Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To identify early predictors of factors influencing the efficacy of infliximab (IFX) treatment in patients with Crohn's disease (CD) .Methods:This study is a nested case-control study, including CD patients treated with IFX at the Second Affiliated Hospital of Soochow University from November 2015 to April 2021 and at the First Affiliated Hospital of Nanjing Medical University from November 2015 to December 2022. All the patients were followed up until June 2023 and categorized into IFX non-response and treatment-effective groups based on changes in clinical symptoms and endoscopic image during the follow-up. Laboratory data of inflammatory markers, post-induction trough IFX concentration and antibody levels in both groups were retrospectively collected and compared. Logistic regression models were employed to identify potential factors associated with the risk of IFX non-responsiveness. Machine learning using random forest analysis was utilized to quantitatively assess the predictive features for IFX treatment efficacy and ROC curves was used to evaluate the model's accuracy.Results:This study included 147 CD patients undergoing IFX treatment, with 58 from the Second Affiliated Hospital of Soochow University and 89 from the First Affiliated Hospital of Nanjing Medical University. Among them, 38 were classified as the IFX non-response group, and 109 as the effective group. Patients in the IFX non-response group had lower trough concentration ( P < 0.001), higher antibody levels ( P < 0.001), and a less pronounced reduction in ESR during the induction therapy ( P < 0.001). Univariate and multi-variate Logistic regression models demonstrated that IFX trough concentration and the ratio of ESR before and after induction therapy was associated with the risk of non-responsiveness. After the induction period, for each unit increase in IFX trough concentration (1 μg/ml), the risk of IFX non-response decreased by 23% ( RR = 0.77, 95% CI = 0.68-0.89), while each doubling of the ESR ratio after induction was associated with a 1.43-fold increase in the risk of non-response ( RR = 2.43, 95% CI = 1.48-4.00). Random forest machine learning analysis revealed that IFX trough concentration below 1.5 μg/ml could predict IFX non-response, with area under the ROC curve was 0.722. Conclusion:Lower post-induction IFX trough concentrations is predictive of IFX non-response, while a lack of significant decrease in ESR during the induction phase is also significantly associated with IFX non-response.

Objective:To identify early predictors of factors influencing the efficacy of infliximab (IFX) treatment in patients with Crohn's disease (CD) .Methods:This study is a nested case-control study, including CD patients treated with IFX at the Second Affiliated Hospital of Soochow University from November 2015 to April 2021 and at the First Affiliated Hospital of Nanjing Medical University from November 2015 to December 2022. All the patients were followed up until June 2023 and categorized into IFX non-response and treatment-effective groups based on changes in clinical symptoms and endoscopic image during the follow-up. Laboratory data of inflammatory markers, post-induction trough IFX concentration and antibody levels in both groups were retrospectively collected and compared. Logistic regression models were employed to identify potential factors associated with the risk of IFX non-responsiveness. Machine learning using random forest analysis was utilized to quantitatively assess the predictive features for IFX treatment efficacy and ROC curves was used to evaluate the model's accuracy.Results:This study included 147 CD patients undergoing IFX treatment, with 58 from the Second Affiliated Hospital of Soochow University and 89 from the First Affiliated Hospital of Nanjing Medical University. Among them, 38 were classified as the IFX non-response group, and 109 as the effective group. Patients in the IFX non-response group had lower trough concentration ( P < 0.001), higher antibody levels ( P < 0.001), and a less pronounced reduction in ESR during the induction therapy ( P < 0.001). Univariate and multi-variate Logistic regression models demonstrated that IFX trough concentration and the ratio of ESR before and after induction therapy was associated with the risk of non-responsiveness. After the induction period, for each unit increase in IFX trough concentration (1 μg/ml), the risk of IFX non-response decreased by 23% ( RR = 0.77, 95% CI = 0.68-0.89), while each doubling of the ESR ratio after induction was associated with a 1.43-fold increase in the risk of non-response ( RR = 2.43, 95% CI = 1.48-4.00). Random forest machine learning analysis revealed that IFX trough concentration below 1.5 μg/ml could predict IFX non-response, with area under the ROC curve was 0.722. Conclusion:Lower post-induction IFX trough concentrations is predictive of IFX non-response, while a lack of significant decrease in ESR during the induction phase is also significantly associated with IFX non-response.

Objective To evaluate the effect of dexmedetomidine administered at different time points on the quality of anesthesia recovery and inflammatory response in children undergoing craniotomy.Methods According to the randomized double-blind method,200 pediatric patients who underwent craniotomy in Beijing Fengtai Hospital from August 2017 to August 2022 were divided into 4 groups,with 50 cases in each group.In preoperative group,0.5μg/(kg?h)dexmedetomidine was intravenously pumped 30min before anesthesia induction,and the drug was stopped before the start of surgery.In intraoperative group,0.5μg/(kg?h)dexmedetomidine was infused intravenously after the beginning of the operation,and the drug was stopped 30min before the end of the operation.In postoperative group,0.5μg/(kg?h)dexmedetomidine was infused intravenously after the main steps of the operation,and the drug was discontinued at the end of the operation.In control group,the same volume of normal saline was injected intravenously 30min before anesthesia induction.The recovery quality,hemodynamics,inflammatory response,and adverse reactions were compared among the four groups.Results The extubation time of postoperative group[(43.84±5.12)min]was significantly longer than that of preoperative group[(16.73±3.28)min],intraoperative group[(18.05±3.47)min],and control group[(25.63±4.64)min],the difference was statistically significant(P<0.05).Ramsay sedation scores,mean arterial pressure(MAP),heart rate(HR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 were compared between preoperative group and intraoperative group before anesthesia induction in a quiet state(T0),immediately after extubation(T1)and 5min after extubation(T2).The difference was not statistically significant(P>0.05).Ramsay sedation scores and levels of CRP,TNF-α and IL-6 at T1 and T2 in postoperative group were significantly higher than those in preoperative group,intraoperative group and control group,and MAP and HR were significantly lower than those in preoperative group,intraoperative group and control group,with statistically significant differences(P<0.05).There was no significant difference in the overall incidence of adverse reactions among the four groups(P>0.05).Conclusion Intravenous infusion of dexmedetomidine at different time points in children undergoing craniotomy has no obvious adverse reactions,but intravenous infusion of dexmedetomidine before and during operation has little effect on hemodynamics and inflammatory response during anesthesia recovery period,and the quality of recovery and sedation is better.Intravenous infusion of dexmedetomidine after operation will prolong extubation time.

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

Objective:To probe the diagnostic performance of the combined evaluation of stenosis and plaque characteristics based on coronary computed tomography angiography (CCTA) in identification of myocardial ischemic lesions, using the invasive coronary angiography (ICA)-based fractional flow reserve (FFR) as the gold standard.Methods:From November 2018 to March 2020, the patients with suspected or known coronary artery disease and scheduled for ICA at 5 clinical trials centers were enrolled in this study. All the patients underwent CCTA, ICA and FFR in turn in one week. The luminal stenosis and plaque characteristics were measured and assessed including plaque burden, volume ratios of calcification and non-calcification, lesion length and CT vulnerable features. All culprit vessels were divided into FFR≤0.8 and FFR>0.8 groups, and the parameters of plaque characteristics were compared. The correlation of ischemic lesions with CCTA stenosis and plaque characteristics was analyzed by the logistic regression analysis. The ROC curve was used to evaluate the sensitivity and specificity of CCTA stenosis rate and plaque characteristics, meanwhile the area under curve (AUC) of each parameter was compared by Delong test.Results:Three hundred and sixty-six culprit vessels in 317 patients were analyzed in this study (169 vessels in ischemia group and 197 in nonischemia group). The plaque burden [34.3% (30.3%, 38.8%) vs. 32.4% (28.5%, 37.9%); Z=-2.622, P=0.009], proportion of CT vulnerable features [26.9% (45/169) vs.11.7% (23/197); χ 2=15.311, P<0.001] and lesion length [22.1 (14.4, 35.0) mm vs. 17.6 (11.0, 26.0) mm; Z=-4.388, P<0.001] in FFR≤0.8 group were higher than those in FFR>0.8 group. The results of logistic regression analysis revealed that CCTA stenosis, lesion length, and CT vulnerable features were significant predictors for myocardial ischemia (OR values: 3.794, 2.461, 1.027; P<0.001, P=0.002, P=0.002). The diagnostic performance of CCTA ≥50% stenosis alone in identification of ischemic lesions was low (AUC=0.625). When it combined high-risk plaque characteristics and lesion length, the AUC was improved to 0.714 with a statistical significance. Conclusions:CCTA stenosis, lesion length, and CT vulnerable features are major predictors in identification of myocardial ischemic lesions, and the combination will significantly improve the diagnostic performance of CCTA ≥50% stenosis.

Objective To evaluate the effects of leptin on brain injury and long-term cognitive function in rats undergoing orthotopic liver transplantation. Methods Ninety clean-grade male Sprague-Dawley rats, aged 3 months, weighing 200-250 g, were divided into 3 groups by a random number table method: sham operation group ( S group) , liver ischemia-reperfusion ( I∕R) group ( I∕R group) and lep-tin group ( L group) , with 18 rats in each group. Orthotopic liver transplantation was performed to estab-lish the model of liver I∕R injury in I∕R and L groups. Leptin 1 mg∕kg was intraperitoneally injected at the onset of ischemia in L group, and the equal volume of normal saline was given instead of leptin in S and I∕R groups. Twelve rats in each group were sacrificed at 3 days after operation, and brains were removed for ex-amination of the pathological changes in hippocampal CA1 region ( with a light microscope) and for determi-nation of apoptosis in hippocampal neurons ( by TUNEL assay) and expression of aquaporin 4 ( AQP4) and protein kinase C ( PKC) in the hippocampus ( by Western blot) . The apoptosis rate was calculated. The remaining 6 rats in each group underwent a Morris water maze test at 30 days after surgery to evaluate long-term cognitive function. Results Compared with S group, the apoptosis rate of hippocampal neurons was significantly increased, the expression of AQP4 and PKC was up-regulated, the escape latency was pro-longed, and the time of staying at the platform quadrant was shortened in I∕R and L groups (P<0. 05). Compared with I∕R group, the apoptosis rate of hippocampal neurons was significantly decreased, the ex-pression of AQP4 and PKC was down-regulated, the escape latency was shortened, and the time of staying at the platform quadrant was prolonged in L group (P<0. 05). Conclusion Leptin can reduce the brain damage in rats undergoing orthotopic liver transplantation, the mechanism may be related to down-regulating the expression of PKC and AQP4, and leptin can also improve long-term cognitive function after orthotopic liver transplantation in rats.

Objective To study the clinical value of whole －body magnetic resonance diffusion weighted imaging(WB－DWI) in evaluating the chemotherapy response for lung cancer,thus to provide evidence for optimizing clinical imaging examination. Methods From October 2017 to May 2018,60 patients with lung cancer confirmed by histopathology in Linfen Central Hospital were selected. The patients underwent DWI examinations before chemotherapy and after two cycles of chemotherapy. The change of tumor size,distant metastasis and apparent diffusion coefficient (ADC) value were compared before and after chemotherapy. The correlation between the change rate of ADC value and the shrinkage rate of tumor size in the effective group was analyzed. Results Of 60 cases,1 case had new cerebral metastases after chemotherapy. There were statistically significant differences in ADC value [(1. 12 ± 0.33) ×10 －3mm2/svs.(1.56±0.40) ×10 －3mm2/s]andtumorsize[(4.63±2.75)cmvs.(2.28±1.45)cm] between before and after chemotherapy in the effective group(t= －3. 954,4. 711,all P＜0. 01). There was correlation between the change of ADC value and tumor size(r=0. 34,P＜0. 05). Conclusion WB－DWI can not only detect the change of tumor size and distant metastasis quickly and effectively,but also can observe the microscopic changes of tumor cells by measuring ADC value. So it can predict the early therapeutic response of the tumor and make effective evaluation for the staging and chemotherapy response of lung cancer.