/119), respectively. For the self-assessment of basic public health service ability, the proportion of respondents with excellent abilities in health education, disease prevention and control, health management, health care for key and special groups, handling public health emergencies, management of infectious diseases, epidemiology-based community diagnosis and community health leadership was 38.7% (46/119), 33.6% (40/119), 33.6% (40/119), 26.1% (31/119), 25.2% (30/119), 2.7% (27/119), 22.7% (27/119), and 21.0% (25/119), respectively. For humanistic literacy, the proportion of respondents with excellent abilities in privacy protection, sense of responsibility for patients, understanding patients′ needs, effective communication and cooperation with patients was 82.4% (98/119), 73.9% (88/119), 61.3% (73/119), 55.5% (66/119) and 2.1% (62/119), respectively. For research and teaching, the proportion of respondents with excellence abilities in continuous learning and innovation, training and teaching and literature retrieval was 47.9% (57/119), 10.9% (13/119), 10.1% (12/119), respectively. In addition 56.3% (67/119) of respondents were interested in scientific research, 23.5% (28/119) had published articles as the first author or correspondence author, and only 6.7% (8/119) had scientific research projects in the last 5 years.Conclusion:The post competency of general practitioners who received standardized residency training in our hospital varies in different aspects, their abilities in basic public health service, scientific research and teaching are relatively low, which need to be strengthened.

Objective :To analyze correlation among fasting (FBL) and postprandial blood lipids (PBL) ,blood lipid fluctuation (absolute value of PBL‐FBL) and severity of coronary artery disease .Methods :Cross‐sectional study was performed among 264 patients undergoing coronary angiography (CAG) in our hospital .According to percutaneous coronary intervention (PCI) or not based on CAG results ,patients were divided into plaque group (n＝128) and PCI group (n＝136).Gensini score was used to assess severity of coronary artery disease .Blood lipid levels and its fluctu‐ation were compared between two groups .Correlation among blood lipid levels ,blood lipid fluctuation and severity of coronary artery disease were analyzed .Results :Compared with plaque group ,there were significant rise in per‐centages of men and smokers ,waist circumference ,levels of postprandial‐fasting (P‐F ) serum LDL‐C (ΔLDL‐C ) and P‐F plasma apolipoprotein B (ΔApoB ) , and significant reduction in plasma level of P‐F apolipoprotein A1 (ΔApoA1) in PCI group , P＜0. 05 or ＜ 0. 01. Pearson correlation analysis indicated that serum fasting and post‐prandial HDL‐C levels ,plasma fasting and postprandial levels of ApoA1 and ΔApoA1 were significant inversely cor‐related with Gensini score ( r＝ －0. 130～ －0.218 , P＜0. 05 or ＜0. 01) ,and levels of plasma fasting lipoprotein a (Lp (a)) ,serum fasting and postprandial levels of free fatty acid (FFA) ,serum P‐F FFA (Δ FFA) were significant positively correlated with Gensini score ( r＝0. 139－0. 176 , P＜0.05 or ＜0.01).Multifactor linear regression anal‐ysis indicated that postprandial serum HDL‐C was protective factor for Gensini score (B＝ －22.274 , P＝0.002 ) , while postprandial serum FFA ,Δ FFA ,waist circumference and hyperlipidemia history were its influencing factors (B＝0. 388～24. 135 , P＜0. 05 or ＜0.01).Conclusion :Measurements of fasting and postprandial blood lipid levels and their fluctuation contribute to more comprehensively and objectively assessing blood lipid levels and severity of coronary disease in patients with coronary artery disease .

Objective To investigate the transient hemodynamic changes during balloon deflation in coronary interventional operation, so as to explore the potential influence of balloon deflation on the occurrence of post-operative no-reflow. Methods An in vitro experimental apparatus was built, in which a high-speed camera was used to take snapshots of balloon deformation and flow field (marked by dyed water) during balloon deflation. Subsequently, image processing techniques were employed to derive the parameters of balloon deformation and estimate the flow velocity downstream from the balloon. A computer model of the experimental apparatus was constructed, with the incorporation of the measured balloon deformation data, to simulate the balloon deflation process under various perfusion pressure and fluid conditions. Results The balloon exhibited a highly nonlinear deformation behavior during deflation. The measured and simulated flow velocities downstream from the balloon were in reasonable agreement, both manifesting a monotonic increase with post-deflation time and perfusion pressure. Numerical simulations further revealed that when the flow velocity downstream from the balloon approached the physiological value of blood flow velocity in the coronary artery, the flow velocity in the balloon-vessel gap and wall shear stress (WSS) reached up to 8-10 times and 60-70 times of their physiological values, respectively. Conclusions Balloon deflation led to a sharp acceleration of flow in balloon-vessel gap and a concomitant abnormal rise in WSS, which might promote the stripping of plaque or thrombus flakes. In view of the fact that the balloon deflation-induced rise in WSS was augmented by the increase in perfusion pressure, taking strategies such as lowering pre-operative blood pressure or implementing balloon deflation during diastole in coronary interventional operation might help to reduce the risk of no-reflow.

Although oxymatrine (OMT) has been shown to directly inhibit the replication of hepatitis B virus (HBV), limited research has been done with this drug. In the present study, the antiviral effect of OMT was investigated in an immunocompetent mouse model of chronic HBV infection. The infection was achieved by tail vein injection of a large volume of DNA solution. OMT (2.2, 6.7 and 20 mg/kg) was administered by daily intraperitoneal injection for 6 weeks. The efficacy of OMT was evaluated by the levels of HBV DNA, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and hepatitis B core antigen (HBcAg). The immunoregulatory activity of OMT was evaluated by serum ELISA and flow cytometry. Results shows that OMT at 20 mg/kg inhibited HBV replication, and it was more efficient than entecavir (ETV) in the elimination of serum HBsAg and intrahepatic HBcAg. In addition, OMT accelerated the production of interferon-(IFN-) in a dose-dependent manner in CD4T cells. Our findings demonstrate the beneficial effects of OMT on the enhancement of immunological function and in the control of HBV antigens. The findings suggest this drug to be a good antiviral therapeutic candidate for the treatment of HBV infection.

Objective:To explore predictive value of arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) for early atherosclerosis (AS) in middle-aged population.Methods:A total of 138 middle-aged patients hospitalized in our hospital from May 2016 to Nov 2016 were enrolled.According to coronary angiography (CAG) outcomes, they were divided into AS group (n=86) and non-AS group (n=52).Before CAG, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected in two groups.General data and arterial stiffness indexes were compared between two groups, and the correlation among AVI, API, baPWV and general data were analyzed.Results:Compared with non-AS group, there were significant rise in AVI [(20.4±4.2) vs.(22.8±5.3)] and baPWV [(14.0±2.5) m/s vs.(16.3±3.0) m/s] in AS group,P<0.01 both.AVI was significant positively correlated with age, SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP), API and baPWV (r=0.219~0.471, P<0.05 or <0.01);API was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, brain natriuretic peptide (BNP), AVI and baPWV (r=0.213~0.726, P<0.05 or <0.01);baPWV was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, AVI and API (r=0.201~0.472, P<0.05 or <0.01).Multi-factor linear regression analysis indicated that SBP was influencing factor for AVI (B=0.162,P=0.001), SBP, DBP and HDL-C were influencing factors for API (B=-0.166~2.146,P<0.05 or <0.01), SBP and HDL-C were influencing factors for baPWV (B=0.116,-3.009,P<0.01 both).Conclusion:Both elevated AVI and baPWV can predict atherosclerosis in middle-aged population

Objective To study the possible influencing factors in the formation of coronary collateral circulation in patients with chronic total occlusion (CTO). Methods Patients were enrolled having at least 1 major coronary artery angiography revealed as CTO of 144 patients. According to the Rentrop classification, patients with grade 0 and grade 1 filling were catogorized as insufficient collateral circulation group (n=72) and patients with grade 2 and grade 3 filling as collateral circulation group (n=72). Serum biomarkers and insulin-resistance by HOMA model were also studied in all patients. Results In the insufficient collateral circulation, BMI,TC,ApoB, lipoprotein a, fasting insulin HOMA-IR,HOMA- beta, CRP was significantly higher than the well collateral circulation group and ApoA-Ⅰ, ISI lower than the well collateral group ( all P ﹤0. 05 ) . Bivariate correlation alaysis showed. Rentrop score, BMI, TC, ApoB, lipoprotein a, fasting insulin, HOMA-IR,HOMA- beta and CRP are positively correlated to the formation of collateral circulation ( P ﹤ 0. 05 ); ApoA-Ⅰ and ISI were negatively correlated ( P ﹤0. 05 ) . Logistic regression analysis after calibration with weight, ApoA-Ⅰ and HOMA-beta factors, lipoprotein a ( OR 7. 575,P=0. 009), TC (OR 2. 154,P =0. 001) were found to be the independent factors of coronary collateral circulation formation. Conclusions TC, lipoprotein a, obesity, CRP, and HOMA-IR are correlated with the formation of coronary collateral circulation and may predict formation of collateral circulation in patients with CTO.

Objective:To explore the relationship between arterial plasma levels of von Willebrand factor (vWF) and cardiovascular events in patients with stable coronary heart disease (CHD) .Methods :A total of 88 stable CHD pa‐tients from Aug 2007 to Dec 2008 , were enrolled ,their clinical ,coronary angiography (CAG) and percutaneous coronary intervention (PCI) data were collected .Enzyme linked immunosorbent assay was used to measure arterial (aortic root) plasma vWF level before PCI .Except two lost cases ,according to baseline vWF level ,other patients were divided into high vWF level group (vWF≥13.5 ng/ml ,n=43) and low vWF level group (vWF <13.5 ng/ml , n=43) .Incidence rate of major adverse cardiovascular events (MACE) ,including mortality rate ,non-fatal acute myocardial infarction (AMI) , CAG+PCI etc .after six years were followed up .Results:After a mean 74.7 months follow-up ,there were no significant difference in mortality rate (9% vs . 9% ) ,person‐time of non‐fatal AMI (12% vs .7% ) ,arrhythmia (9% vs .16% ) ,CAG+ PCI (53% vs .67% ) ,heart failure (30% vs .23% ) ,cere‐brovascular incident (14% vs .26% ) between low vWF level group and high vWF level group ,P>0.05 all .Conclu‐sion:In patients with stable coronary heart disease ,level of von Willebrand factor is not significantly related to long-term cardiovascular events .

Objective:To explore therapeutic effect and prognosis of thrombus suction in patients with acute ST seg-ment elevation myocardial infarction (STEMI)during percutaneous coronary intervention (PCI).Methods:A total of 105 STEMI patients were enrolled and divided into thrombus suction + PCI group (n=34,received thrombus suction + PCI therapy)and routine PCI group (n=71,received routine PCI treatment).Postoperative TIMI flow, cardiac function during hospitalization,incidence of major adverse cardiovascular events (MACE)and rehospitaliza-tion within one-year follow-up after PCI were compared between two groups.Results:Compared with routine PCI group,there were significant reductions in peak values of creatine kinase isoenzyme [CK-MB,(236.62± 133.00) ng/ml vs.(186.47±69.20)ng/ml]and creatine kinase [CK,(2833.39± 198.70)ng/ml vs.(2129.59± 199.40) ng/ml],peak time of CK-MB [(12.38±6.70)h vs.(9.65±3.90)h]and CK [(12.80±8.10)h vs.(9.68± 3.50)h]after blood flow recovery,P < 0.05 all in thrombus suction + PCI group;there were downtrend of MACE (19.7% vs.8.8%)and rehospitalization rate (66.2% vs.50.0%)in thrombus suction + PCI group,but no significant difference between routine PCI group and thrombus suction + PCI group during one-year follow-up,P >0.05. Conclusion:Thrombus suction is help for improving patients condition,reducing enzymology level may be effect improving prognosis.

Objective:To explore the clinic and coronary disease lesion features in patients with acute coronary syn-drome (ACS) ≥ 75 years old and the outcomes of one-year follow up after percutaneous coronary intervention (PCI) .Methods :A total of 355 ACS patients ,who hospitalized in our hospital from Jan 2012 to Dec 2012 and re-ceived PCI ,were divided into ≥75 years group (n=205) and <75 years group (n=150) .Clinical and coronary dis-ease lesion characteristics and results of one-year follow up after PCI were compared between two groups .Results:Compared with < 75 years group , there were significant rise in incidence rates of hypertension (66.83% vs . 78.67% ) ,diabetes mellitus (28.29% vs .39.33% ) ,arrhythmia (17.07% vs .44.00% ) ,and percentage of type C lesions in coronary angiography (41.95% vs .56.00% ) in ≥75 years group , P<0.05~ <0.01 .There were no sig-nificant difference in incidence rates of adverse events during one-year follow up between two groups ( P>0.05 ) . Conclusion :Higher incidence rates of clinical complications and complex lesions are found in ≥75 years patients with acute coronary syndrome ;but no significant difference is found in one-year prognosis between the two groups .