Inadvertent left ventricular pacing and perforation by a temporary pacemaker.

Myocardial perforation by pacemaker electrode is a very serious complication. Usually, the pacemaker electrode perforates the right ventricle, but rarely the left ventricular myocardium. We describe an 82-year-old female patient who presented with left ventricular pacing after temporary pacemaker implantation and was diagnosed with myocardial perforation. Emergency thoracotomy showed that the exact position of the cardiac perforation was close to the left ventricular apex. Perforation of the left ventricular free wall by an electrode sometimes progresses slowly. We should be alert to the possibility of left ventricular perforation, in which case, immediate surgery is the best option.

Real-world safety profile of zanubrutinib: a disproportionality analysis based on the FAERS database.

OBJECTIVE: Zanubrutinib is a second-generation Bruton's tyrosine kinase inhibitor that has been approved for the treatment of several B cell malignancies. The aim of this study was to evaluate adverse events (AEs) associated with zanubrutinib based on the real-world data. DESIGN: A disproportionality analysis was performed to identify the potential zanubrutinib-related AEs. SETTING: The Food and Drug Administration AE Reporting System database from the fourth quarter of 2019 to the third quarter of 2023. MAIN OUTCOME MEASURES: The results of the disproportionality analyses were presented as reported ORs (RORs). When the lower limit of the 95% CI for the ROR is greater than 1 and the number of AE reports is≥3, it indicates that the preferred term (PT) may be a positive AE signal. RESULTS: A total of 846 AE reports with zanubrutinib as the primary suspect drug were obtained, with 2826 AEs. A total of 74 positive PT signals were detected across 18 system organ classes (SOCs). The most significant signal for SOC was 'blood and lymphatic system disorders' (ROR=2.8, 95% CI 2.3 to 3.3), while the most significant signal for PT was 'haemorrhage subcutaneous' (ROR=190.8, 95% CI 128.0 to 284.5). 13 unexpected off-label AEs were also observed, such as abnormal hair texture, skin discolouration, hypernatraemia, pericardial effusion and hypersomnia. The median time to onset of AEs associated with zanubrutinib was 51 days (IQR 13-192 days) and was consistent with the early failure model. In comparison with zanubrutinib monotherapy, the combination of zanubrutinib and rituximab therapy was linked to a higher risk of specific AEs, including myelosuppression, pneumonia, leucopenia, thrombocytopenia, abdominal pain, anaemia, pancytopenia and respiratory failure. Furthermore, the combination of zanubrutinib and chemotherapy increased the risk of several severe AEs, such as cardiac arrest, elevated blood lactate dehydrogenase levels and pancytopenia. CONCLUSIONS: The results of the analysis provided valuable insights into the safety profile of zanubrutinib-treated patients, which was helpful for clinical monitoring and identifying potential AEs related to zanubrutinib.

Kernel Masked Image Modeling Through the Lens of Theoretical Understanding.

Masked image modeling (MIM) has been considered as the state-of-the-art (SOTA) self-supervised learning (SSL) technique in terms of visual pretraining. The impressive generalization ability of MIM also paves the way for the remarkable success of large-scale vision foundation models. In this article, we further discuss the validity and advantages of implementing MIM techniques in the reproducing kernel Hilbert spaces (RKHSs) and we associate the analysis with a novel MIM method named R-MIM (short for RKHS-MIM). Through the careful construction of an augmentation graph and by using spectral decomposition techniques, we establish a systematic theoretical understanding between the proposed R-MIM's generalization ability and the choice of kernel function used during training. Specifically, we reach a conclusion that both of the local Lipschitz constant of the resultant R-MIM model and the corresponding expected pretraining error can have a strong composite effect on bounding downstream task error, depending on the kernel options. We demonstrate that under mild mathematical assumptions, R-MIM method is guaranteed to return a lower bound on downstream tasks in comparison to vanilla MIM techniques, such as masked autoencoder (MAE) and SimMIM. Empirical justification well corroborates our theoretical hypothesis and analysis in showing the superior generalization of the proposed R-MIM and the theoretical link to kernel choices. The code is available at: https://github.com/yurui-q/R-MIM.

Cost-effectiveness analysis of anlotinib versus sunitinib as first-line treatment for metastatic renal cell carcinoma in China.

BACKGROUND: Sunitinib was approved several years ago as a first-line drug for treating metastatic renal cell carcinoma (mRCC); however, its high price and broad side effects when administered at the standard dose have limited its clinical use. A clinical trial (NCT02072031) confirmed that anlotinib could be used as the first-line treatment for mRCC. This study was conducted to evaluate the cost-effectiveness of anlotinib as a first-line treatment for mRCC compared to that of sunitinib in China. METHODS: A Markov model was established to compare the cost-effectiveness of anlotinib with that of sunitinib. Clinical data were obtained from a multi-center phase II trial (clinical trial information: NCT02072031). Utility values were obtained from the literature. Total costs were calculated from a Chinese societal perspective. A sensitivity analysis was conducted to assess the model uncertainty. The life-year (LY), quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio were calculated. RESULTS: The base-case analysis over a lifetime horizon of 10 years showed that the anlotinib group had 2.196 LYs and 1.487 QALYs at a total cost of $68,597.84. The sunitinib group had 2.194 LYs and 1.432 QALYs at a total cost of $88,060.02. This resulted in incremental cost-effectiveness ratios (ICER) of anlotinib versus sunitinib of $-9,210,858.93 per LYs and $-354,117.07 per QALYs, suggesting that anlotinib is a more effective and less costly strategy than sunitinib. CONCLUSION: Anlotinib may be a more cost-effective first-line treatment strategy for mRCC than sunitinib in China.

A Low Rank Promoting Prior for Unsupervised Contrastive Learning.

Unsupervised learning is just at a tipping point where it could really take off. Among these approaches, contrastive learning has led to state-of-the-art performance. In this paper, we construct a novel probabilistic graphical model that effectively incorporates the low rank promoting prior into the framework of contrastive learning, referred to as LORAC. In contrast to the existing conventional self-supervised approaches that only considers independent learning, our hypothesis explicitly requires that all the samples belonging to the same instance class lie on the same subspace with small dimension. This heuristic poses particular joint learning constraints to reduce the degree of freedom of the problem during the search of the optimal network parameterization. Most importantly, we argue that the low rank prior employed here is not unique, and many different priors can be invoked in a similar probabilistic way, corresponding to different hypotheses about underlying truth behind the contrastive features. Empirical evidences show that the proposed algorithm clearly surpasses the state-of-the-art approaches on multiple benchmarks, including image classification, object detection, instance segmentation and keypoint detection. Code is available: https://github.com/ssl-codelab/lorac.

Predicting Adverse Neonatal Outcomes for Preterm Neonates with Multi-Task Learning.

Diagnosis of adverse neonatal outcomes is crucial for preterm survival since it enables doctors to provide timely treatment. Machine learning (ML) algorithms have been demonstrated to be effective in predicting adverse neonatal outcomes. However, most previous ML-based methods have only focused on predicting a single outcome, ignoring the potential correlations between different outcomes, and potentially leading to suboptimal results and overfitting issues. In this work, we first analyze the correlations between three adverse neonatal outcomes and then formulate the diagnosis of multiple neonatal outcomes as a multi-task learning (MTL) problem. We then propose an MTL framework to jointly predict multiple adverse neonatal outcomes. In particular, the MTL framework contains shared hidden layers and multiple task-specific branches. Extensive experiments have been conducted using Electronic Health Records (EHRs) from 121 preterm neonates. Empirical results demonstrate the effectiveness of the MTL framework. Furthermore, the feature importance is analyzed for each neonatal outcome, providing insights into model interpretability.

Using a Hybrid Multiattribute Decision-Making Model for Evaluating the Sustainable Development Potential of Characteristic Towns and Exploring Development Planning Strategies.

In recent years, with the development of 'China's new urbanization, the "characteristic town movement" with the development of industrial economy first has brought problems to a large number of rural settlements, such as no cultural planning, no consumption of industry, and no soul. Then, in reality, there are still a large number of rural settlements under the planning of the upper-level local government, with the goal of developing into a characteristic town in the future. Therefore, this study believes that there is an urgent need to build a framework for evaluating the construction potential of rural settlements with sustainable characteristic towns. Not only that but also a decision analysis model should be provided for real-world empirical cases. This model needs to cover the assessment of the sustainable development potential of characteristic towns as the goal and the formulation of improvement strategies. This study combines the data collection of current characteristic town development rating reports, applies data exploration technology to extract core impact elements and obtain hierarchical decision rules, integrates expert domain knowledge with DEMATEL technology, and establishes an impact network relationship diagram between core impact elements. At the same time, the representative characteristic town cases are assessed for their sustainable development potential, and the modified VIKOR technique is applied to clarify the actual problems of the empirical cases, in an attempt to determine whether the development potential and development plan of the characteristic town meet the sustainable development needs from the pre-evaluation mechanism.

Dual Surface Modifications of NiOx/Perovskite Interface for Enhancement of Device Stability.

Various phosphonic acid based self-assembled monolayers (SAMs) have been commonly used for interface modifications in inverted perovskite solar cells. This typically results in significant enhancement of the hole extraction and consequent increase in the power conversion efficiency. However, the surface coverage and packing density of SAM molecules can vary, depending on the chosen SAM material and underlying oxide layer. In addition, different SAM molecules have diverse effects on the interfacial energy level alignment and perovskite film growth, resulting in complex relationships between surface modification, efficiency, and lifetime. Here we show that ethanolamine surface modification combined with [2-(9H-carbazol-9-yl)ethyl]phosphonic acid (2PACz) results in significant improvement in device stability compared to devices with 2PACz modification only. The significantly smaller size of ethanolamine enables it to fill any gaps in 2PACz coverage and provide improved interfacial defect passivation, while its different chemical structure enables it to provide complementary effects to 2PACz passivation. Consequently, the perovskite films are more stable under illumination (slower photoinduced segregation), and the devices exhibit significant stability enhancement. Despite similar power conversion efficiencies (PCE) between 2PACz only and combined ethanolamine-2PACz modification (PCE of champion devices ∼21.6-22.0% for rigid and ∼20.2-21.0% for flexible devices), the T80 lifetime under simulated solar illumination in ambient is improved more than 15 times for both rigid and flexible devices.

CD151 promotes proliferation and migration of PC3 cells via the formation of CD151-integrin α3/α6 complex.

Over-expression of CD151 was found to be associated with metastasis and poor prognosis of prostatic carcinoma. This study was designed to examine the mechanism by which CD151 promotes the proliferation and migration of prostatic cancer cells. The pAAV-CD151, pAAV-GFP and pAAV-CD151-AAA mutant plasmids were constructed and used to transiently transfect PC3 cells (a prostatic carcinoma 3 cell line) by the mediation of Fugene HD. Then, the cells were assigned to control group, pAAV-GFP group, pAAV-CD151 group, and pAAV-CD151-AAA group respectively. Cell proliferation was evaluated by using the 3-[4,5-dimet-hylthiazol-2-yl]-2,5, diphenyltetrazolium bromide (MTT) method. Cell migration assay was performed by using Boyden chambers. The formation of CD151-integrin α3/α6 complex was determined by the method of co-immunoprecipitation. The protein expression levels of CD151 and extracellular signal-regulated kinase (ERK) were measured by Western blotting. The results showed that transfection of pAAV-CD151 or pAAV-CD151-AAA mutant increased the expression of CD151 protein in PC3 cells. Co-immunoprecipitation showed that more CD151-integrin α3/α6 complex was formed in the pAAV-CD151 group than in the control group, the pAAV-GFP group and the pAAV-CD151-AAA mutant group. Furthermore, the proliferative and migrating capacity of PC3 cells was substantially increased in the pAAV-CD151 group but inhibited in the pAAV-CD151-AAA mutant group. CD151 transfection increased the expression of phospho-ERK. Taken together, it was concluded that CD151 promotes the proliferation and migration of PC3 cells through the formation of CD151-integrin complex and the activation of phosphorylated ERK.

Targeting mitochondrial tyrosyl-tRNA synthetase YARS2 suppresses colorectal cancer progression.

Defects in tRNA expressions and modifications had been linked to various types of tumorigenesis and progression in recent studies, including colorectal cancer. In the present study, we evaluated transcript levels of mitochondrial tyrosyl-tRNA synthetase YARS2 in both colorectal cancer tissues and normal colorectal tissues using qRT-PCR. The results revealed that the mRNA expression level of YARS2 in colorectal cancer tissues was significantly higher than those in normal intestinal tissues. Knockdown of YARS2 in human colon cancer cell-line SW620 leads to significant inhibition of cell proliferation and migration. The steady-state level of tRNATyr, OCR, and ATP synthesis were decreased in the YARS2 knockdown cells. Moreover, our data indicated that inhibition of YARS2 is associated with increased reactive oxygen species levels which sensitize these cells to 5-FU treatment. In conclusion, our study revealed that targeting YARS2 could inhibit colorectal cancer progression. Thus, YARS2 might be a carcinogenesis candidate gene and can serve as a potential target for clinical therapy.

Photo-Thermo-Mechanochemical Approach to Synthesize Quinolines via Addition/Cyclization of Sulfoxonium Ylides with 2-Vinylanilines Catalyzed by Iron(II) Phthalocyanine.

A novel photo-thermo-mechanochemical approach to assembling quinolines catalyzed by iron(II) phthalocyanine has been realized for the first time. This transformation features a cost-efficient catalytic system and operational simplicity, is free of solvent, and shows good substrate tolerance, providing a green alternative to existing thermal approaches. Mechanistic experiments demonstrate that the in-situ-formed secondary amine may be the key intermediate for the further cyclization/aromatization process.

Encapsulation and Stability Testing of Perovskite Solar Cells for Real Life Applications.

With the progress in the development of perovskite solar cells, increased efforts have been devoted to enhancing their stability. With more devices being able to survive harsher stability testing conditions, such as damp heat or outdoor testing, there is increased interest in encapsulation techniques suitable for this type of tests, since both device architecture compatible with increased stability and effective encapsulation are necessary for those testing conditions. A variety of encapsulation techniques and materials have been reported to date for devices with different architectures and tested under different conditions. In this Perspective, we will discuss important factors affecting the encapsulation effectiveness and focus on the devices, which have been subjected to outdoor testing or damp heat testing. In addition to encapsulation requirements for these testing conditions, we will also discuss device requirements. Finally, we discuss possible methods for accelerating the testing of encapsulation and device stability and discuss the future outlook and important issues, which need to be addressed for further advancement of the stability of perovskite solar cells.

Adeno associated viral vector-delivered and hypoxia response element-regulated CD151 expression in ischemic rat heart.

AIM: The aim of this study was to improve the delivery efficacy and target specificity of the pro-angiogenic gene CD151 to the ischemic heart. METHODS: To achieve the inducible expression of adeno-associated viral (AAV)-delivered CD151 gene in only the ischemic myocardium, we generated an AAV construct in which CD151 expression can be controlled by the hypoxia response element (HRE) sequence from the human Enolase gene. The function of this vector was examined in rat H9C2 cardiac myoblasts and in ischemic rat myocardium. The expression of CD151 in the areas of ischemic myocardium was confirmed at the mRNA level by real-time PCR and on the protein level by Western blot, whereas the CD151 expression in the microvessels within the areas of ischemic myocardium was detected by immunohistochemistry. RESULTS: HRE significantly enhances the expression of CD151 under hypoxic conditions or in the ischemic myocardium, and forced CD151 expression increases the number of microvessels in the ischemic myocardium. CONCLUSION: The AAV-mediated, HRE regulated delivery of the CD151 gene shows higher expression in the ischemic myocardium and more efficiently targets CD151 to the hypoxic regions after myocardial infarction.

Low curcumin concentration enhances the anticancer effect of 5-fluorouracil against colorectal cancer.

BACKGROUND: Colon cancer treatments include surgery, radiotherapy, and chemotherapy. Chemotherapy using 5-fluorouracil (5-FU) has been widely applied to treat colorectal cancer (CRC). However, it is important to explore the use of chemotherapy drugs in combination with other agents to decrease severe adverse effects. PURPOSE: This study aimed to investigate the effects of curcumin in combination with 5-FU on the proliferation, migration, and apoptosis of CRC SW620 cell line both in vitro and in vivo. METHODS: Flow cytometry was used to study the effect of curcumin on chemotherapy-induced apoptosis in CRC cells. The mechanism of curcumin's enhanced antitumor effect in vivo was investigated using gene knockdown, TUNEL, western blot, qRT-PCR and immunohistochemistry. RESULTS: The results showed a synergistic effect of the two compounds on CRC cells. Considerable reduction in the proliferation and migration of SW620 cells was observed in the combination treatment group. Significantly increased apoptosis rate extended the survival of immunodeficient mice in the combination group as compared to that of the 5-FU group (p < 0.05). The results showed that curcumin significantly inhibited pERK signaling and downregulated L1 expression in SW620 cells. CONCLUSIONS: We conclude that curcumin promotes chemosensitivity of CRC cells to 5-FU by downregulating L1 expression. Our findings provide experimental evidence for the synergism between curcumin and 5-FU, which can be utilized in clinical applications for reducing the toxicity and adverse effects of 5-FU.

Predicting Progression of COVID-19 Infection to Prioritize Medical Resource Allocation: A Novel Triage Model Based on Patient Characteristics and Symptoms at Presentation.

Background: The COVID-19 global pandemic has posed unprecedented challenges to health care systems all over the world. The speed of the viral spread results in a tsunami of patients, which begs for a reliable screening tool using readily available data to predict disease progression. Methods: Multicenter retrospective cohort study was performed to develop and validate a triage model. Patient demographic and non-laboratory clinical data were recorded. Using only the data from Zhongnan Hospital, step-wise multivariable logistic regression was performed, and a prognostic nomogram was constructed based on the independent variables identifies. The discrimination and calibration of the model were validated. External independent validation was performed to further address the utility of this model using data from Jinyintan Hospital. Results: A total of 716 confirmed COVID-19 cases from Zhongnan Hospital were included for model construction. Men, increased age, fever, hypertension, cardio-cerebrovascular disease, dyspnea, cough, and myalgia are independent risk factors for disease progression. External independent validation was carried out in a cohort with 201 cases from Jinyintan Hospital. The area under the curve (AUC) was 0.787 (95% confidence interval [CI]: 0.747-0.827) in the training group and 0.704 (95% CI: 0.632-0.777) in the validation group. Conclusions: We developed a novel triage model based on basic and clinical data. Our model could be used as a pragmatic screening aid to allow for cost efficient screening to be carried out such as over the phone, which may reduce disease propagation through limiting unnecessary contact. This may help allocation of limited medical resources.

Activation of the ERK signaling pathway is involved in CD151-induced angiogenic effects on the formation of CD151-integrin complexes.

AIM: To assess the roles of extracellular signal-regulated kinase (ERK), p38, and CD151-integrin complexes on proliferation, migration, and tube formation activities of CD151-induced human umbilical vein endothelial cells (HUVECs). METHODS: CD151, anti-CD151 and CD151-AAA mutant were inserted into recombinant adeno-associated virus (rAAV) vectors and used to transfect HUVECs. After transfection, the expression of CD151 was measured. Proliferation was assessed using the 3-[4,5-dimethylthiazol- 2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay. Cell migration was evaluated in Boyden transwell chambers using FBS as the chemotactic stimulus. The tube formation assay was performed on matrigel. The potential involvement of various signaling pathways was explored using selective inhibitors. RESULTS: CD151 gene delivery increased the expression of CD151 at both the mRNA and protein levels. Overexpression of CD151 promoted cell proliferation, migration and tube formation in vitro, and phosphorylation of ERK was also increased. Further, CD151-induced cell proliferation, migration, and tube formation were attenuated by the ERK inhibitor PD98059 (20 micromol/L) but not by a p38 inhibitor (SB203580, 20 micromol/L). Moreover, there was no significant difference in CD151 protein expression between the CD151 group and the CD151-AAA group, but the CD151-AAA mutant abrogated cellular proliferation, migration, and tube formation and decreased the phosphorylation of ERK. CONCLUSION: This study suggests that activation of the ERK signaling pathway may be involved in the angiogenic effects of CD151. Activation of ERK was dependent on the formation of CD151-integrin complexes. Therefore modulation of CD151 may be as a novel therapeutic strategy for regulating angiogenesis.

Effects of transfection of ICAP-1α and its mutants on adhesion and migration of 2H-11 cells.

This study examined the effect of integrin cytoplasmic domain-associated protein 1α (ICAP-1α) and its mutatants T38A and I138A on the adhesion, migration and tube formation of 2H-11 cells. rAAV-ICAP-1α, rAAV-T38A and rAAV-I138A were constructed. After infection, the expression of ICAP-1α and p-ERK1/2, p-c-Jun protein was measured by Western blotting. Adhesion ability was evaluated by using MTT. Cell migration was determined by using Boyden chamber method. Tube formation test was conducted on Matrigel. The results showed that in ICAP-1α, T38A and I138A groups, ICAP-1α protein expression was increased. In T38A and I138A groups, phospho-ERK1/2, phospho-c-Jun protein expressions were significantly increased as compared with the control group and the GFP group. ICAP-1α group protein expression was obviously decreased when compared with the control group and the GFP group. Cell adhesion ratio was 0.1429±0.0080 in control group, 0.1434±0.0077 in GFP group and the ratio in T38A and I138A groups increased to 0.3210±0.0082 and 0.3250±0.0079, respectively. In ICAP-1α group, the ratio was decreased to 0.1005±0.0073. In T38A and I138A groups, the number of migrating 2H-11 cells was increased to 31.45±3.20 and 33.10±5.40 against 18.51±2.80 in control group and 20.47±3.12 in GFP group. In ICAP-1α group, the number was decreased to 12.06±1.72. The number of tube-like structures was increased to 20.41±2.54 in T38A and to 22.26±3.07 in I138A groups as compared to those of control group 12.45±1.84 and GFP group 13.63±2.71. In ICAP-1α group, the number of tube-like structures was decreased to 8.32±1.24. It was suggested that rAAV-T38A and rAAV-I138A transfection can substantially increase 2H-11 cell adhesion, migration and angiogenisis, while rAAV-ICAP-1α can greatly inhibit the effect. These effects might be correlated with ERK1/2 and c-Jun protein phosphorylation.

Lattice-strained palladium nanoparticles as active catalysts for the oxygen reduction reaction.

Introduction of lattice strain into catalysts is a facile way to modify catalytic behaviour. Here, we report the synthesis of Pd nanoparticles with compressive strain by pulsed laser ablation of a Pd target immersed in an aqueous solution. The intensive quenching effect induces obvious compressive strain which improves the ORR performance of the Pd nanoparticles significantly.

Salvianolate Blocks Apoptosis During Myocardial Infarction by Down Regulating miR-122-5p.

BACKGROUND: Recent studies have provided evidence that microRNAs (miRNAs), as a potential biomarker, were involved in the regulation of gene expression in Myocardial Infarction (MI). This study aimed to highlight the role of salvianolate on cardiomyocyte apoptosis in MI. METHODS: Anterior descending branch of left coronary artery was ligated to set up MI model. MiR- 122-5p mimic was transfected into cardiomyocytes and verified by quantitative real-time PCR (qRT-PCR). Cell viability and apoptotic rate were measured by MTT assay and flow cytometry together with TUNEL method, respectively. Changes in the expression of caspase-3, Bax and Bcl-2 were quantified by qRT-PCR and western blot. RESULTS: After treatment with salvianolate, miR-122-5p expression and caspases-3 activity significantly decreased in rat myocardial tissues. Furthermore, cardiomyocytes apoptosis rate was obviously suppressed while cell viability dramatically increased in H9C2 cardiomyocytes. However, overexpression of miR-122-5p reversed the aforementioned trends. Simultaneously, it could also mitigate the anti-apoptosis effect of salvianolate on the upregulation of caspases-3 viability and Bax expression and downregulation of Bcl-2 expression. CONCLUSION: Salvianolate induces the anti-apoptosis mechanism of cardiomyocytes via downregulation of miR-122-5p, Bax expression and caspases-3 as well as upregulation of Bcl-2 expression. In contrast, overexpression of miR-122-5p inhibits the effect of salvianolate.

Low NT-proBNP levels: An early sign for the diagnosis of ischemic heart failure.

BACKGROUND: N-terminal pro-brain natriuretic peptide (NT-proBNP) is seen to be mostly elevated in patients with acute heart failure (AHF). However, cases of AHF presenting with low NT-proBNP levels have been reported. In this study designed to investigate the factors associated with low NT-proBNP levels in AHF patients, we discovered that etiology and related factors have an influence on NT-proBNP levels. METHODS: In this study, 154 AHF patients met the study criteria (117 men, median age 74years; left ventricular ejection fraction [LVEF] 46±13%; New York Heart Association [NYHA] classes II-IV). We analyzed the different clinical variables of patients based on plasma NT-proBNP levels. In addition, we identified the differences in NT-proBNP levels between ischemic and non-ischemic etiologies, as well as the relationships between time from symptom onset to ED visit and NT-proBNP levels. RESULTS: The group with low NT-proBNP levels showed an ischemic association, higher LVEF, lower NYHA class and shorter time from symptom onset to ED visit. Plasma NT-proBNP levels were lower in the ischemic group than in the non-ischemic group (P<0.01). Meanwhile, NT-proBNP levels were relatively low in patients during early phases of AHF hospitalization and increased with time from symptom onset to ED visit (P<0.01). CONCLUSION: We inferred that low NT-proBNP levels may infer the ischemic etiology especially in patients with normal LVEF in the early phases of AHF hospitalization.