Objective To investigate the effects of Qili Qiangxin Capsule combined with standardized Western medicine treatment on cardiac function and serum levels of microfibrillar-associated protein 4(MFAP4), fibrillin-1(FBN1), and mitochondrial transcription factor A(TFAM) in patients with chronic heart failure(CHF), and to preliminarily explore its potential mechanism of action. Methods A total of 120 patients with CHF treated in the Department of Cardiology, Xingtai Central Hospital, from January 2022 to December 2023 were enrolled and randomly assigned into a control group and an observation group, with 60 cases in each group. Both groups received standardized Western medicine treatment. The observation group was additionally given Qili Qiangxin Capsules. The treatment duration for both groups was 12 weeks.The changes in traditional Chinese medicine(TCM) syndrome scores, clinical efficacy based on improvement in New York Heart Association(NYHA)functional class, 6-minute walking distance(6 MWD), left ventricular ejection fraction(LVEF), N-terminal pro-B-type natriuretic peptide(NT-pro BNP), serum MFAP4, FBN1, TFAM levels, and safety indexes were compared between the two groups before and after treatment. Pearson correlation analysis was performed to evaluate the correlations between biomarkers and cardiac function indexes. Results After 12 weeks of treatment, the overall distribution of clinical efficacy was superior in the observation group compared with the control group(U = 1276.000,P = 0.003), and the total effective rate was also higher in the observation group than in the control group(93.33% vs. 76.67%, χ2= 6.536, P = 0.011). In both groups, TCM syndrome scores decreased and 6 MWD increased after treatment, with greater improvement in the observation group than in the control group(t/P = 3.514/<0.001 and 2.522/0.013, respectively). LVEF increased and NT-pro BNP levels decreased in both groups after treatment, with more pronounced changes in the observation group(t/P = 4.329/<0.001 and-8.497/<0.001, respectively).Serum MFAP4 and FBN1 levels decreased, whereas TFAM levels increased in both groups after treatment, and the magnitude of change was greater in the observation group(t/P = 7.591/<0.001, 9.602/<0.001, and 8.393/<0.001, respectively). Pearson correlation analysis showed that MFAP4 was positively correlated with NT-pro BNP and negatively correlated with LVEF(r/P =0.691/<0.001 and-0.460/<0.001, respectively); FBN1 was positively correlated with NT-pro BNP and negatively correlated with LVEF(r/P = 0.572/<0.001 and-0.646/<0.001, respectively); and TFAM was positively correlated with LVEF and negatively correlated with NT-pro BNP(r/P = 0.538/<0.001 and-0.517/<0.001, respectively). No statistically significant differences were found in alanine aminotransferase(ALT), aspartate aminotransferase(AST), serum creatinine(Scr), or estimated glomerular filtration rate(eGFR) between the two groups before and after treatment(all P >0.05). Conclusion On the basis of standardized Western medicine treatment,Qili Qiangxin Capsule can further improve cardiac function and clinical symptoms in patients with CHF. Its therapeutic effects may be related to downregulation of MFAP4 and FBN1, which are associated with myocardial fibrosis, and upregulation of TFAM, which is related to mitochondrial function.

Objective To explore the diagnostic value of the combination of cardiac Tei index, serum Rho-associated coiled-coil kinase 1( ROCK1), and Fibulin-5 for complicated pulmonary arterial hypertension( PAH) in patients with congenital heart disease(CHD). Methods A total of 90 patients with CHD-PAH who were admitted to Beijing Anzhen Hospital, Capital Medical University from April 2023 to April 2025 were selected as the CHD-PAH group and 90 CHD patients with simple CHD were selected as the CHD group. Serum levels of ROCK1 and Fibulin-5 were detected by ELISA.Logistic regression analysis was used to analyze the influencing factors of CHD-PAH. The diagnostic value of cardiac Tei index, serum ROCK1, and Fibulin-5 for CHD-PAH was analyzed by ROC curve. Internal validation was conducted using the Bootstrap method(1000 repeated samplings). Results Compared with the CHD group, the proportion of NYHA class Ⅲ–Ⅳ, Tei index, and serum levels of ROCK1 and Fibulin-5 were significantly higher in the CHD-PAH group(χ2/t = 28.357,7.488, 7.925, 7.634, all P <0.001). High NYHA class [OR(95%CI) = 2.950(1.382-6.299)], high Tei index [OR(95%CI) =3.284(1.389-7.764)], high serum ROCK1 level [OR(95%CI) = 3.975(1.518-10.406)], and high Fibulin-5 level [OR(95%CI) = 2.536(1.360-4.730)] were independent risk factors for the occurrence of CHD-PAH. The AUCs of cardiac Tei index,serum ROCK1, Fibulin-5 alone, and their combination for diagnosing CHD-PAH were 0.781, 0.800, 0.790, and 0.908, respectively. The combined diagnosis was significantly superior to each individual index(De Long method: Z combination-Tei index =3.947, Z combination-ROCK1 = 3.812, Z combination-Fibulin-5 = 3.730, all P <0.001). The cutoff values for cardiac Tei index, serum ROCK1, and Fibulin-5 were 0.56, 21.73 ng/mL, and 3.94 ng/mL, respectively. Moreover, the Hosmer-Lemeshow test indicated a good model fit(χ2= 6.064, df = 8, P = 0.640), confirming good consistency between the predicted probability and the measured results. Conclusion Cardiac Tei index, serum ROCK1, and Fibulin-5 levels are elevated in patients with CHD-PAH. The combination of these three parameters has high diagnostic efficacy for CHD-PAH.

Objective To investigate the combination of serum 8-iso-prostaglandin F2α(8-iso-PGF2α) and complement component 5a(C5a) in evaluating myocardial injury and prognosis in children with myocarditis(MC). Methods A total of 120 children with MC(MC group) admitted to the Department of Cardiovascular and Rheumatology of Shanxi Children' s Hospital(Shanxi Maternal and Child Health Hospital) from January 2021 to June 2024 were prospectively selected, and120 healthy children(healthy control group) were selected at a 1 ∶1 ratio. Serum 8-iso-PGF2α and C5a levels were detected by enzyme-linked immunosorbent assay. Myocardial injury markers [cardiac troponin I(cTnI), creatine kinase isoenzyme MB(CK-MB)] were measured by paramagnetic particle chemiluminescence immunoassay. Pearson correlation analysis was used to analyze the correlation between serum 8-iso-PGF2α, C5a, and myocardial injury markers in children with MC. Factors influencing prognosis and the efficacy of serum 8-iso-PGF2α and C5a levels in evaluating poor prognosis in children with MC were analyzed. Results Compared with the healthy control group, serum levels of 8-iso-PGF2α, C5a, c Tn I, and CK-MB were significantly higher in the MC group(t = 14.759, 16.801, 29.383, 14.007, all P <0.001). Serum 8-iso-PGF2α and C5a levels in children with MC were positively correlated with c Tn I and CK-MB levels(r = 0.708, 0.699, 0.637, 0.625, all P <0.001).The 1-year poor prognosis rate among the 120 children with MC was 26.67%(32/120). Levels of C-reactive protein(CRP),c Tn I, CK-MB, 8-iso-PGF2α, and C5a were significantly higher in the poor prognosis subgroup than in the good prognosis subgroup(t = 2. 395, 2. 295, 2. 341, 2. 993, 5. 707, all P < 0. 05). Elevated CRP, elevated c Tn I, elevated CK-MB, elevated8-iso-PGF2α, and elevated C5a were independent risk factors for poor prognosis in children with MC [OR(95%CI) = 2.657(1.366-5.165), 4.658(1.672-12.982), 1.228(1.051-1.435), 1.047(1.024-1.070), 1.055(1.027-1.083)]. The AUCs of serum8-iso-PGF2α, C5a, and their combination in evaluating poor prognosis in children with MC were 0.795, 0.806, and 0.905,respectively. The combined detection was superior to each individual marker(Z = 3.198, 2.683; P = 0.001, 0.007). Conclusion Elevated serum 8-iso-PGF2α and C5a levels are associated with aggravated myocardial injury and poor prognosis in children with myocarditis. Combined detection of serum 8-iso-PGF2α and C5a provides higher predictive value for prognosis assessment.

Objective To explore the predictive value of serum CC chemokine ligand 2(CCL2), pyruvate dehydrogenase kinase 4(PDK4), and Yin Yang 1 transcription factor(YY1) for myocardial injury in children with severe pneumonia in the emergency department. Methods A total of 215 children with severe pneumonia admitted to the Emergency Internal Medicine Department of Kunming Children's Hospital from January 2025 to December 2025 were selected as study subjects.According to whether they developed myocardial injury within 7 days after admission, they were divided into a myocardial injury group(n = 62) and a non-myocardial injury group(n = 153). Clinical data of the children were collected, and serum levels of CCL2, PDK4, and YY1 were measured within 24 hours of admission. Independent risk factors for the development of myocardial injury in children with severe pneumonia were analyzed. The predictive efficacy of serum CCL2, PDK4, and YY1 alone and in combination for myocardial injury was evaluated, and the clinical utility of the prediction model was assessed using decision curve analysis. Risk analysis was performed to examine the strength of the association between serum levels of CCL2, PDK4, YY1 and the development of myocardial injury in pediatric emergency patients with severe pneumonia. Results The incidence of myocardial injury among the 215 children with severe pneumonia was 28.84%(62/215). Serum levels of CCL2 and PDK4 in the myocardial injury group were significantly higher than those in the non-myocardial injury group,while YY1 level was significantly lower(t = 9.123, 8.700, 8.555, respectively, all P <0.001). Respiratory failure, elevated C-reactive protein(CRP), elevated creatine kinase-MB(CK-MB), elevated CCL2, and elevated PDK4 were independent risk factors for myocardial injury in children with severe pneumonia, while elevated YY1 was an independent protective factor[OR(95%CI)=3.574(1.064-12.001), 2.104(1.115-3.970), 2.060(1.171-3.623), 2.811(1.498-5.274), 4.319(1.543-12.086),0.338(0.131-0.869)]. The AUCs of CCL2, PDK4, YY1, and their combination for predicting myocardial injury were 0.806,0.783, 0.826, and 0.895, respectively. The combined model had a significantly larger AUC(DeLong method:Z/P = 2.677/0.007,3.375/0.001, 2.116/0.034). Within the threshold probability range of 0.10-0.85, the combined prediction model showed higher clinical net benefit(P <0.05). Conclusion Elevated serum CCL2 and PDK4 levels, as well as decreased YY1 levels, are independent risk factors for the development of myocardial injury in pediatric emergency patients with severe pneumonia. Combined detection of these three markers demonstrates good predictive value and favorable potential for clinical application.

Objective To explore the evaluation value of CT perfusion parameters combined with serum activating transcription factor 4(ATF4) and 14-3-3 protein gamma(YWHAG) for post-stroke cognitive impairment(PSCI). Methods From March 2023 to May 2025, 196 stroke patients treated in the Department of Neurology at Yan'an People's Hospital were selected to constitute the stroke group. All patients underwent CT cerebral perfusion imaging and were divided into a PSCI subgroup(n = 121) and a non-PSCI subgroup(n = 75) based on the occurrence of PSCI. During the same period, 160 individuals undergoing routine health examinations at the hospital were selected as the healthy control group. CT cerebral perfusion parameters and serum ATF4 and YWHAG levels were compared among the groups. Multivariate logistic regression analysis was used to identify risk factors for PSCI. ROC curve analysis was performed to evaluate the predictive value of CT perfusion parameters combined with serum ATF4 and YWHAG for PSCI. Results Serum ATF4 and YWHAG levels were significantly higher in the stroke group than in the healthy control group(t/P = 14.681/<0.001, 15.167/<0.001). In the PSCI subgroup, MMSE scores, cerebral blood flow(CBF), and cerebral blood volume(CBV) were significantly lower than those in the non-PSCI subgroup(t/P = 25.742/<0.001, 4.724/<0.001, 7.455/<0.001), while mean transit time(MTT), time to peak(TTP),and serum ATF4 and YWHAG levels were significantly higher(t/P = 5.587/<0.001, 4.839/< 0.001, 7.430/< 0.001, 6.646/<0.001). High MTT [OR(95%CI) = 2.141(1.220-3.758)], high TTP [OR(95%CI) = 2.512(1.363-4.630)], high ATF4 [OR(95%CI) = 4.271(1.817-10.038)], and high YWHAG [OR(95%CI) = 5.455(2.063-14.421)] were independent risk factors for PSCI, whereas high MMSE scores [OR(95%CI) = 0.651(0.428-0.990)], high CBF [OR(95%CI) = 0.691(0.491-0.972)], and high CBV [OR(95%CI) = 0.643(0.438-0.944)] were protective factors. The AUCs for predicting PSCI using CBF, CBV, MTT, TTP, serum ATF4, YWHAG, and the combination of all six factors were 0.696, 0.791, 0.750, 0.703, 0.752,0.717, and 0.934, respectively. The combined prediction of these six factors was significantly superior to each individual predictor(Z/P = 5.124/<0.001, 3.862/<0.001, 4.231/<0.001, 4.657/<0.001, 3.985/<0.001, 4.412/<0.001). Conclusion ATF4 and YWHAG are abnormally overexpressed in the serum of PSCI patients. Their combination with CT perfusion parameters demonstrates higher predictive power for PSCI and may assist in the clinical evaluation of stroke complicated by cognitive impairment.