Objective To explore the clinical efficacy of urokinase arterial thrombolysis combined with tirofiban sequential therapy in acute cerebral infarction with digital subtraction angiography(DS A)negative.Methods The clinical data of 82 acute cerebral infarction patients with DSA negative were collected.All patients were divided into the control group(n=41)and the observation group(n=41).The control group received routine treatment such as arterial thrombolysis and dual antiplatelet.The observation group was treated with arterial thrombolysis and intravenous tirofiban treatment for 36 h,and subsequent treatment was the same as the control group.The National Institutes of Health Stroke Scale(NIHSS)scores were analyzed at different time points including before,during,and after interven-tion.The modified Rankin scale(mRS)scores and changes in coagulation function were compared before and 90 d after intervention,and the incidence of complications of all patients were recorded.The differences of all indicators were analyzed.Results The NIHSS scores during and 30 d after intervention in the control group and at various time points during and after intervention in the observa-tion group were lower than those before intervention(P＜0.05).The NIHSS score of the observation group at various time point after intervention was significantly lower than those of the control group(P＜0.05).The clinical effective rate of the observation group 30 d after intervenion was significantly higher than those of the control group(92.68％vs 78.05％).The mRS scores of the two groups 90 d after intervention were significantly lower than those before intervention,and the observation group was significantly lower than the control group(P＜0.05).There were significant differences in prothrombin time(PT),thrombin time(TT),and fibrinogen(FIB)between the two groups 3 d after intervention compared to before intervention(P＜0.05).There was no difference in FIB and PT 7 d after intervention between the two groups(P＞0.05),while TT of the observation group was significantly higher than that of the control group(P=0.038).There was no significant difference in the incidence of complications between the two groups(P=0.073).Conclusion Urokinase arterial thrombolysis combined with tirofiban can effectively improve the neurological function and prognosis of acute cerebral infarction patients with DSA negative,shorten the recovery time,with good clinical safety.

Objective:To analyze the occurrence of malignant ventricular arrhythmias(VA)in elderly heart failure patients with reduced ejection fraction(HFrEF)and its influence on the prognosis.Methods:A total of 1 171 elderly patients with heart failure were included in this study.These patients were admitted to the First People's Hospital of Shangqiu from January 2017 to June 2020.They were divided into three groups: VA group(85 cases), HFrEF group(340 cases), and heart failure with normal left ventricular ejection fracture(LVEF)group(340 cases).The division was based on the propensity score matching(PSM)method with a 1∶4∶4 ratio.The main outcome measure was major adverse cardiovascular events(MACE)in the three groups, which were followed up for 2 years.Results:After PSM, the N-terminal pro-brain natriuretic peptide(NT-proBNP), left ventricular end diastolic diameter(LVEDD), and left ventricular end systolic diameter(LVESD)of the LVEF normal group were significantly lower than those of the HFrEF group and VA group, while LVEF was significantly higher( P<0.05 for all).During a median follow-up of 22(17-25)months, a total of 219 cases(28.6%)of MACE occurred, including 30 cardiac deaths, 133 readmissions with worsening heart failure, and 56 cases of acute coronary syndrome.Kaplan-Meier survival analysis revealed that the VA group had a significantly higher overall risk of MACE compared to the normal LVEF control group and LVEF reduced control group( χ2=6.213, P=0.012).Among the three groups, the VA group exhibited the highest risk of cardiogenic death and worsening heart failure readmission, surpassing the normal LVEF group and HFrEF group( χ2=4.143, 16.861, both P<0.05).The results of the multivariate Logistic regression analysis revealed that a history of VA( OR=1.317, 95% CI: 1.109-1.564, P=0.002), NT-proBNP( OR=2.138, 95% CI: 1.235-3.701, P=0.007), and LVEDD( OR=2.413, 95% CI: 1.134-5.135, P=0.022)were found to be associated with an increased risk of VA during hospitalization.Additionally, the multivariate Cox regression analysis indicated that age >68 years( HR=1.723, 95% CI: 1.134-2.618, P=0.011), new VA occurrence( HR=2.346, 95% CI: 1.268-4.341, P=0.007), diabetes( HR=2.008, 95% CI: 1.135-3.553, P=0.017), NT-proBNP>1 957.3 ng/L( HR=2.734, 95% CI: 1.368-5.464, P=0.004), LVEF<35.0%( HR=2.265, 95% CI: 1.206-4.254, P=0.011), implantable cardioverter defibrillators( HR=0.887, 95% CI: 0.789-0.997, P=0.045), and sodium glucose co transporter 2(SGLT2)inhibitors usage( HR=0.904, 95% CI: 0.833-0.981, P=0.016)were identified as factors related to MACE. Conclusions:Patients diagnosed with VA have a significantly increased risk of MACE during the follow-up period.Several factors, including age, new VA occurrence, diabetes, NT-proBNP levels, LVEF, implantable cardioverter defibrillators, and SGLT2 inhibitor usage, have been found to be associated with the risk of MACE during the follow-up.

Objective To investigate the effect of miR-22-3p on pyroptosis of vascular smooth muscle cells(VSMCs)induced by homocysteine(Hcy).Methods Human VSMCs were cultured in vitro and divided into a Control group(0 μmol/L Hey)and a Hey group(100 μmol/L Hey).After intervention,expression levels of pro Caspase-1,gasdermin D(GSDMD),N-GSDMD,and NLR family pyrin domain containing 3(NLRP3)were detected by Western blot.MiR-22-3p expression was determined by quantitative real-time reverse-transcription polymerase chain reaction.Interleukin(IL)-1 β and IL-18 levels in the supernatant were measured by enzyme-linked immunosorbent assay.Cells were also transfected with control miR-22-3p(miR-22-3p-NC),miR-22-3p-mimic,and miR-22-3p-inhibitor,to observe the effects on VSMC pyroptosis induced by Hcy.Results Expression levels of pro Caspase-1,GSDMD,N-GSDMD,and NLRP3 in VSMCs were increased(P＜0.05),IL-1 β and IL-18 levels were increased(P＜0.01),and the relative expression level of miR-22-3p was reduced(P＜0.01)in the Hcy group compared with the Control group.Transfection with miR-22-3p-mimic significantly decreased the expression levels of pro Caspase-1,GSDMD,N-GSDMD,and NLRP3 in VSMCs(P＜0.01),and significantly decreased levels of IL-1β and IL-18(P＜0.01),while transfection with miR-22-3p-inhibitor significantly increased the expression levels of pro Caspase-1,GSDMD,N-GSDMD,and NLRP3 in VSMCs(P＜0.01)and significantly increased the levels of IL-1β and IL-18(P＜0.05).Conclusions MiR-22-3p may delay Hcy-induced VSMC pyroptosis.

Objective:To evaluate the relationship between sleep arousal, ambulatory blood pressure and new-onset heart failure(NOHF)in elderly patients with obstructive sleep apnea(OSA).Methods:A total of 584 elderly patients with OSA who were diagnosed and treated in our hospital between March 2015 and March 2019 were prospectively and consecutively selected, with a mean age of(70.1±7.2)years.Polysomnography(PSG)results were obtained at baseline, and the arousal index(AI)was calculated.Based on the quartiles of AI, patients were divided into 4 groups: a low-level group(AI<18.4/h, 186 cases), a low-medium level group(18.4-29.1/h, 177 cases), a medium-high level group(29.2-41.2/h, 137 cases)and a high-level group(>41.2 /h, 84 cases). Participants were followed up for 18 months, the results of ambulatory blood pressure were recorded and compared, and the relationship between AI and the risk of NOHF was analyzed.Results:Compared with the low-level group, patients in the low-medium, medium-high, and high-level groups were older(70.1, 70.3, 73.3 vs.68.7 years, F=2.726, P=0.043)and had more smokers(43.8%, 49.6%, 54.8% vs.38.2%, χ2=8.809, P=0.032), a larger body mass index(26.3, 26.7, 27.6 vs.25.4 kg/m 2, F=2.731, P=0.042), a higher Epworth sleepiness scale score(7.83, 8.50, 9.91 vs.7.64, F=5.124, P=0.018), a higher apnea hypopnea index(23.5, 34.8, 52.7 vs.17.6, F=5.632, P=0.007), lower nocturnal oxygen saturation(80.2, 75.3, 72.1 vs.83.7 mmHg, F=4.811, P=0.024), and higher N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels(317.5, 337.5, 359.2 vs.267.5 pg/L, F=4.307, P=0.033). At the median follow-up(18 months, 14-24 months), the results of ambulatory blood pressure monitoring showed that 24-hour systolic blood pressure(24 h SBP)(147.3, 148.6, 156.2 vs.143.8 mmHg, F=5.4311, P=0.013), 24-hour diastolic blood pressure(24 h DBP)(80.1, 79.5, 83.7 vs.76.5 mmHg, F=5.679, P=0.011)in the low-medium, medium-high and high-level groups were higher than those in the low-level group.The results of survival analysis showed that there were 75(12.8%)cases of NOHF, mostly with preserved ejection fraction(47 cases)or mid-range ejection fraction heart failure(20 cases). The incidences of NOHF were 6.5%, 12.4%, 16.1% and 22.4%, respectively for the low level, low-medium, medium-high and high-level groups, and the risk of NOHF in the low-medium, medium-high and high-level groups was significantly higher than in the low level group(log-rank χ2=11.624, P=0.007). Variables with P<0.2 in the univariate analysis, age and sex were included in the multivariate Cox regression analysis.The results showed that age( HR=1.724, 95% CI: 1.216-3.135), diabetes( HR=1.514, 95% CI: 1.127-3.058), NT proBNP( HR=1.517, 95% CI: 1.232-2.366), nocturnal diastolic blood pressure( HR=2.004, 95% CI: 1.332-4.638), and middle-high AI level( HR=1.611, 95% CI: 1.204-2.967)and high AI level( HR=1.863, 95% CI: 1.272-3.538)were independent factors of NOHF in elderly OSA patients. Conclusions:Sleep arousal in elderly patients with OSA increases blood pressure levels and the risk of NOHF.

Objective:To examine the clinical effect of early administration of Shakubatracvalsartan following early percutaneous coronary intervention(PCI)in patients diagnosed with acute myocardial infarction and acute heart failure.Methods:This study prospectively included 65 patients with acute myocardial infarction and acute heart failure who were admitted to the First People's Hospital of Shangqiu from June 2018 to October 2022.The patients were randomly divided into two groups: the control group(35 cases)and the observation group(30 cases).Both groups received early PCI treatment.After the operation, the control group received oral administration of Benazepril hydrochloride, while the observation group received oral administration of Shakubatracvalsartan for a duration of 8 weeks.The study compared the total treatment efficiency and cardiac function parameters, such as left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), and clear brain natriuretic peptide precursor(NT-proBNP)as well as myocardial injury markers(creatine kinase isoenzyme MB(CK-MB)and myoglobin(Myo))before and at 8 weeks of treatment between the two groups.Additionally, any adverse effects that occurred during the treatment period were also compared.Results:The total effective rate was 93.33%(28 cases)in the observation group and 71.43%(25 cases)in the control group.The observation group had a higher rate compared to the control group, and this difference was statistically significant( χ2=5.149, P<0.05).Both groups showed an increase in left ventricular ejection fraction, a decrease in left ventricular end-diastolic diameter, and a decrease in N-terminal pro-brain natriuretic peptide.In the observation group, the left ventricular ejection fraction was(48.52±3.28)%, which was higher than the control group's(43.86±2.52)%, and the left ventricular end-diastolic diameter was(46.70±2.88)mm and the N-terminal pro-brain natriuretic peptide was(680.44±87.04)pg/L, which were lower than the control group's(50.46±3.47)mm and(1 715.94±115.41)pg/L, respectively.These differences were statistically significant( t=13.434, 5.287, 5.330, P<0.05 for all).The levels of creatine kinase-MB and myoglobin in both groups were significantly lower after treatment.Specifically, the observation group had levels of(31.42±5.76)U/L and(34.42±5.36)mg/L, which were lower than the levels in the control group of(38.44±4.94)U/L and(43.15±7.46)mg/L.These differences were statistically significant( t=5.287, 5.330, P<0.05 for all).The readmission rate was 10.00%(3 cases)in the observation group and 14.29%(5 cases)in the control group.The readmission rate of the observation group was lower than that of the control group, and the difference was not statistically significant( χ2=0.021, P>0.05). Conclusions:The early administration of Shakubatracvalsartan following early PCI has been shown to effectively enhance cardiac function in patients with acute myocardial infarction and acute heart failure.It also facilitates the repair of myocardial cells and improves the therapeutic outcomes after surgery.

Objective:To assess the differences in multidimensional clinical manifestations between patients with irritable bowel syndrome (IBS) matching the Rome Ⅲ criteria but not matching Rome Ⅳ and IBS patients matching the Rome Ⅳ criteria, among patients diagnosed with IBS according to Rome Ⅲ criteria.Methods:From November 2016 to October 2017, a total of 472 IBS patients admitted to six hospitals were selected, which included Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (139 cases), Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University (95 cases), the First Affiliated Hospital of Dalian Medical University (96 cases), the Affiliated Hospital of Guizhou Medical University (90 cases), the People′s Hospital of Guangxi Zhuang Autonomous Region (20 cases), and the Second Affiliated Hospital of Xi′an Jiaotong University (32 cases). The 472 IBS patients were divided into the group that matching the Rome Ⅳ criteria (Rome Ⅳ group), and the group that matching the Rome Ⅲ criteria but not matching the Rome Ⅳ criteria (Rome Ⅲ group). The basic characteristics (IBS course, post-infectious IBS, history of smoking or drinking, etc.), abdominal symptoms, and defecation-related symptoms of two groups were compared and analyzed by face-to-face questionnaires. Multi-dimensional clinical manifestations assessment was completed by questionnaires, which included gastrointestinal symptom rating scale (GSRS), irritable bowel syndrome-severity scoring system (IBS-SSS), irritable bowel syndrome-quality of life (IBS-QOL), and hospital anxiety and depression scale (HADS). Independent sample t-test, rank sum test, and chi-square test were used for statistical analysis. Results:There were 344 patients (72.9%) in Rome Ⅳ group and 128 patients (27.1%) in Rome Ⅲ group. The IBS course of patients in Rome Ⅳ group was longer than that in Rome Ⅲ group (3.0 years (7.0 years) vs. 2.0 years (5.7 years)), and the difference was statistically significant ( Z=-2.73, P=0.006). The GSRS scores of loose stools and abdominal pain of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group, and the GSRS scores of increased exhaust and abdominal distension of IBS patients in Rome Ⅳ group were lower than those in Rome Ⅲ group (3.0(2.0) vs. 2.0(4.0), 3.0(2.0) vs.1.0(2.0), 1.5(3.0) vs. 2.0(3.0), 1.0 (3.0) vs. 2.0(3.0)), and the differences were statistically significant ( Z=-2.48, -9.90, -2.11 and -2.06, P=0.013, <0.001, =0.035 and =0.040). The proportions of fatigue and dizziness of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group (58.4% (201/344) vs. 43.0% (55/128), 30.8% (106/344) vs. 29.7% (38/128)), and the differences were statistically significant ( χ2=8.37 and 12.36, P=0.004 and <0.001). The scores of anxiety and depression subscales of the HADS of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group (6.5 (6.8) vs. 6.0 (6.0), 5.0 (6.0) vs. 3.0 (5.0)), and the differences were statistically significant ( Z=-2.58 and -2.40, P=0.010 and 0.017). The scores of IBS-SSS scale, abdominal pain severity, abdominal pain frequency, and impact on quality of life of IBS patients in Rome Ⅳ group were all higher than those in Rome Ⅲ group (249.5 (108.0) vs. 177.0 (111.8), 50.0 (25.0) vs. 20.0 (30.0), 50.0 (70.0) vs. 10.0 (30.0), 66.0 (42.0) vs. 42.5 (34.0)), and the differences were statistically significant ( Z=-7.79, -9.64, -10.65 and -2.48, P<0.001, <0.001, <0.001 and =0.013). The score of IBS-QOL for behavioral disorder of IBS patients in Rome Ⅳ group was lower than that in Rome Ⅲ group (74.5±21.6 vs. 79.2±17.7), and the difference was statistically significant ( t=-2.22, P=0.027). Conclusion:The clinical symptoms of patients mathching the Rome Ⅳ criteria are more typical and severe, as compared with those of IBS patients matching the Rome Ⅲ criteria but not matching the Rome Ⅳ criteria.

Objective To investigate any therapeutic effect of combining hyperbaric oxygen with mesenchymal stem cells (MSCs) in treating traumatic brain injury (TBI).Methods Eighty healthy adult rats were randomly divided into a control group,a hyperbaric oxygen group,a stem cell group and a combination group,each of 20.TBI was introduced into the rats of all 4 groups.Twenty-four hours after the modelling,the hyperbaric oxygen group received hyperbaric oxygen therapy,the stem cell group received MSCs transplantation,the combination group was given the hyperbaric oxygen therapy an hour after the MSCs transplantation,while the control group was not given any treatment.All of the rats were evaluated using neurological severity scores (NSSs) after the modeling and again after the treatment.They were then sacrificed for HE staining and the expression of nuclear factor kappa B (NF-kB) and brain-derived neurotrophic factor (BDNF) were observed.Results On the 3rd,5th,10th and 20th day after the modeling,the average NSS of the combination group was significantly lower than those of the other three groups.However,the average NSS of the combination group on the 20th day was significantly superior to that on the 3rd and the 5th days.Compared with the control group,the edema of brain cells was less severe in the other 3 groups.The average expression of NF-kB and BDNF in the combination group was significantly higher than in the other 3 groups on the 3rd,5th,10th and 20th day after the modeling.Conclusion Hyperbaric oxygen,especially long term treatment combined with stem cell transplantation,can significantly improve nerve function in the brain after trauma,relieve inflammation and edema in and around the damaged area,and promote the expression of the NF-kB and BDNF.

Objective To preliminarily discuss the effect of thrombectomy with the TREVO device in patients with acute ischemic stroke.Methods Six patients with acute ischemic stroke treated with TREVO device at the Department of Neurointervention,Beijing Fengtai You′anmen Hospital from April to June 2016 were analyzed retrospectively,including 2 patients with middle cerebral artery (MCA)occlusion (time window from 2. 7 to 5. 5 h),4 with basilar artery occlusion (time window from 4. 0 to 7. 0 h). The effect of thrombectomy was evaluated by the modified thrombolysis in cerebral infarction (mTICI ) scores. The National Institutes of Health Stroke Scale (NIHSS)scores were used to evaluate the neurological status of patients before and after treatment. The prognosis was evaluated by the modified Rankin scale. Results (1 )After 1 to 2 embolectomies,the occlusive arteries of 5 patients achieved recanalization (mTICI gradeⅡb-Ⅲ;posterior circulation in 4 cases,MCA in 1 case). (2)Compared with at admission,the NIHSS score in 1 of 2 patients with MCA occlusion was reduced by 8 points at discharge,and 1 was not any improvement;compared with at admission,the NIHSS scores in 3 of 4 patients with basilar artery occlusion were decreased by 8-26 points at discharge,and 1 was not any improvement;in 2 patients with MCA occlusion,the modified Rankin scale scores were 0 to 1 at 3 months after discharge (0 in 1 case,4 in 1 case);the Rankin scale scores in 4 patients with basilar artery occlusion at 3 months after discharge were 0 in 1 case,1 in 2 cases,and 5 in 1 case.Conclusion The preliminary experience of using TREVO device embolectomy for patients with acute ischemic stroke shows that it is more safe and effective.

Objective:To explore interleukin (IL)-8 and C reactive protein (CRP) levels change after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD) .Methods :A total of 90 CHD patients , who hospitalized in our hospital from Mar 2010 to Dec 2012 ,were selected .According to their therapeutic methods , they were divided into PCI group (n=70) and conservative treatment group (n=20) .Another 20 healthy people were regarded as healthy control group .Changes of IL-8 and C reactive protein (CRP ) concentrations before and within 20d after treatment were compared among three groups .Results :Compared with before treatment ,on 1d af-ter treatment ,there were significant reductions in levels of IL-8 [ (63.22 ± 13.10) pg/ml vs .(31.58 ± 9.10) pg/ml] and CRP [ (14.59 ± 6.13) mg/L vs .(9.61 ± 2.35) mg/L] in PCI group ,IL-8 was significantly lower than that of conservative treatment group [(50.18 ± 19.31) pg/ml] ,P<0.01 ;after 20d ,levels of IL-8 [(15.13 ± 5.22) pg/ml] and CRP [ (3.01 ± 0.76) mg/L] further declined in PCI group (P<0.05~ <0.01) ,and they were significantly lower than those of conservative treatment group [ (27.22 ± 14.69) pg/ml ,(5.46 ± 2.77) mg/L] , P<0.01 all , e-ven the IL-8 level of PCI group was not significant different from that of healthy control group [ (15.58 ± 4.10) pg/ml] , P>0.05. Conclusion:IL-8 and C reactive protein levels significantly reduce after PCI ,which can be treated as indexes evaluating PCI postoperative prognosis in CHD patients .

Objective Indocyanine green (ICG) video angiography is widely used in aneurysm surgery.This study is to evaluate and analyze the effect of intraoperatively aneurysms clipping by quantitative analysis of ICG video angiography.Methods Twenty patients with cerebral aneurysms (six with anterior communicating artery aneurysms,five with communicating artery aneurysms and nine with middle cerebral artery aneurysms),admitted to our hospital from September 2012 to September 2013,were chosen in our study; they all underwent aneurysms clipping involving ICG.Same areas of interest (AOIs,aneurysm area,parent artery area and branch artery area) of images intercepted from angiogram videos before and after clipping of aneurysms were analyzed by Image-pro plus.Results Dramatic differences in time to peak of blood flow of aneurysm areas were observed before and after clipping of aneurysms ([10.975±1.208] s vs.[47.950±2.350] s,t=57.299,P=0.000).There were no dramatic differences in times to peak of blood flow of parent and branch vessels before aneurysms clipping and after aneurysms clipping ([10.600±1.619] svs.[10.350±1.452] s,t=0.641,P=0.529;[10.400±1.153] s vs.[10.425±1.311] s,t=-0.079,P=0.938).Conclusion Quantitative analysis is a good method to evaluate the effect of aneurysm clipping surgery according to the blood flow,which might improve the success rate.