Acute respiratory distress is a common problem in many clinical departments, and in severe cases, it can lead to respiratory failure, shock and even death. Lung ultrasound technology has gradually become one of the essential bedside imaging tools for the diagnosis and treatment of patients with acute and critical illnesses due to its advantages of bedside convenience, non-invasiveness, accuracy and reproducibility. In recent years, ultrasonographers have developed a wide range of bedside examination programs. The cross-disciplinary approach of using ultrasound as a "visual window" and integrating it with clinical theories such as hemodynamics and cardiopulmonary pathophysiology in acute and critical illnesses is expected to become one of the future directions for the diagnosis and treatment of bedside dyspnea. This expert recommendation is based on previous research and work experience and aims to provide ideas for the application of bedside lung ultrasound.

Objective To investigate the relationship between serum fibroblast growth factor(FGF-21) and in stent restenosis(ISR) after second-generation drug eluting stent(DES) implantation, as well as the value of combining N-terminal proBNP to predict ISR. Methods One hundred and seventy-five patients with coronary heart disease(CAD) who underwent second-generation DES percutaneous coronary intervention(PCI) in the Cardiovascular Department of the Second Affiliated Hospital of Hainan Medical College from January 2019 to June 2021 were selected. Peripheral blood samples were collected before DES PCI, and serum FGF21 levels were detected by enzyme-linked immunosorbent assay. Coronary angiography was reexamined 9 to 24 months after PCI, and 32 cases were divided into an ISR group and 143 cases in a non ISR group based on the occurrence of ISR. Application of Generalized Additive Model(GAM) to explore the relationship between FGF-21 and ISR risk, multivariate logistic regression analysis of clinical factors affecting 2-year DES ISR risk in CAD patients, and receiver operating characteristic(ROC) curve analysis of its predictive value. Results The serum FGF21 level in the ISR group was higher than that in the non ISR group(Z=7.081,P<0.001). The results of multivariate logistic regression analysis showed that the total length of the stent≥38 mm, elevated NT-proBNP, and FGF21 were independent predictive factors for the 2-year increased risk of DES ISR in CAD patients [OR(95%CI)=1.072(1.040-1.106), 1.004(1.002-1.007), 1.038(1.021-1.056)]. The fitting curve between serum FGF21 level and 2-year DES ISR incidence showed a positive correlation(r=0.508, P<0.001). The area under the curve(AUC) of serum FGF21 predicting 2-year DES ISR risk is 0.891, the AUC of NT proBNP is 0.739, and the AUC predicted by FGF21 combined with NT proBNP is 0.966(P<0.001). Conclusion Serum FGF21 is an independent risk factor for 2-year ISR risk in CAD patients receiving second-generation DES PCI treatment. The combination of FGF21 and NT proBNP has higher predictive potential for DES ISR.

Objective To analyze the relationship between serum irisin, meteoric-like protein(Metrnl), and multiligand proteoglycan-1(syndecan-1) and echocardiographic indexes and prognosis of patients with heart failure with intermediate ejection fraction(HFmrEF). Relationship. Methods One hundred and thirty-two patients with HFmrEF who were hospitalized in the Department of Cardiovascular Medicine of Zhu Xianyi Memorial Hospital of Tianjin Medical University from October 2019 to March 2022 were selected as the HFmrEF group, and 102 volunteers who were healthy during the same period of physical examination were selected as the healthy control group. Serum Irisin, Metrnl, and syndecan-1 levels were detected and echocardiograms were examined in the 2 groups. Pearson's correlation analysis was performed to correlate serum Irisin, Metrnl, and syndecan-1 with echocardiographic indices of patients with HFmrEF; and patients with HFmrEF were followed up for 1 year after discharge. Multifactorial Cox proportional risk regression was used to analyze the influencing factors of poor prognosis in HFmrEF patients, and the value of Irisin, Metrnl, and syndecan-1 in predicting poor prognosis in HFmrEF patients was analyzed by the subject's work characteristics(ROC) curve. Results The serum Irisin and Metrnl levels, left ventricular ejection fraction(LVEF), mitral early diastolic filling velocity(E)/early diastolic mitral annular velocity(e') of the HFmrEF group were lower than those of the control group(t/P=-26.188/<0.001,-7.671/<0.001,-21.702/<0.001,-20.261/<0.001), syndecan-1 level, left ventricular end-diastolic internal diameter(LVEDD), and left ventricular end-systolic internal diameter(LVESD), LV end-diastolic posterior wall thickness(LVPWD) and end-diastolic septal wall thickness(IVSD) were higher than those in the control group(t/P=28.682/<0.001, 10.067/<0.001, 11.061/< 0.001, 17.371/<0.001, 18.950/<0.001). Serum Irisin and Metrnl levels in HFmrEF patients were positively correlated with LVEF, E/e', and negatively correlated with LVEDD, LVESD, LVPWD, IVSD,(Irisin: r/P=0.326/<0.001, 0.391/0.001,-0.301/0.003,-0.226/0.021,-0.358/<0.001,-0.423/<0.001, Metrnl: r/P=0.402/<0.001, 0.374/<0.001;-0.277/0.007,-0.293/0.005,-0.315/<0.001,-0.338/<0.001); and syndecan-1 levels were negatively correlated with LVEF and E/e' and positively correlated with LVEDD and LVESD, LVPWD and IVSD(r/P=-0.427/<0.001,-0.385/<0.001, 0.337/<0.001, 0.275/0.008, 0.308/0.002, 0.265/0.012). Multifactorial Cox proportional risk regression analysis showed that New York Heart Association(NYHA) cardiac function class IV, high levels of NT-proBNP, and high levels of syndecan-1 were risk factors for poor prognosis in patients with HFmrEF [HR(95%CI)=1.165(1.075-5.162),2.353(1.228-4.512), 1.551(1.129-2.131)], and high levels of Irisin, high levels of Metrnl were protective factors [HR(95%CI)=0.505(0.312-0.819),0.583(0.374-0.911)]. The area under the curve(AUC) of Irisin, Metrnl, and syndecan-1 for predicting poor prognosis in HFmrEF patients was 0.775, 0.799, and 0.782, respectively, and the combined prediction AUC was 0.873, which was higher than the prediction of the indicators alone(Z=3.025, 2.532, 2.834,P<0.001, 0.012, 0.006). Conclusion The levels of serum Irisin and Metrnl in HFmrEF patients are decrease, and the level of syndecan-1 is increase, which is relate to cardiac dysfunction and poor prognosis. The combination of serum Irisin, Metrnl and syndecan-1 has a higher value in predicting the prognostic risk of HFmrEF patients.

Objective To analyze the value of quantitative flow ratio in the evaluation of moderate-to-severe coronary artery stenosis and the interventional strategy in conjunction with the results of intravascular ultrasound.Methods A total of 55 patients admitted to Beijing Anzhen Hospital for coronary angiography or percutaneous coronary intervention and intravascular ultrasound guidance were retrospectively collected. The minimum lumen area(MLA) and plaque burden(PB) measured by intravascular ultrasound were collected. The data of coronary angiography were used to calculate the quantitative flow Ratio of the treated target vessels. Based on intravascular ultrasound, to evaluate the value of quantitative flow ratio in the diagnosis of vascular disease and the guidance of interventional surgery strategy.Results 110 cases of critical lesions were screened and examined by IVUS, of which 13 cases had serious artifacts in IVUS images, 18 cases had serious tortuous vessels, and 24 cases had full lesions or poor image quality, and 55 patients and 55 target vessels were enrolled in the final study. The diagnostic criteria for myocardial ischemia due to significant stenosis were IVUS lumen area ≤3 mm2 or IVUS lumen area ≤4 mm2 and IVUS plaque load ≥70%. The QFR value of 0.75±0.12, MLA(3.32±0.74) mm2, and PB(70±9)%. QFR values ≤0.80 were in good agreement with IVUS for evaluating coronary artery stenosis ischemia(Kappa=0.656, P<0.01, 95%CI 0.452-0.860). The sensitivity of QFR was 0.853, specificity was 0.810, positive predictive value was 87.9%, negative predictive value was 77.3%; there was a moderate positive correlation between MLA and QFR values(r=0.566,P<0.01). There was a slight negative correlation between PB and QFR values(r=-0.371,P<0.01).Conclusions QFR has good diagnostic significance in guiding the treatment decision of coronary critical lesion stenosis.

Objective To observe the changes of serum levels of inducible co-stimulatory molecules(ICOS) and inducible co-stimulatory molecule ligands(ICOSL) and clinical significance in patients with chronic obstructive pulmonary disease(COPD) combined with pulmonary heart disease(PHD). Methods One hundred and seventy-two COPD patients admitted to the Department of Cardiology, Suzhou Jiulong Hospital, School of Medicine, Shanghai Jiaotong University, from June 2020 to February 2023 were selected and divided into the PHD group(82 patients) and the COPD group(90 patients) according to whether they were combined with PHD or not. PHD patients were divided into mild subgroups(30-50 mmHg, 21 cases), moderate subgroups(51-70 mmHg, 37 cases), and severe subgroups(≥71 mmHg, 24 cases) according to pulmonary artery systolic pressure(PASP), and then PHD patients were divided into subgroups of grades Ⅰ to Ⅱ(44 cases), and grades Ⅲ to Ⅳ(38 cases) according to the New York Heart Association(NYHA) classification. Enzyme-linked immunosorbent assay(ELISA) was used to detect serum ICOS and ICOSL levels and analyze the correlation between ICOS, ICOSL and PASP, NYHA classification, and the value of ICOS and ICOSL in diagnosing COPD combined with PHD was analyzed by the subject's work characteristics(ROC) curve. Results The serum ICOS and ICOSL levels in the PHD group were higher than those in the COPD group(t=14.526, 34.508,P<0.001). Serum ICOS and ICOSL levels were higher in the severe subgroup than in the moderate and mild subgroups(F/P=125.351/<0.001, 163.591/<0.001, 84.292/<0.001), and serum ICOS was higher in the subgroups of grade III-IV, ICOSL levels were higher than those in the subgroups of grades I-II(t/P=11.658/<0.001, 27.345/<0.001). The serum ICOS and ICOSL levels of patients with PHD were positively correlated with the PASP and NYHA grading(r=0.439, 20.416, 0.501, 0.497,P<0.001). ICOS, ICOSL and both the area under the curve of combined PHD in patients with COPD diagnosis was 0.780, 0.723, 0.926, respectively, and the combination of the two was higher than the diagnosis of ICOS and ICOSL alone(Z=4.021, 5.194, and P all <0.001).Conclusion Serum ICOS and ICOSL levels were significantly higher in patients with COPD combined with PHD, and were associated with pulmonary hypertension and reduced cardiac function, and the combined detection of ICOS and ICOSL could effectively evaluate the risk of PHD in patients with COPD.