OBJECTIVES: To develop a risk prediction model for left ventricular adverse remodeling (LVAR) based on cardiac magnetic resonance (CMR) parameters in patients undergoing percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 329 acute STEMI patients undergoing primary PCI at 8 medical centers from January, 2018 to December, 2021 were prospectively enrolled. The parameters of CMR, performed at 7±2 days and 6 months post-PCI, were analyzed using CVI42 software. LVAR was defined as an increase >20% in left ventricular end-diastolic volume or >15% in left ventricular end-systolic volume at 6 months compared to baseline. The patients were randomized into training (n=230) and validation (n=99) sets in a 7∶3 ratio. In the training set, potential predictors were selected using LASSO regression, followed by univariate and multivariate logistic regression to construct a nomogram. Model performance was evaluated using receiver-operating characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis. RESULTS: LVAR occurred in 100 patients (30.40%), who had a higher incidence of major adverse cardiovascular events than those without LVAR (58.00% vs 16.16%, P<0.001). Left ventricular global longitudinal strain (LVGLS; OR=0.76, 95% CI: 0.61-0.95, P=0.015) and left atrial active strain (LAAS; OR=0.78, 95% CI: 0.67-0.92, P=0.003) were protective factors for LVAR, while infarct size (IS; OR=1.05, 95% CI: 1.01-1.10, P=0.017) and microvascular obstruction (MVO; OR=1.26, 95% CI: 1.01-1.59, P=0.048) were risk factors for LVAR. The nomogram had an AUC of 0.90 (95% CI: 0.86-0.94) in the training set and an AUC of 0.88 (95% CI: 0.81-0.94) in the validation set. CONCLUSIONS LVGLS, LAAS, IS, and MVO are independent predictors of LVAR in STEMI patients following PCI. The constructed nomogram has a strong predictive ability to provide assistance for management and early intervention of LVAR.
Humans ; Percutaneous Coronary Intervention ; Prospective Studies ; ST Elevation Myocardial Infarction/diagnostic imaging* ; Ventricular Remodeling ; Magnetic Resonance Imaging ; Male ; Female ; Middle Aged ; Risk Factors ; Aged ; Risk Assessment

Objective:To explore advantages of CT and MRI imaging in clinical assessment of specific indicators (trochlear dysplasia and tibial tubercle lateralization) of acute patellar dislocation in adolescents by comparing CT versus MRI imaging.Methods:A retrospective study was conducted to analyze the CT and MRI imaging data of 73 patients with acute patellar dislocation who had been admitted to Department of Orthopedics, The Second Hospital of Tangshan from January 2014 to September 2024. There were 37 males (21 left knees and 16 right knees) and 36 females (19 left knees and 17 right knees), with a mean age of 15 (13, 16) years. On MRI images, the distance between the patellar tendon-trochlear groove (PT-TG) was measured. On CT images, the distance between the tibial tuberosity-trochlear groove (TT-TG) was measured. Additionally, the distance from the tibial tubercle-Roman arch (TT-RA), the sulcus angle (SA), the trochlear depth (TD), the lateral trochlear inclination (LTI), and the trochlear facet asymmetry (TFA) were measured on both MRI and CT images.Results:The TT-TG measured on CT [(20.47±4.42) mm] was significantly greater than that on MRI [(17.89±4.23) mm] ( t = -4.047, P < 0.001). The TT-RA [(24.28±4.27) mm], TD [2.95 (2.36, 4.08) mm], LTI (15.4°±3.85°), and TFA [0.42 (0.38, 0.49)] measured on CT were all significantly greater than those on MRI [(21.34±3.99) mm, 2.52 (1.64, 2.98) mm, 14.11°±3.58°, 0.38 (0.34, 0.44)] ( P < 0.001). The SA measured on CT (151.30°±6.74°) was significantly less than that measured on MRI (159.06°±5.40°) ( P < 0.001). The intra-observer ICC values for all indicators were greater than 0.9, and the inter-observer ICC values greater than 0.85. Conclusions:There are differences between CT and MRI in each indicator in evaluation of acute patellar dislocation in adolescents. The PT-TG measured on MRI and the TT-RA measured on CT can better evaluate the tibial tubercle lateralization; the indicators for trochlear dysplasia measured on MRI respond better to the severity of trochlea dysplasia than those on CT.

Central venous pressure(CVP)is a commonly used hemodynamic index in clinical practice,and the accuracy of its measurement results is influenced by the measurement technical specifications.Based on research evidence and clinical practice,this article interprets the main content of the group standard of CVP measurement technology,and proposes suggestions for its use.It aims to guide clinical nursing staff to correctly understand the principles and methods of CVP measurement,and promote the standardization of nursing practice and the accuracy of measurement results.

Objective A scoping review of studies on pulmonary prehabilitation in cardiac surgery patients was conducted to provide evidence support for the construction of a preoperative pulmonary rehabilitation program for cardiac surgery patients that suitable for China's national conditions.Methods In accordance with the scope review's research methodologies,databases including PubMed,Embase,Web of Science,CINAHL,CNKI and Wanfang were searched by the computer for relevant studies.The deadline for retrieval is from the establishment of databases to June,2024.The included literature was systematically analyzed.Results 26 articles were finally included.Among them,4 were quasi-experiment studies,while the other 22 were randomized controlled trials.Forms of the intervention included comprehensive breathing exercises,inspiratory muscle training,positive expiratory pressure,incentive spirometer training and balloon blowing training.The intervention initiation ranged from 10 weeks to 1 day preoperatively;the outcome measures included postoperative pulmonary complications,lung function metrics,the 6-Minute Walk Test,duration of mechanical ventilation,length of hospital stay,patient-reported outcomes and so on.Conclusion There remains a deficiency in standardized protocols for preoperative pulmonary rehabilitation training among patients undergoing cardiac surgery.High-quality studies should be conducted,and intervention strategies for pulmonary prehabilitation in cardiac surgery patients should be optimized and a unified evaluation standard system should be established.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Dysfunction of the diaphragm is a common problem in mechanically ventilated patients and is closely related to various adverse outcomes.This review summarizes the evaluation methods of diaphragm function,the association between diaphragm dysfunction and adverse clinical outcomes in critically ill mechanically ventilated patients,and the protective effect of diaphragm function on adverse outcomes related to mechanical ventilation.The aim is to provide references for medical staff to optimize evaluation techniques,develop personalized nursing plans,and improve patients' quality of life and health outcomes.

Objective:To investigate the long-term efficacy and influencing factors of transcatheter adrenal ablation in patients with primary aldosteronism (PA).Methods:This cohort study retrospectively enrolled PA patients who underwent transcatheter adrenal ablation at Daping Hospital, Army Medical University between January 2021 and December 2024. According to PASO criteria, patients were categorized into groups based on clinical outcomes (complete, partial, or no remission), biochemical outcomes (complete, partial, or no remission), and composite outcomes (complete or incomplete remission). All participants underwent 1-year follow-up, with intergroup comparisons of clinical characteristics and surgical approaches. Multivariate logistic regression models were used to identify factors influencing long-term efficacy post-transcatheter adrenal ablation in PA patients.Results:A total of 122 PA patients were enrolled, aged (47.7±11.1) years, including 55 males (45.1%). Baseline aldosterone-to-renin ratio was 0.43(0.19,0.86)(pmol·L -1)/(μU·L -1). Bilateral adrenal lesions were present in 33 cases (27.1%), while 70 (57.4%) had nodules or adenomas. Adrenal venous sampling confirmed lateralized hypersecretion in 107 patients (87.7%, left or right dominance). According to PASO criteria, 93.4% (114/122) and 95.1% (116/122) of patients achieved complete or partial remission in biochemical and clinical parameters at 1-year post-ablation, respectively. For biochemical outcomes: 40 complete, 74 partial, and 8 no remission. Patients in the partial-remission group were older than those in the no-remission group ((49.4±11.2) vs. (39.6±9.8) years), while complete-remission group had higher bilateral non-lateralized secretion rates than partial remission group (27.5% vs. 4.1%, both P<0.05). For clinical outcomes: 26 complete, 90 partial, 6 no remission. Compared to complete-remission group, partial-remission group had higher male proportion (51.1% vs. 26.9%), longer hypertension duration (4.0 (0.7, 10.0) years vs. 1.5 (0.1, 5.0) years), but lower office diastolic blood pressure ((88±11) mmHg vs. (94±12 mmHg), 1 mmHg=0.133 kPa, all P<0.05). For composite outcomes: 56 complete and 66 incomplete remission. Compared with incomplete remission group, complete remission group had lower prevalence of diabetes (8.9% vs. 22.7%) and higher proportion of bilateral non-lateralized secretion (21.4% vs. 4.6%, both P<0.05). Multivariate logistic regression identified diabetes ( OR=3.635, 95% CI 1.029-12.834, P=0.045) and lateralized secretion ( OR=9.056, 95% CI 2.039-40.212, P=0.004) as independent risk factors for poor composite outcomes after transcatheter adrenal ablation in PA patients, whereas higher office diastolic blood pressure acts as a protective factor ( OR=0.957, 95% CI 0.925-0.992, P=0.015). Conclusion:One year after transcatheter adrenal ablation, the majority of patients achieved complete or partial remission in biochemical and clinical parameters.Patients with non-lateralized adrenal hypersecretion demonstrated a higher likelihood of sustained biochemical remission and superior composite outcomes compared to those with lateralized hypersecretion.

Objective:To investigate the effects and underlying molecular mechanisms of Utidelone (UTD1) in small cell lung cancer (SCLC).Methods:The study utilized small cell lung cancer H446 and H1048 cell lines along with animal models. Cell proliferation, cell cycle progression, apoptosis, autophagy, and related activities following UTD1 treatment were assessed using Cell Counting Kit-8 (CCK-8), flow cytometry, immunofluorescence staining, reactive oxygen species (ROS) generation assay, and Western blot analysis. The involvement of the ROS/adenosine monophosphate-activated protein kinase (AMPK) signaling pathway was also examined. Data analysis was performed using GraphPad Prism version 8 software.Results:UTD1 inhibited the viability of H446 and H1048 cells in a dose- and time-dependent manner. The half inhibitory concentrations (IC 50) of UTD1 for H446 and H1048 cells were 0.675 and 0.439 μg/ml, respectively. The proportion of cells in the G 2/M phase for H446 and H1048 cells in the UTD1 group at 6 h, 12 h, and 24 h was [(53.86±4.54)%, (68.59±5.49)%, (60.89±3.26)%] and [(46.83±2.20)%, (60.67±3.44)%, (57.88±5.11)%], which were significantly higher than that in the control group, except for the proportion of H1048 cells at 6 h [(38.99±2.60)% vs. (40.73±2.50)%, P＜0.05]. The apoptosis rates were [(23.57±0.12)%, (35.79±1.59)%, and (46.15±4.57)%] for H446 cells and [(23.05±2.70)%, (37.73±2.97)%, and (43.39±3.31)% for H1048 cells], all of which were significantly higher than those in the control group [(6.44±0.96)%, (6.31±0.75)%, respectively; all P＜0.05]. The number of LC3 fluorescent spots was [(56±11), (69±8), and (66±8)] for H446 cells and [(39±7), (56±12), and (50±11)] for H1048 cells, both significantly higher than those in the control group [(13±6) and (12±5), respectively; both P＜0.05]. The relative fluorescence intensity of ROS was 2.54±0.48, 2.85±0.68, and 5.03±0.72 for H446 cells and 2.26±0.51, 4.17±0.35, and 4.66±0.51 for H1048 cells, which were also significantly higher than those in the control group ( P＜0.05). The expression levels of cyclin B1, cyclin A2, and P21 of H446 cells in the three time points were [(0.63±0.07, 0.33±0.05, 0.23±0.04), (0.68±0.08, 0.46±0.03, 0.27±0.06), and (0.64±0.03, 0.32±0.05, 0.22±0.03), respectively], all significantly lower compared to the control group ( P＜0.05). The apoptosis rates of H446 and H1048 cells in the UTD1+Z-VAD-FMK group were (19.97±3.19)% and (17.68±3.14)%, both lower than those in the UTD1 group [(40.73±3.35)% and (39.82±2.45)%, respectively; all P＜0.05]. The absorbance values of H446 and H1048 cells in the UTD1+3-MA group were significantly higher than those in the UTD1 group at 6h, 12h, and 24h (all P＜0.05). The levels of p-AMPKα/AMPKα, LC3-II expression, and the percentage of apoptotic cells in the H446 and H1048 cells of the UTD1+NAC group were [(1.33±0.09, 1.33±0.11), (1.49±0.16, 1.55±0.05), (17.24±2.15)%, and (19.40±4.28)%], all of which were lower than those observed in the UTD1 group [(1.98±0.17, 2.23±0.23), (2.81±0.19, 2.49±0.38), (38.07±3.53)%, and (41.20±1.87)%, all P＜0.05]. The number of LC3 fluorescence points and the percentage of apoptotic cells in the H446 and H1048 cells of the UTD1+si-AMPKα group [(24±5, 23±3), (18.35±1.15)%, and (19.15±3.46)%] were all lower than those in the UTD1+si-NC group [(46±6, 36±6), (39.34±1.77)%, and (39.50±2.15)%, all P＜0.05]. The tumor inhibition rates in small cell lung cancer tumor-bearing nude mice for the 2.5 mg/kg UTD1 group and the 5 mg/kg UTD1 group were 46.43% and 58.33%, respectively. Furthermore, the proportions of apoptosis-positive cells and p-AMPKα-positive cells in the UTD1 group were significantly higher compared to the control group, while the levels of Ki-67 positivity were significantly reduced. Conclusion:UTD1 inhibits SCLC cell proliferation, induces G 2/M phase arrest, and promotes cell apoptosis and autophagy through the activation of the ROS/AMPK signaling pathway.

Objective To explore the immediate recanalization efficacy of flexible endoscopy-assisted retrograde ureteral catheterization for uretero-ileal anastomotic stenosis after Bricker ileal bladder surgery.Method A retrospective analysis was conducted on the clinical data of 17 patients who underwent Bricker ileal bladder surgery in the hospital from November 2016 to October 2022.There were a total of 28 sites of ureterileal anastomotic stenosises,all of which were treated with flexible endoscopy-assisted retrograde ureteral catheterization.Result There were 21 sites who successfully underwent recanalization after endoscopic treatment,the median length of hospital stay was 6(4.75,8.50)days.Among the 28 uretero-ileal anastomotic stenosises,21 sites were successfully recanalized immediately under endoscopy(10 on the left and 11 on the right),while 7 sites failed to recanalize immediately under endoscopy(4 on the left and 3 on the right).The 21 sites of successful immediate recanalization under endoscopy include:15 sites of simple retrograde placement of ureteral catheters,1 site of endoscopic ureterileal anastomotic dilation,net basket stone removal and retrograde stent placement,3 sites of retrograde ureteral stent placement under ultra-fine endoscopy,and 2 sites of retrograde ureteral stent placement under duodenoscopy.The total operation time of all patients was less than 50 minutes.Among the 17 patients,the urine drainage of the ureteral stent was unobstructed.There were varying degrees of abrasions and a small amount of bleeding at the bladder ileal and ureterileal anastomoses.No serious complications such as delayed bleeding,perforation,severe urinary tract infection,stent blockage or displacement occurred.Conclusion Flexible endoscopy-assisted retrograde ureteral catheterization are safe and effective for immediate recanalization of uretero-ileal anastomotic stenosis.It is worth applying in clinical practice.

The blood products industry in China,the United States,the European Union and Japan are at different stages of development,with very different laws,regulations and regulatory systems.This paper uses methods such as literature review,policy comparison,and case study.By analyzing and comparing the blood product regulatory policies in various countries,it is found that compared with the United States,the European Union and Japan,China has differences in several areas,including plasma quarantine period,plasma fractionation processes and intermediate products,segmented production of blood products,and import management policies.It is suggested that we should learn from foreign regulatory experiences,and explore the establishment of blood product regulatory policies suitable for China's national conditions.Recommendations include optimizing China's source plasma quarantine period and blood product production process management policies,promoting multiple sites and segmented production of blood products,and establishing flexible blood product import and export management systems.These measures aim to provide references for promoting the development of the blood product industry and improving the accessibility of medications for the public.