关键词： STEMI   primary PCI   hemoglobin A1c   TIMI flow   thrombus grade  

摘要： Objectives: The acute phase of ST-segment elevation myocardial infarction (STEMI), as determined by TIMI angiographic criteria, is influenced by various factors that impact the patient's clinical outcome. However, the modifiable risk factors of impaired TIMI flow (TIMI<3) and its effective treatment are not fully understood. Hyperglycemia may induce a pro thrombotic state and thus affect TIMI flow before or after PCI. This study investigates the correlation between hemoglobin A1c levels, TIMI flow grade, and thrombus grade in infarct-related arteries, assessing its predictive value in non-diabetic patients with STEMI. Methods: The 265 patients selected based on the hemoglobin A1c level lower than 6.5 % and were divided into three groups based on HbA1c level. Comparison between three groups in terms of risk factors, troponin level, blood glucose level, lipid profile, kidney function, number of involved vessels, type of MI, left ventricular ejection fraction, TIMI flow before and after primary angioplasty, thrombus burden, complications and hospital mortality was made. Results: With the increase in HbA1c level, the prevalence of TIMI 3 flow after primary PCI decreased. The prevalence of TIMI flow 2-3 before angioplasty also decreased with the increase in HbA1c level. Increased hemoglobin A1c was also significantly related to large thrombus burden (p=0.021). Morover, hemoglobin A1c remained an independent predictor of post-PCI TIMI flow and thrombus burden. Conclusions: Elevated hemoglobin A1c is a predictor of TIMI flow less than 3 after primary PCI and high thrombus burden, in STEMI patients without a history of diabetes mellitus.

关键词： Annonaceae   Duguetia   Traditional use   Phytochemistry   Bioactivity  

摘要： This review summarizes key features of the genus Duguetia over the past 54 years (1970 to May 2024), focusing on its occurrence, distribution, isolation, and bioactivities. A thorough literature review was performed using databases such as Google Scholar, PubMed, ScienceDirect, SciFinder, and Web of Science. The search utilised the keyword "Duguetia" in combination with relevant terms like "distribution," "traditional use," "phytochemicals," "chemical compounds," "pharmacology," and "bioactivity." The findings indicate that the genus Duguetia, closely related to Keetia and Psydrax, belongs to the Annonaceae family and consists of trees and shrubs. It comprises 95 species, primarily distributed in South and Central America, with four species located in West Africa. Traditionally, plants of the genus Duguetia have been used in medicine to manage kidney colic, stomachaches, rheumatism, coughs, toothaches, fever, muscle pain, digestive issues, and respiratory problems. Chemical investigations have identified 146 secondary metabolites, with alkaloids representing approximately 76% of these compounds, serving as a chemotaxonomic marker for the genus. Other compound classes, including flavonoids, benzoic compounds, sesquiterpenoids, steroids, bisnorlignans, cinnamates, and triterpenoids, account for the remaining 24%. Pharmacological studies of chemical constituents and extracts from Duguetia species have revealed a wide range of bioactivities. These include cytotoxicity, antimalarial, antioxidant, anti-inflammatory, urease inhibition, antifungal, antinociceptive, antibacterial, antitumor, anticancer potential, and insecticidal properties. The structural diversity of alkaloids and the variety of bioactivities position the genus Duguetia as a promising resource for drug discovery and medicinal applications.

关键词： myosteatosis   fat infiltration   muscle quality   sarcopenia   ST-segment elevation myocardial infarction  

摘要： Objective: To investigate the value of myosteatosis in predicting the prognosis of patients with ST-elevation myocardial infarction (STEMI). Methods: This retrospective study involved 324 patients with STEMI who had undergone emergency percutaneous coronary intervention (PCI) at our institution between 2017 and 2020. Myosteatosis was assessed using mean muscle attenuation (MMA). Cox proportional hazards models were utilized to identify prognostic determinants required for the construction of a nomogram. The discriminatory performance of the nomogram was assessed via calibration curve analysis. Results: Among the 324 patients, 35 patients (10.8%) died during the follow-up period. A lower MMA was observed in patients who died after discharge. In the multivariate analysis, MMA was identified as an independent prognostic factor. The optimal cutoff MMA value for the prediction of all-cause mortality was 32.5 Hu. The patients were classified into high (>= 32.5, n=208) and low (<32.5, n=116) MMA groups. Compared with patients in the high-MMA group, patients in the low-MMA group had shorter overall survival (OS). Finally, nomograms for OS that integrate the MMA and other clinical parameters were constructed. The calibration analysis revealed that the nomograms accurately predicted the 1-, 3- and 5-year OS rates of patients. Conclusions: Myosteatosis was associated with poorer survival outcomes in STEMI patients who underwent emergency PCI. A novel risk model comminating myosteatosis with other common clinical indicators can accurately predict the prognosis of STEMI patients.