Abstract:As a new clinical trial mode, decentralized & digitalized clinical trial (DCT) is based on digital health equipment and uses internet and artificial intelligence technologies to complete the screening, registration, randomization, intervention, evaluation and follow-up of subjects, which is helpful to improve efficiency and reduce trial costs. The DCT mode has been applied to evaluate the treatment and management effects of cardiovascular diseases such as atrial fibrillation, heart failure, coronary heart disease, and hypertension, showing broad development prospects and application space. This article will provide a brief introduction to representative DCT in the global cardiovascular disease field, and look forward to the application prospects of this model, providing reference and guidance for accelerating the development of cardiovascular DCT in China.

Abstract:Aim To investigate the role of cholesterol in the regulation of lipid raft and the function of platelets. Methods Using in vitro incubation of methyl β-cyclodextrin (MβCD) and in vivo elevation of peripheral blood total cholesterol levels to remove and load platelet cholesterol, respectively. Cholera toxin B staining combined with flow cytometry was used to detect platelet lipid raft content, fluorescence antibody staining combined with flow cytometry was used to detect the expression levels of P-selectin and activated integrin αⅡbβ3, annexin V labeling combined with flow cytometry was used to detect the level of phospholipid efflux, in vitro experimental system and rat tail bleeding experiment were used to detect platelet aggregation ability. Results The content of lipid raft on B lymphocytes decreased with the removal of cholesterol, while in vitro incubation of MβCD to remove platelet cholesterol significantly increased its lipid raft level (P＜0.05). Consistent with this, in vivo cholesterol loading increased the lipid raft content of B lymphocytes but decreased the lipid raft content of platelets (P＜0.05). The increase in lipid raft after removing cholesterol was not conducive to platelet activation and aggregation function. In vivo cholesterol loading downregulated platelet lipid raft content (P＜0.05), enhanced its ability to respond to low concentration stimulant for activation aggregation and coagulation, and this enhancing effect disappeared after cholesterol removal. Conclusion Platelet cholesterol is a key regulator of platelet lipid raft content and platelet function, which can negatively regulate lipid raft, promote platelet activation, and enhance their coagulation function.

Abstract:Aim To explore the impact of ablation termination on the maintenance of sinus rhythm in long-standing persistent atrial fibrillation (LSPAF) by “Stepwise” ablation strategy. Methods This study involved 260 LSPAF patients who underwent “Stepwise” ablation strategy and clinical characteristics were collected. According to the ablation procedure, the patients were divided into ablation termination group and cardioversion group. The prognostic value of conversion to atrial flutter (AFL) and ablation termination was analyzed using subgroup analysis, followed up for 1 year to explore their impact on prognosis. Results Overall, 103 (39.6%) cases of LSPAF were terminated by ablation. Compared to the cardioversion group, the courses of atrial fibrillation and left atrial diameter were lower in the ablation termination group (all P＜0.05). At 1 year of follow-up, 45 (17.3%) patients had experienced recurrence, with no statistical difference in the proportion of recurrence between the two groups (all P＞0.05). Compared to preoperative, left atrial diameter was significantly lower after 1 year regardless of recurrence. In subgroup analysis, conversion to AFL and ablation termination was associated with the maintenance of long-term sinus rhythm (all P＜0.05). On multivariable Cox regression, the courses of atrial fibrillation, body mass index, left atrial diameter and fasting blood glucose were independent risk factors for recurrence. Conclusions 39.6% of LSPAF recovered sinus rhythm during the “Stepwise” ablation process, but there was no correlation with long-term sinus rhythm maintenance. Termination of ablation after conversion to AFL during ablation has a predictive effect on the maintenance of long-term sinus rhythm.

Abstract:Aim To explore the related influencing factors of stroke in middle-aged and elderly population in China, and to construct a nomogram prediction model to provide more personalized reference for the prevention and treatment of stroke. Methods This study included 13 063 participants from the China Health and Retirement Tracking Survey project. This project conducted a cross-sectional survey in 2011 using a multi-stage sampling method, targeting individuals aged 45 and above from 150 counties and 450 communities (villages) in 28 provinces (autonomous regions and municipalities). Detailed data were collected on participants' socio-demographic characteristics, physical measurements, health status, healthcare utilization, household income, and expenditure. The study participants were followed up to assess stroke in 3,5, and 2018. Univariate and multivariate Cox regression analyses were employed to identify the factors associated with stroke incidence and to construct a nomogram predictive model. Results During the follow-up, 774 participants developed to stroke. Multivariate Cox regression results showed that older age (HR＝1.8,5%CI:1.019~1.038), being single (HR＝1.5,5%CI:1.031~1.626), smoking (HR＝1.4,5%CI:1.074~1.489), abnormal body mass index (HR＝1.4,5%CI:1.020~1.420), hypertension (HR＝2.0,5%CI:1.855~2.609) and diabetes (HR＝1.3,5%CI:1.117~1.970) were the risk factors affecting the incidence of stroke, high levels of annual per capita expenditure (HR＝0.3,5%CI:0.642~0.953) are antagonistic factors in the incidence of stroke. The nomogram constructed based on the above factors had good predictive performance, and its area under the curve (AUC) was about 0.700. Conclusion Old age, being single, smoking, abnormal body mass index, history of hypertension and diabetes are independent risk factors for stroke, the nomogram constructed based on these factors can help predict the incidence rate of stroke.

Abstract:Aim To investigate the value of ultrasound in the diagnosis of congenital internal carotid artery hypoplasia (CICAH). Methods Patients diagnosed with CICAH by ultrasound in Baotou Central Hospital, Inner Mongolia from July 2022 to December 2023 were retrospectively collected. The general data, ultrasound and imaging data of all patients were recorded. Results Among the 25 317 carotid artery ultrasonography subjects, 13 patients were diagnosed as CICAH. The ultrasonic detection rate of CICAH was 0.051%. The 13 cases of CICAH included 11 cases of unilateral internal carotid artery hypoplasia and 2 cases of bilateral internal carotid artery hypoplasia. CT scan of carotid canal confirmed that all 13 cases of internal carotid artery hypoplasia were unilateral lesions, among which 2 cases of unilateral lesions were misdiagnosed as bilateral lesions by ultrasound, with a misdiagnosis rate of 15%. Taking carotid canal dysplasia as the gold standard, ROC curve was plotted to evaluate the diagnostic value of ultrasound in CICAH. The area under the curve (AUC) was 0.941, and the optimal diagnostic threshold value of CICAH was 3.2 mm, sensitivity was 100%, and specificity was 85%. The consistency test between ultrasonic examination and gold standard test method for CT scanning of carotid artery canal showed that Kappa value was 0.846. Conclusion Ultrasound has a high diagnostic value in the diagnosis of CICAH, and can be used as the first choice of clinical examination.

Abstract:Aim To investigate the effects of Gubu decoction combined with intraluminal reconstruction on bipedal vibration sensation threshold and microcirculation in patients with lower extremity arteriosclerotic occlusive disease (LEAOD). Methods A total of 152 patients who came to Lishui Gentral Hospital for LEAOD treatment from April 2021 to April 2023 were divided into the observation group (intraluminal reconstruction+Gubu decoction, 76 cases) and the control group (intraluminal reconstruction, 76 cases) by random number table method, and the traditional Chinese medicine (TCM) syndrome scores, clinical efficacy, microcirculation indicators and bifoot vibration sensation threshold of the two groups were compared. Results After treatment, the scores of TCM syndromes such as limb pain, limb numbness, intermittent claudication, and limb fear of cold decreased after treatment in both groups,and the decrease of observation group was more obvious (P＜0.05). The clinical effect of observation group (96.05%) was significantly higher than that of control group (84.21%) (P＜0.05). After treatment, the flow state integral, tube loop integral and periloop integral decreased, and the apical vessel diameter increased in both groups, and the changes of various indexes in the observation group were more significant (P＜0.05). After treatment, the threshold of sensation in both groups decreased, and the observation group was significantly lower (P＜0.05). Conclusion Gubu decoction combined with intraluminal reconstruction can effectively reduce the foot sensation threshold and improve the microcirculation of affected limbs in LEAOD patients.

Abstract:Aim To study the causal relationship between coffee consumption and atherosclerosis risk. Methods Based on the public genome database IEU Open GWAS project website, relevant data were obtained, and instrumental variables closely related to exposure and outcome were screened. Mendelian randomization analysis was performed using the inverse variance weighted method, weighted median method, and MR Egger method to assess the causal relationship between coffee consumption and arteriosclerosis (including coronary atherosclerosis, peripheral atherosclerosis, cerebral atherosclerosis, and other atherosclerosis). In addition, the Egger intercept method was used to detect the level of pleiotropy, the Cochran Q test was used to assess the heterogeneity, and the leave one out method was used to perform sensitivity analysis, so as to ensure the robustness of the results. Results The study showed that the F-values of the instrumental variables included in the study were all greater than 10, and there was no weak instrumental variables bias. Coffee consumption was positively correlated with the risk of coronary atherosclerosis (OR＝1.535 5,5%CI＝1.108 4～2.127 2, P＝0.009 9), peripheral atherosclerosis (OR＝2.098 6,5%CI＝1.182 2～3.725 7, P＝0.011 4), and other atherosclerosis (OR＝1.864 7,5%CI＝1.052 9～3.302 4, P＝0.032 6), but not with the risk of cerebral atherosclerosis. Heterogeneity test Q_pval＞0.05, level pleiotropy test interval P＞0.05. Conclusions The single nucleotide polymorphisms selected in the study are all strong instrumental variables, and there is no heterogeneity or horizontal pleiotropy, indicating reliable results. The research shows that coffee consumption increases the risk of coronary atherosclerosis, peripheral atherosclerosis and other atherosclerosis, and has no significant correlation with the risk of cerebral atherosclerosis.The health management of atherosclerosis patients should reduce coffee consumption.

Abstract:Copper, an essential trace element in the human body, is pivotal in numerous physiological functions, including mitochondrial respiration, antioxidant reactions, and the synthesis of biological macromolecules. The cellular copper content is tightly regulated, as both copper deficiency and copper overload can be detrimental and lead to the onset of various diseases. Recently, a novel form of cell death known as Cuproptosis has been identified, which is triggered by an excess of copper. Excessive intracellular copper promotes the degradation of Fe-S cluster proteins and protein toxicity by stimulating the sulfur-acylation aggregation process of mitochondria-related proteins, ultimately resulting in cell death. With the emergence of the concept of copper-induced cell death, researchers have shifted their focus towards understanding the potential role of copper in atherosclerosis. This review delves into the regulatory mechanisms of copper metabolism and cuproptosis, encapsulates current research connecting an abundance of copper to atherosclerosis, and examines how cuproptosis influences atherosclerosis progression, with the goal of devising novel approaches for atherosclerosis prevention and management through cuproptosis.

Abstract:Macrophages play an important role in the development of inflammation, the core mechanism of atherosclerosis. In recent years, nanotechnology has provided a new perspective for the diagnosis and treatment of atherosclerosis with its unique characteristics of biological compatibility and precise targeting. In this paper, the pathological mechanism of atherosclerosis, the realization of atherosclerosis imaging by targeting macrophages with nanomaterials and the application of macrophage cell membrane biomimetic nanoparticles in anti-atherosclerosis were reviewed.

Abstract:Atherosclerosis is a lipid-driven chronic inflammatory disease that typically forms plaques in large and medium-sized arteries and is a major cause of ischemic heart disease and stroke. Recent studies have found that during the progression of atherosclerosis, the level of cellular glycolysis in plaques increases, leading to excessive production and excretion of lactate and acidification of the extracellular environment, which may further affect the development of atherosclerosis through multiple mechanisms. This article reviews the research progress on the role of lactate metabolism in atherosclerosis, which may provide new therapeutic targets and directions for the prevention and treatment of atherosclerosis.

Abstract:Endothelial cell senescence is increasingly recognized as an important factor in the development of vascular dysfunction and age-related diseases. As is well known, the occurrence of endothelial cell senescence involves multiple factors, and endothelial cell senescence and vascular dysfunction interact with each other. This review summarized the phenotypic changes of endothelial cell senescence, and reviewed the relationship between endothelial cell senescence and various vascular dysfunction, such as dysfunction of vascular relaxation and contraction, impaired vascular barrier function, and vasculitis. The aim is to provide reference for delaying human vascular aging and improving vascular function.