BACKGROUND: The potential impact of pre-existing coronary artery stenosis (CAS) on right ventricular (RV) function during acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and RV dysfunction in patients with acute PE. METHODS: In this multicenter, case-control study, 89 cases and 176 controls matched for age were enrolled at three study centers (Peking Union Medical College Hospital, Fuwai Hospital, and the Second Affiliated Hospital of Harbin Medical University) from January 2016 to December 2020. The cases were patients with acute PE with CAS, and the controls were patients with acute PE without CAS. Coronary artery assessment was performed using coronary computed tomographic angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression analysis was used to evaluate the association between CAS and RV dysfunction. RESULTS: The percentages of RV dysfunction (19.1% [17/89] vs. 44.6% [78/176], P <0.001) and elevated systolic pulmonary artery pressure (sPAP) (19.3% [17/89] vs. 39.5% [68/176], P = 0.001) were significantly lower in the case group than those in the control group. In the multivariable logistic regression model, CAS was independently and negatively associated with RV dysfunction (adjusted odds ratio [OR]: 0.367; 95% confidence interval [CI]: 0.185-0.728; P = 0.004), and elevated sPAP (OR: 0.490; 95% CI: 0.252-0.980; P = 0.035), respectively. CONCLUSIONS Pre-existing CAS was significantly and negatively associated with RV dysfunction and elevated sPAP in patients with acute PE. This finding provides new insights into RV dysfunction in patients with acute PE with pre-existing CAS.
Humans ; Pulmonary Embolism/complications* ; Case-Control Studies ; Male ; Ventricular Dysfunction, Right/physiopathology* ; Female ; Middle Aged ; Aged ; Coronary Stenosis/complications* ; Logistic Models ; Adult

Biliary tract cancer (BTC) is a rare group of malignancies that develop from the epithelial lining of the biliary tree and have a poor prognosis. Although chemotherapy is the standard of care for patients with advanced BTC in China, its clinical benefits are moderate. In recent years, the approval of targeted therapies and immunotherapies has provided new avenues for the management of advanced BTC. Nonetheless, the increasing number of personalized medicine approaches has created a challenge for clinicians choosing individualized treatment strategies based on tumor characteristics. In this article, we discuss recent progress in implementing precision medicine approaches for advanced BTC in China and examine genomic profiling studies in Chinese patients with advanced BTC. We also discuss the challenges and opportunities of using precision medicine approaches, as well as the importance of considering population-specific factors and tailoring treatment approaches to improve outcomes for patients with BTC. In addition to providing a comprehensive overview of current and emerging precision medicine approaches for the management of advanced BTC in China, this review article will support clinicians outside of China by serving as a reference regarding the role of patient- and population-specific factors in clinical decision-making for patients with this rare malignancy.
Humans ; Precision Medicine/methods* ; Biliary Tract Neoplasms/genetics* ; China ; Molecular Targeted Therapy ; Immunotherapy/methods*

Background::The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE.Methods::In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results::The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P = 0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243–5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056–5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792–30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467–8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288–36.484) were independently associated with elevated hs-cTnI. Conclusions::CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective: To understand the prevalence and associated factors of spinal curvature in children and adolescents in the Yangtze River Delta Region and to provide reference and help for the prevention and intervention of spinal curvature in children and adolescents. Methods: From September to November 2021, 8 246 middle school students in Anhui, Jiangsu, Shanghai, and Zhejiang provinces in the Yangtze River Delta Region were selected by stratified cluster sampling for spinal curvature assessment and questionnaire survey. Results: The detection rate of spinal curvature in middle school students in the Yangtze River Delta was 8.46 %. Girls (9.82%) were significantly higher than boys (7.20%)( χ 2=18.25, P <0.01), and students from urban area (10.77%) was significantly higher than that of suburban area (4.94%)( χ 2=86.75, P <0.01). Junior high school students (6.65%) were significantly lower than high school students (10.34%)( χ 2=36.26, P <0.01). Logistic regression analysis showed that urban area( OR= 2.58, 95%CI =1.72-3.86), time usage of electronic equipment ≥ 3 h/d( OR=1.61, 95%CI =1.14-2.29), break between near work for more than 1 h ( OR=1.42, 95%CI =1.01-1.97) and outdoor activity <2 h/d( OR=1.84, 95%CI =1.26-2.69) were positively correlated with the occurrence of spinal curvature( P <0.05). Conclusion The detection rate of spinal curvature in middle school students in the Yangtze River Delta is relatively high, which is related to time spent on screen, near work and outdoor activity. Education and guidance should be strengthened to reduce the detection rate of spinal curvature.

OBJECTIVES: The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups. METHODS: Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups. RESULTS: Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint. CONCLUSIONS Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.

Purpose Placenta accreta is a rare but severe pregnancy complications, and imaging diagnosis is always difficult. This paper aims to analyze the MRI manifestations of placenta accreta, and explore its misdiagnosis reasons. Materials and Methods A retrospective study was carried out on the findings and classification of MRI plain scan and diffusion weighted imaging (DWI) scan of 18 patients with placenta accreta confirmed surgically and pathologically. Results The prenatal MRI scan reported 15 patients of placenta accreta correctly (83.33%), and missed 3 (16.67%) among which 2 were with placenta accreta and the other 1 with placenta increta. The MRI of placenta accreta presented rather thin muscular layer, discontinuous junctional zone, and some unclear boundary of placenta and uterine wall; the signal of the placenta was heterogeneous, and we could see enlarged vessels of extremely low signal on T2 HASTE and high signal on TruFISP sequences, and low signal of thick intraplacental band; moreover, hematoma with high intensity on T1WI and low intensity on T2WI could be seen. DWI demonstrated uneven intensity and dark thicker intraplacenta bands in 2 cases. Conclusion As an important clinical auxiliary tool in diagnosing placenta increta, MRI has high accuracy in the diagnosis of placenta increta and placenta percreta; however, it has rather low accuracy in placenta accreta.

Objective To document the MRI features of renal angiomyolipoma (RAML) containing minimal fat and to explore whether the MR features vary depending on the tumor size. Methods The MR findings of 15 cases of pathologically-proved RAML containing minimal fat were reviewed retrospectively from January 2008 to March 2010. All patients underwent MR in a 1.5 T or 3.0 T scanners. The MR features of the lesions were analyzed, with emphasis on the signal intensity and homogeneity on T2WI, in regards to pseudocapsule, lipid component, hemorrhage, cystic degeneration or necrosis, blood vessels, interface with renal parenchyma and enhancement pattern. All lesions were categorized into 2 groups; those with diameter ＞4 cm and those with diameter ≤4 cm. The difference of imaging characteristics between these two groups was analyzed using Fisher exact test. Results All 15 lesions demonstrated hypointensity on T2WI compared to the renal parenchyma. Homogeneous signal intensity on T2WI was seen in 6 lesions (6/15); peritumoral pseudocapsule in 3 lesions (3/15); cystic degeneration or necrosis, hemorrhage in 5 lesions (5/15); flow void of blood vessels in 2 lesions (2/15); lipid component in 4 lesions (4/15); angular interface with renal parenchyma in 10 lesions (10/15); homogeneous enhancement in 8 lesions (8/15). Fifteen lesions were divided into two groups; 9 categorized into group 1 (the maximum diameter ≤ 4 cm) and 6 into group 2 ( the maximum diameter ＞ 4 cm). Cystic degeneration or necrosis was seen in 0 of 9 in group one and 5 of 6 in group two respectively, hemorrhage(0 of 9 and 5 of 6 respectively) and pseudocapsule(0 of 9 and 3 of 6 respectively. The difference between these findings in the two groups demonstrated statistical significance (P ＜ 0. 05). Conclusion The MR features of RAML containing miminal fat were hypointensity on T2 WI,angular interface with renal parenchyma and homogeneous contrast enhancement, however, these findings can vary depending on the tumor size.

Objective To study the effects and mechanism of Yunnan Baiyao on the inflammatory response and satellite cell regeneration after acute injury of skeletal muscle in rats. Methods Rat models of skeletal muscle injury (gastrocnemius,fast twich;soleus,slow twich) induced by treadmill were constructed 24 h after establishment of the models,the left sides of hind limbs in rats were treated with Yunnan Baiyao,and the right sides were treated with saline at the equal volume.4 rats were chosen 2,4,7,10,14 d after injury,respectively,and gastrocnemius and soleus of the treated sides (the left sides) and untreated sides (the right sides) from hind limbs of 4 rats were obtained,and stained with immunohistochemistry and HE. The quantity and morphological changes of inflammatory cells and satellite cells were observed under optical microscope. Results Compared with untreated sides,the number of inflammatory cells of fast twich after injury in the treated sides was decreased obviously at the 2nd,4th,7th day after injury(P

ObjectiveTo evaluate the characteristics of MRI of common hepatic lesions by using measurement of T1,T2 and ADC on the MRI and DWI. MethodsMRI and DWI were obtained in 100 patients with common hepatic lesions, and T1,T2,ADCs and the ratios of the ADC of lesion/liver were estimated. (Results)Average T1,T2 and ADCs of hepatic lesions were as follows: hepatocellular carcinoma, (843.92167.75) ms , (73.9014.21) ms and(0.990.26)10~(-3)mm~2/s respectively; hepatic (metastasis), (946.89186.13) ms, (76.3919.76) ms and(1.170.32)10~(-3)mm~2/s (respectively); hepatic cavernous hemangioma, (1102.33213.12)ms, (142.3228.51) ms and (1.810.42)10~(-3)mm~2/s respectively; hepatic cyst, (1516.32617.84)ms ,(247.33112.52)ms and (3.110.38)10~(-3)mm~2/s respectively. The ratio of the ADC of lesion/liver:(hepatocellular) carcinoma was 0.890.17, and significantly lower than the ratio of hepatic metastases((1.27)0.21, P