Objectives:To explore the feasibility of a coronary angiography-based method developed with artificial intelligence which was able to automatically and quickly calculate coronary volumetric blood flow and coronary flow reserve (CFR), and explore the differences in CFR after injection of different vasodilators.Methods:This was a observational study screening patients with suspected coronary artery disease who underwent coronary angiography From June to September 2022 in Fuwai Hospital, Chinese Academy of Medical Sciences. Patients without obstructive coronary artery disease in the left anterior descending artery (<50% diameter stenosis by visual) and accompanied by coronary slow flow phenomenon (Thrombolysis in Myocardial Infarction flow grade ≤2) were enrolled. According to pre-specified coronary angiography acquisition protocol, one angiographic image in optimal projection was acquired for each of the following five states: baseline when none of the vasodilators was injected (resting state), intracoronary injection of 200 μg nitroglycerin (nitroglycerin-induced hyperemia), intracoronary injection of 100 μg adenosine (adenosine-induced hyperemia), 5 minutes after cessation of adenosine injection (resting state 2), and intracoronary injection of 4 mg nicorandil (nicorandil-induced hyperemia). Coronary volumetric blood flow and CFR were assessed in a fully automatic manner at an independent core laboratory. One-way repeated measures ANOVA was used to detect the differences in coronary volumetric blood flow at five states and the differences in CFR after injection of different vasodilators.Results:A total of 21 eligible patients were included. The age was (62±9) years, and 5 (24%) were female. Coronary volumetric blood flow at five states and CFR after injection of different vasodilators were successfully calculated in all patients, with a feasibility of 100% (21/21) for CFR. Resting coronary volumetric blood flow was (80.6±12.4) ml/min. Using this as a reference, the volumetric blood flow increased to (167.7±30.5) ml/min under nitroglycerin-induced hyperemia (adjusted P<0.001), and remained at (171.5±23.1) ml/min under adenosine-induced hyperemia (adjusted P<0.001). The volumetric blood flow under resting state 2 was (83.8±15.6) ml/min, returning to baseline level (adjusted P=0.94). Under nicorandil-induced hyperemia, the coronary volumetric blood flow increased again to (182.9±28.3) ml/min (adjusted P<0.001). CFR was 2.09±0.29, 2.15±0.27, and 2.29±0.29 after injection of nitroglycerin, adenosine, and nicorandil, respectively( P=0.034). Using CFR after adenosine injection as a reference, CFR after nicorandil injection was higher (adjusted P=0.044). Using the coronary volumetric blood flow under resting state 2 as the baseline flow for CFR calculation, there was no statistically significant difference compared to the CFR calculated using the volumetric blood flow under resting state (all P>0.05). Conclusions:Preliminary findings confirm the high feasibility of rapid, automated assessment of coronary volumetric blood flow and CFR from a single angiographic projection, as well as good reproducibility in calculating baseline volumetric blood flow. In patients with coronary slow flow, the CFR after nicorandil injection is significantly higher than that after adenosine injection.

Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective To explore the role and mechanism of mechanically sensitive ion channel Piezo2 in mechanical allodynia of rats with low back pain induced by simulating the low-frequency vibration of a helicopter.Methods Low-frequency vibration(LFV)model with 3-dimensional 6 degrees of freedom was used to induce low back pain in awake rats in a sitting position.Twenty-four male SD rats(8 weeks old)were randomly divided into control(Ctrl)group and LFV group.HE staining was used to evaluate the injury of the multifidus muscle.Von Frey test was carried out to detect pain sensitivity.Open field test was employed to assess the spontaneous activity and anxiety.ELISA,Western blotting and immunofluorescence staining were performed to detect the expression of NGF,TrkA and downstream molecule Piezo2.Dorsal root ganglia(DRG)neurons was isolated from SD rats and primarily cultured.After identified with immunofluorescence staining,the neurons were divided into the Ctrl group,the LFV group,and the LFV+D-GsMTx4(D-G4,an Piezo2 channel antagonist)group.Western blotting was used to detect the protein expression of Piezo2,and a calcium ion fluorescent probe was utilized to detect the intracellular Ca2+.The DRG neurons were pretreated with 50 ng/mL NGF for 1 h.Calcium ion fluorescent probe was used to observe the changes in intracellular Ca2+in the LFV group,the LFV+NGF group,and the LFV+NGF+D-G4 group.Results The rats of the LFV group showed abnormal morphology in multifidus muscles,accompanied with inflammatory cell infiltration,decreased paw withdrawal reflex threshold(P<0.05),and shortened total active time and active time in the centre,and decreased distance traveled in the centre(P<0.05),while prolonged total stationary time,stationary time in the periphery,and increased distance traveled in the periphery(P<0.05),and moreover,enhanced expression of Piezo2,NGF and TrkA in the DRG tissues(P<0.05).Cell experiments showed that compared with the Ctrl group,the expression of Piezo2 in the neurons was increased(P<0.05),and the intracellular Ca2+level was significantly elevated in the LFV group(P<0.05).Compared with the LFV group,the Ca2+level was higher in the LFV+NGF group(P<0.05),and the sensitization effect of NGF on Piezo2 was reversed after D-G4 treatment(P<0.05).Conclusion Sustained low-frequency vibration induces low back pain and mechanical allodynia in rats through the NGF-TrkA/Piezo2 pathway.

Objective:To analyze and summarize the clinical features and short-medium term follow-up results of children with multisystem inflammatory syndrome（MIS-C）following coronavirus infection.Methods:The data of six children with MIS-C admitted to the Intensive Care Unit of Shanghai Children's Medical Center from January to March 2023 were retrospectively analyzed.Results:All six cases were in shock，requiring vasoactive drugs，and one case required invasive mechanical ventilation.All the six patients had multiple organ function injury and increased inflammation indicators.After admission，they received organ support，glucocorticoids and gamma globulin treatment.Two patients were treated with biological agents.Both organ function and inflammation indicators showed significantly improvement after therapy.Six patients had mild coronary artery widening.All patients had good prognosis following short-medium term follow-up.Conclusion:Children with severe MIS-C may suffer life-threatening hemodynamic instability.Timely assessment，active anti-inflammatory and organ support therapy can obtain favorable prognosis.

Objective:To analyze and summarize the clinical features and short-medium term follow-up results of children with multisystem inflammatory syndrome（MIS-C）following coronavirus infection.Methods:The data of six children with MIS-C admitted to the Intensive Care Unit of Shanghai Children's Medical Center from January to March 2023 were retrospectively analyzed.Results:All six cases were in shock，requiring vasoactive drugs，and one case required invasive mechanical ventilation.All the six patients had multiple organ function injury and increased inflammation indicators.After admission，they received organ support，glucocorticoids and gamma globulin treatment.Two patients were treated with biological agents.Both organ function and inflammation indicators showed significantly improvement after therapy.Six patients had mild coronary artery widening.All patients had good prognosis following short-medium term follow-up.Conclusion:Children with severe MIS-C may suffer life-threatening hemodynamic instability.Timely assessment，active anti-inflammatory and organ support therapy can obtain favorable prognosis.

Objectives:To explore the feasibility of a coronary angiography-based method developed with artificial intelligence which was able to automatically and quickly calculate coronary volumetric blood flow and coronary flow reserve (CFR), and explore the differences in CFR after injection of different vasodilators.Methods:This was a observational study screening patients with suspected coronary artery disease who underwent coronary angiography From June to September 2022 in Fuwai Hospital, Chinese Academy of Medical Sciences. Patients without obstructive coronary artery disease in the left anterior descending artery (<50% diameter stenosis by visual) and accompanied by coronary slow flow phenomenon (Thrombolysis in Myocardial Infarction flow grade ≤2) were enrolled. According to pre-specified coronary angiography acquisition protocol, one angiographic image in optimal projection was acquired for each of the following five states: baseline when none of the vasodilators was injected (resting state), intracoronary injection of 200 μg nitroglycerin (nitroglycerin-induced hyperemia), intracoronary injection of 100 μg adenosine (adenosine-induced hyperemia), 5 minutes after cessation of adenosine injection (resting state 2), and intracoronary injection of 4 mg nicorandil (nicorandil-induced hyperemia). Coronary volumetric blood flow and CFR were assessed in a fully automatic manner at an independent core laboratory. One-way repeated measures ANOVA was used to detect the differences in coronary volumetric blood flow at five states and the differences in CFR after injection of different vasodilators.Results:A total of 21 eligible patients were included. The age was (62±9) years, and 5 (24%) were female. Coronary volumetric blood flow at five states and CFR after injection of different vasodilators were successfully calculated in all patients, with a feasibility of 100% (21/21) for CFR. Resting coronary volumetric blood flow was (80.6±12.4) ml/min. Using this as a reference, the volumetric blood flow increased to (167.7±30.5) ml/min under nitroglycerin-induced hyperemia (adjusted P<0.001), and remained at (171.5±23.1) ml/min under adenosine-induced hyperemia (adjusted P<0.001). The volumetric blood flow under resting state 2 was (83.8±15.6) ml/min, returning to baseline level (adjusted P=0.94). Under nicorandil-induced hyperemia, the coronary volumetric blood flow increased again to (182.9±28.3) ml/min (adjusted P<0.001). CFR was 2.09±0.29, 2.15±0.27, and 2.29±0.29 after injection of nitroglycerin, adenosine, and nicorandil, respectively( P=0.034). Using CFR after adenosine injection as a reference, CFR after nicorandil injection was higher (adjusted P=0.044). Using the coronary volumetric blood flow under resting state 2 as the baseline flow for CFR calculation, there was no statistically significant difference compared to the CFR calculated using the volumetric blood flow under resting state (all P>0.05). Conclusions:Preliminary findings confirm the high feasibility of rapid, automated assessment of coronary volumetric blood flow and CFR from a single angiographic projection, as well as good reproducibility in calculating baseline volumetric blood flow. In patients with coronary slow flow, the CFR after nicorandil injection is significantly higher than that after adenosine injection.

Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective To explore the correlation of nerve function and prognosis with serum uric acid(UA),homocysteine(Hcy)and low-density lipoprotein cholesterol(LDL-C)in patients with acute cerebral infarction(ACI)after alteplase intravenous thrombolysis.Methods A total of 220 ACI patients undergoing thrombolysis in Changsha First Hospital ICU between January 2020 and December 2022 were enrolled,and according to mRS score at 3 months after thrombolysis,they were divided into poor prognosis group(mRS score＞2,91 cases)and good prognosis group(mRS score ≤2,129 cases).The serum levels of UA,Hcy and LDL-C were compared between the two groups.The correlation between the three indexes and score of National Institutes of Health Stroke Scale(NIHSS),and their predictive value for poor prognosis were analyzed.Results At 1 and 3 d after thrombolysis,the serum levels of UA,Hcy and LDL-C and NIHSS score were sig-nificantly decreased in both groups,and the serum levels of UA and Hcy and NIHSS score at 3 d after thrombolysis were significantly lower than those at 1 d(P＜0.05).The poor prognosis group had obviously higher serum levels of UA,Hcy and LDL-C and NIHSS score at 1 and 3 d after thrombolysis than the good prognosis group(P＜0.05,P＜0.01).Pearson correlation analysis showed that the serum levels of UA,Hcy and LDL-C were positively correlated with NIHSS score at 1 and 3 d after thrombolysis(P＜0.01).ROC curve analysis indicated that the AUC values of UA,Hcy and LDL-C at 1 d after thrombolysis for predicting poor prognosis were 0.707(95％CI:0.639-0.776),0.800(95％CI:0.739-0.860)and 0.624(95％CI:0.550-0.698),respectively,while the values of them at 3 d after thrombolysis were 0.655(95％CI:0.583-0.726),0.730(95％CI:0.664-0.795)and 0.573(95％CI:0.497-0.649),respectively.Conclusion In ACI patients after thrombolysis,the serum levels of UA,Hcy and LDL-C are increased in those with poor prognosis,and are associated with the severity of nerve injury.The levels at 1 d after throm-bolysis have good predictive value for poor prognosis.

【Objective】 To explore the diagnosis and management of liver injury caused by percutaneous nephrolithotripsy (PCNL), so as to provide reference for the diagnoise and treatment of similar patients. 【Methods】 The clinical data of 926 patients who underwent PCNL during Oct.2017 and Oct.2022 were searched, and the data of those complicated with liver injury were analyzed. 【Results】 A total of 11 cases were collected, including 6 males and 5 females, average age (55.00±13.25)years.All injuries were confirmed with CT.The average decrease of hemoglobin after operation was (14.00±11.97)g/L.One patient needed blood transfusion due to pyonephrosis and multiple operations, and all patients were cured and discharged after delaying the removal of nephrostomy tube [an average of (6.73±1.27)days] . 【Conclusion】 In the absence of obvious signs of peritonitis and hemodynamic stability, conservative treatment of liver injury caused by PCNL is safe and effective.

Objective To determine the effects of treadmill training on the structure of hippocampal myelin and cognitive function in rats exposed to acute plateau hypoxia.Methods With 30 SPF-grade female SD rats (aged 6-8 weeks,weighing 200-220 g),6 of them were used for observation of myelin structure after injury,and the remaining 24 rats were randomly divided into control group,hypobaric hypoxia group and treadmill training group (n=8).The rats in above experimental groups were placed in a low-pressure oxygen chamber at an altitude of 6000 m for 7 consecutive days,and the rats of the control group were placed in the confined chamber for the same period without hypoxia.Then,the rats of the treadmill training group received a 4-week treadmill training scheme since the day after hypoxia.Finally,all the rats were tested for cognitive function with open field test (OFT)and Morris water maze (MWM).Transmission electron microscopy (TEM) was used to observe the changes of demyelination in the hippocampus. The expression of oligodendrocyte transcription factor 2 (Olig2)and myelin basic protein (MBP )in the hippocampal CA1 and CA3 regions was measured by immunofluorescence staining and Western blotting.Results Behavioral tests showed that the number into the central area,total distance,distance ratio in OFT and the number of platform crossings and distance to the target area in MWM were reduced in the hypobaric hypoxia group than the control group (P<0.05 ),while these indexes were increased in the treadmill training group than in the hypobaric hypoxia group (P<0.05).Immunofluorescence staining indicated that the number of Olig2 positive cells per unit area and the mean fluorescence intensity of MBP in the CA1 and CA3 regions were significantly lessen in the hypobaric hypoxia group than the control group (P<0.05 ),while these indicators were higher in the treadmill training group than the hypobaric hypoxia group (P<0.05 ).Western blotting displayed that the expression levels of Olig2 and MBP in the hippocampus were obviously lower in the hypobaric hypoxia group than the control group (P<0.01 ),while the levels were increased in the treadmill training group than the hypobaric hypoxia group (P<0.01 ).Conclusion Treadmill training promotes the number of the oligodendrocyte spectrum cells in CA1 and CA3 regions,enhances the expression of myelin-related proteins and improves myelin repair in hippocampus of hypobaric hypoxia rats,and thereby ameliorates hypoxia-induced anxiety-like behaviors and memory dysfunction.