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Ling Hou,1,* Jinbo Zhao,2,* Ting He,2 Ke Su,2 Yuanhong Li2 1Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China; 2Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhong Li, Email lyh0101@vip.163.comIntroduction: Coronary artery disease (CAD) remains a significant global health challenge, with percutaneous coronary intervention (PCI) being a primary revascularization method. In-stent restenosis (ISR) post-PCI, although reduced, continues to impact patient outcomes. Inflammation and platelet activation play key roles in ISR development, emphasizing the need for accurate risk assessment tools. The systemic inflammation aggregation index (AISI) has shown promise in predicting adverse outcomes in various conditions but has not been studied in relation to ISR.Methods: A retrospective observational study included 1712 patients post-drug-eluting stent (DES) implantation. Data collected encompassed demographics, medical history, medication use, laboratory parameters, and angiographic details. AISI, calculated from specific blood cell counts, was evaluated alongside other variables using machine learning models, including random forest, Xgboost, elastic networks, logistic regression, and multilayer perceptron. The optimal model was selected based on performance metrics and further interpreted using variable importance analysis and the SHAP method.Results: Our study revealed that ISR occurred in 25.8% of patients, with a range of demographic and clinical factors influencing the risk of its development. The random forest model emerged as the most adept in predicting ISR, and AISI featured prominently among the top variables affecting ISR prediction. Notably, higher AISI

Ling Hou,1,* Jinbo Zhao,2,* Ting He,1,* Yinhua Luo,3 Ke Su,2 Yuanhong Li,2 Ruiyang Zhu3 1Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, People’s Republic of China; 2Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of China; 3Center for Gene Diagnosis and Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, 445400, People’s Republic of China, Email lyh0101@vip.163.com Ruiyang Zhu, Center for Gene Diagnosis and Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People’s Republic of China, Email zhuruiyang@whu.edu.cnAbstract: Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis classified as an autoimmune small-vessel vasculitis. Clinically, approximately 80% of affected organs in GPA involve the upper/lower respiratory tract and kidneys, with cardiovascular system involvement being rare. Here, we report a case of a 50-year-old female patient who presented with sudden-onset chest pain lasting for 1 hour. The patient had normal body temperature, and markers of infection such as C-reactive protein and erythrocyte sedimentation rate were within normal limits. Electrocardiography revealed ST-segment elevation in inferior, precordial, and posterior leads. Emergency coronary angiography showed no significant obstructive disease, prompting consideration of vasospastic angina given the patient’s recurrent chest pain symptoms and findings on laboratory and imaging studies. The patient underwent treatment including coronary vasos

Ling Hou,1 Ke Su,2 Jinbo Zhao,2 Yuanhong Li2 1Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China; 2Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of ChinaCorrespondence: Yuanhong Li, Email lyh0101@vip.comObjective: Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory disease that poses a significant health risk to individuals. Patients with COPD are predisposed to a higher incidence of coronary artery disease (CAD) than the general population. This study aims to investigate the correlation between COPD and the incidence of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).Methods: This study retrospectively analyzed the clinical data and laboratory test results of patients who underwent PCI at our hospital between January 2018 and December 2021 to investigate the relationship between COPD and drug-Eluting Stents (DES) postoperative ISR. We employed the best subset method to select the most suitable combination of predictive factors, utilizing the data, and verified the precision of the model by means of internal validation. We ultimately assessed the performance of the prediction model using an ROC curve.Results: The research indicates that COPD is an independent risk factor for ISR after PCI (OR=2.437, 95% CI [1.336, 4.495], P=0.004). The analysis revealed an area under the receiver operating characteristic (ROC) curve of 0.783 for the training group and 0.705 for the testing group, indicating a model fitting for both groups (both > 0.5).Conclusion: COPD history is a dependable predictor of stent restenosis post percutaneous coronary intervention.Keywords: percutaneous coronary intervention, PCI, chronic obstructive pulmonary disease, COPD, in-stent restenosis, ISR, drug-eluting stents, DES, optima

Yinhua Luo,1,* Jinbo Zhao,2,* Xueru Chen,3,* Rui Huang,2 Ling Hou,2 Ke Su,2 Yuhua Lei,2 Yuanhong Li1,2 1Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China; 2Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China; 3Department of General Practice, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510120, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, People’s Republic of China, Email shaoyiju75482@163.comBackground: Ischemic cardiomyopathy (ICM) with high mobility and mortality is closely linked to immunology, oxidative stress, inflammatory response and so on. Early diagnosis counts for the effective treatment of ICM. However, there are still no distinctive diagnostic signatures. This research aims to investigate effective signatures and build the diagnostic model for ICM.Methods: The Gene Expression Omnibus was used to retrieve the microarray data of GSE9800 and GSE580, which were obtained from tissue biopsy samples. Differentially expressed genes (DEGs), GO, and KEGG analyses were then carried out on the microarray data. The PPI network was constructed via STRING database.Following that, CIBERSORT techniques in conjunction with the LM22 feature matrix were used to assess the immune infiltration of the samples.The expression of a few chosen genes served as the predictor variable, and the occurrence of ICM served as the responder variable, in the construction of the best subset stepwise regression model.Results: A total of 28 DEGs were found. And according to the G

Jinbo Zhao,1,* Ling Hou,2,* Ni Zhu,3,* Rui Huang,1 Ke Su,1 Yuhua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China; 2Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China; 3Department of Pathology, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhong Li, Email lyh0101@vip.comObjective: The CHA2DS2-VASc score, a system which has been initially recommended for the assessment of thromboembolic risk in patients with atrial fibrillation (AF), arouses attention in the field of adverse coronary events. The purpose of this study was to explore the predictive value of preprocedural CHA2DS2-VASc score on ISR in patients after drug-eluting stent (DES) implantation.Methods: To further investigate the relationship between CHA2DS2-VASc scores and ISR after DES, a retrospective study of DES was carried on. Additionally, the preoperative variables for the ISR and control groups were contrasted. Predictive factors were chosen using the optimal subset regression. We validate the model using internal validation. The prediction model was evaluated using the receiver operator characteristic (ROC) analysis.Results: We used a 3:7 ratio to create an experimental group and a validation group, and then ran a stepwise regression with the data from each of the two groups. The results showed that CHA2DS2-VASc score was an independent risk factor for ISR in both the experimental (p = 0.0139) and validation groups (p = 0.0014), and both had significant predictive value for ISR. The area of the ROC curve was greater than 0.5 in

Trusted Execution Environments (TEEs) allow user processes to create enclaves that protect security-sensitive computation against access from the OS kernel and the hypervisor. Recent work has shown that TEEs are vulnerable to side-channel attacks that allow an adversary to learn secrets shielded in enclaves. The majority of such attacks trigger exceptions or interrupts to trace the control or data flow of enclave execution. We propose QuanShield, a system that protects enclaves from side-channel attacks that interrupt enclave execution. The main idea behind QuanShield is to strengthen resource isolation by creating an interrupt-free environment on a dedicated CPU core for running enclaves in which enclaves terminate when interrupts occur. QuanShield avoids interrupts by exploiting the tickless scheduling mode supported by recent OS kernels. QuanShield then uses the save area (SA) of the enclave, which is used by the hardware to support interrupt handling, as a second stack. Through an LLVM-based compiler pass, QuanShield modifies enclave instructions to store/load memory references, such as function frame base addresses, to/from the SA. When an interrupt occurs, the hardware overwrites the data in the SA with CPU state, thus ensuring that enclave execution fails. Our evaluation shows that QuanShield significantly raises the bar for interrupt-based attacks with practical overhead., Comment: 15pages, 5 figures, 5 tables

Yinhua Luo,1,&ast; Xiaohong He,2,&ast; Linbo Hu,3 Jinbo Zhao,1 Ke Su,1 Yuhua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, People’s Republic of China; 2Centre for Disease Control and Prevention, Enshi Center for Disease Control and Prevention, Enshi Prefecture, People’s Republic of China; 3Health Management Centre, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Prefecture, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, People’s Republic of China, Email lyh0101@vip.163.comBackground: Ischemic cardiomyopathy (ICM) with high morbidity and mortality is closely associated with an abnormal equilibrium of circulation selenium levels. The oxidative stress theory is the most accepted theory of selenium causing ischemic cardiomyopathy. However, the role of inflammatory responses in ICM has received limited attention.Methods: This study included 119 subjects, 43 of whom were patients with ICM, and 76 were healthy controls. Blood specimens were collected from subjects and serum levels of inflammatory and oxidative stress indicators and plasma levels of selenium were measured.Results: When plasma selenium and indicators of inflammation and oxidative stress were compared between groups, plasma selenium levels were significantly lower in the ICM group than in the control group (68.83874 vs 104.39775, p=0.02032), while indicators of inflammation such as tumour necrosis factor-alpha (TNF-α) (79.09773 vs 46.15634, p< 0.001), interleukin-6 (IL-6) (49.41484 vs 38.46923, p< 0.01) and neutrophil/lymphocyte ratio (3.696574 vs 2.383658, p< 0.001) were significantly higher in the ICM group than in the control group (all of these results were statistically differe

Yinhua Luo,1,&ast; Ni Tan,2,&ast; Jingbo Zhao,3 Yuanhong Li3 1Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China; 2Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China; 3Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, People’s Republic of China, Email lyh0101@vip.163.comObjective: In-stent restenosis (ISR) is a fatal complication of percutaneous coronary intervention (PCI). An early predictive model with the medical history of patients, angiographic characteristics, inflammatory indicators and blood biochemical index is urgently needed to predict ISR events. We aim to establish a risk prediction model for ISR in CAD patients undergoing PCI.Methods: A total of 477 CAD patients who underwent PCI with DES (drug-eluting stents) between January 2017 and December 2020 were retrospectively enrolled. And the preoperative factors were compared between the non-ISR and ISR groups. The least absolute shrinkage and selection operator (LASSO) and multi-factor logistic regression were used for statistical analysis. The prediction model was evaluated using receiver operator characteristic (ROC) analysis, the Hosmer–Lemeshow 2 statistic, and the calibration curve.Results: In this study, 94 patients developed ISR after PCI. Univariate analysis showed that post-PCI ISR was associated with the underlying disease (COPD), higher Gensini score (GS score), higher LDL-C, higher neutrophil/lymphocyte ra

Yinhua Luo,1,&ast; Shengyu Cui,2,&ast; Changjiang Zhang,2 Rui Huang,2 Jinbo Zhao,3 Ke Su,3 Dan Luo,3 Yuanhong Li3 1Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, People’s Republic of China; 2Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China; 3Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, People’s Republic of China, Email lyh0101@vip.163.comObjective: In-stent restenosis (ISR) is regarded as a critical limiting factor in stenting for coronary heart disease (CHD). Recent research has shown that fasting residual cholesterol (RC) has been shown to have a substantial impact on coronary heart disease. Unfortunately, there have not been much data to bear out the relationship between RC and ISR. Then, the predictive value of RC for in-stent restenosis in patients with coronary heart disease was analyzed.Patients and Methods: Aiming to explore the relationship between RC and ISR, we designed a retrospective study of patients with CHD after drug-eluting stent (DES) implantation, combining the data from a public database and selecting the best-fitting model by comparing the optical subset with least absolute shrinkage and selection operator (LASSO) regression.Results: Analysis of the abovementioned two models showed that the optical subset optimal subset model, which was based on RC, creatine, history of diabetes, smoking, multi-vessel lesions (2 vessels or more lesions), peripheral vascular lesions (PAD), and blood uric acid, had a better fit (AUC = 0.68), and that RC was an independent risk factor for ISR in the aboveme

Rui Huang,1,&ast; Yinhua Luo,2,&ast; Yuhua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei Province, People’s Republic of China; 2Department of Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, 442000, Hubei Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong LiCardiovascular Disease Center, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei Province, People’s Republic of ChinaEmail lyh0101@163.vip.comAbstract: It is reported that the incidence of congenital long QT syndrome (cLQTS) is very low, with the incidence of LQTS caused by transient receptor potential melastatin 4 (TRPM4) being even lower, leading to less research on the gene TRPM4. We reported a case of an elderly male patient presenting with frequent syncopal episodes since the age of 20. Electrocardiography showed sinus bradycardia (mean heart rate 59 beats), prolonged QT interval (540ms), and torsade de pointes. His sister also had experienced an episode of syncope, but his other families had not. A novel mutation in the TRPM4 gene was discovered in this patient and his sister, according to genetic analysis. All in all, we provided a new heterozygous shift mutation (NM_017636: exon4: c.434delC, p. Ala145ValfsTer133) on TRPM4, which has never been reported in the past and thus may hopefully serve as useful feedback information for genetic pathogenesis of cLQTS caused by TRPM4 variants.Keywords: long QT syndrome, LQTS, TRPM4, mutation

Rui Huang,1,* Li Yan,2,* Yuhua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi Prefecture, 445000, Hubei Province, People’s Republic of China; 2Pediatrics Department, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi Prefecture, 445000, Hubei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhong Li No. 158 Wuyang Avenue, Enshi City, Hubei Province, People’s Republic of ChinaEmail lyh0101@vip.163.comBackground: Thyroxine is closely related to cardiovascular diseases, such as coronary heart disease, ventricular arrhythmia, atrioventricular block, myocardial systolic weakness, pericardial effusion, low cardiac output and hypertension. Previous studies have also found that hypothyroidism can also lead to mental disorders. Here, we present a rare case of severe hypothyroidism patient accompanied by sick sinus syndrome (SSS) as a cardiovascular manifestation needing cardiac pacing and severe mental disorders.Case Presentation: A 42-year-old female patient, previously healthy, was referred to our hospital because of bradycardia complicated with sick sinus syndrome which requiring cardiac pacing and severe mental disorders. Her clinical features along with laboratory findings strongly suggested that the patient had severe hypothyroidism with sick sinus syndrome and mental disorders, both of which were reversible and successfully treated with levothyroxine.Conclusion: This is the first reported case of hypothyroidism with sick sinus syndrome requiring pacemakers and psychiatric disorders, and the symptoms can be improved and reversed after thyroxine supplementation. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or sick sinus syndrome, especially if combined.Keywords: hypo

Rui Huang,1,* YinHua Luo,2,* Jingbo Zhao,1 Ke Su,1 YuHua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi Prefecture, 445000, Hubei Province, People’s Republic of China; 2Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, 442000, Hubei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhong LiCardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi Prefecture, No. 158 Wuyang Avenue, Enshi City, Hubei Province, People’s Republic of ChinaEmail lyh0101@vip.163.comBackground: ARVC is a rare genetic-related disease characterized by fibrous fat replacement in the ventricular myocardium, caused by mutations in genes encoding for the desmosomal proteins, such as the desmoglein-2 gene (DSG2). It is reported in the literature that other genetic factors may play a role in disease penetrance. Herein, we report a Chinese proband with ARVC, which was probably caused by DSG2 p.Val149Ile mutation as genetic background when carrying heterozygous PRRT2 p.Arg217ProfsTer8 mutation.Case Presentation: A 17-year-old male with a history of paroxysmal kinesigenic dyskinesia (PKD) presented to the hospital for syncope induced by ventricular tachycardia. According to relevant clinical data and the diagnostic criteria of ARVC, a precise positive diagnosis of ARVC was finally made. Gene testing revealed that the patient carried a DSG2 heterozygous missense mutation (NM_001943: exon5: c.445G>A, p.Val149Ile) as well as frameshift mutation of PRRT2 (NM_001256442: exon2: p. Arg217Profs Ter8).Conclusion: This is the first time to report a Chinese proband with ARVC and a history of PKD carrying both DSG2 p. val149ile mutation and PRRT2 p. Arg217ProfsTer8 mutation, wh

The semi-arid Gansu Province is one of the poorest and driest areas in China. Droughts and dry spells are extremely common in this mountainous area, where people depend on rainfed subsistence agriculture. Since the late 1980s, a project for supplying water for domestic use and irrigation has been developed in the area. A simple and affordable rainwater harvesting system, combined with an integrated approach to improving agricultural production, has improved the lives of Gansu farmers