Objective To explore the clinical value of combining high-resolution CT (HRCT) with serum markers in differentiating malignant solitary pulmonary nodules (SPN). Methods Ninety-two SPN patients admitted to Baoji People’s Hospital between January 2022 and January 2024 were included. According to pathological analysis, they were divided into a benign group (30 cases) and a malignant group (62 cases). The serum levels of TUBA1B and ACSL4 were detected. Diagnostic value was determined using the receiver operating characteristic curve. Kappa test was used for consistency evaluation. Results Significant differences were observed between the benign and malignant groups in HRCT imaging, including the number of cases with spiculation, lobulation, pleural indentation, calcification, and vascular convergence sign (P<0.05). The sensitivity, specificity, and accuracy of HRCT in diagnosing malignant SPN were 74.19%, 86.67%, and 78.26%, respectively. The consistency with clinical diagnosis was moderate, as indicated by a Kappa value of 0.552 (P<0.001). The expression level of TUBA1B in the serum of SPN patients in the malignant group was higher than that in the benign group (P<0.05), while the expression level of ACSL4 was lower than that in the benign group (P<0.05). The areas under the receiver operating characteristic curves of serum TUBA1B and ACSL4 in diagnosing malignant SPN were 0.840 (95%CI = 0.749-0.908) and 0.875 (95%CI = 0.790-0.935), respectively, with sensitivities of 74.19% and 75.81% and specificities of 73.33% and 86.67%, respectively. The sensitivity, specificity, and accuracy of HRCT combined with serum TUBA1B and ACSL4 in diagnosing malignant SPN were 96.77%, 63.33%, and 85.87%, respectively. The consistency with clinical diagnosis was high, as indicated by a Kappa value of 0.721 (P<0.001). The sensitivity and negative predictive value of HRCT combined with serum TUBA1B and ACSL4 in diagnosing malignant SPN were higher than those of individual diagnostic indicators (P<0.05). Conclusion HRCT combined with serum TUBA1B and ACSL4 has high value in the differentiation of benign and malignant SPN.

Objective:To investigate the diagnosis，therapeutic strategy and early prognosis of Scimitar syndrome in pediatric patients.Methods:Clinical data of 21 children with Scimitar syndrome admitted to the Department of Cardiothoracic Surgery of Shanghai Children's Medical Center from January 2014 to December 2021 were retrospectively analyzed，and divided into 11 cases in the infantile-type group and 10 cases in the adult-type group.Results:Twenty-one children with Scimitar syndrome，10 males and 11 females，aged 5 days to 10 years old. Compared with the adult-type group，the infant-type group had a high proportion of preoperative clinical symptoms( P<0.05)，a high concomitant rate of intracardiac malformations (100% vs. 40%， P=0.002)，a big size of aortopulmonary collateral(APC)[(0.77±0.25) mm/kg vs.(0.36±0.13) mm/kg， P=0.016]，a high incidence of pulmonary hypertension(91.0% vs. 50.0%， P=0.038), and a high proportion of severe pulmonary hypertension(50 % vs. 0). There was a high rate of postoperative complications of low cardiac output syndrome (36.4% vs. 0， P=0.034)，prolonged postoperative mechanical ventilation [(73.22±44.75) h vs. (19.5±12.79) h， P=0.007]，and prolonged length of ICU stay[(7.89±3.37) d vs. (2.50±1.26) d， P<0.001]. Eleven cases underwent surgical treatment only，and 10 cases received hybrid operation with APC occlusion. The survival rate of the whole group was 90.5%，and there was no case of pulmonary venous obstruction in the early postoperative period. Systolic pulmonary artery pressure/systolic artery pressure decreased significantly after surgery in 15 children with pulmonary arterial hypertension( P<0.01).Five cases in the infantile-type group still had pulmonary hypertension. Conclusion:Surgical effect of Scimitar syndrome in pediatric patients is satisfactory. Infants with Scimitar syndrome usually have more severe symptoms, higher incidence of severe pulmonary hypertension and relatively longer postoperative recovery time.

Objective:To study the differences of ultrasound on kidney in monitoring renal hemodynamics and renal perfusion of patients with septic shock-induced acute kidney injury(AKI),and the predictive value of ultrasound-related parameters on kidney for septic shock-induced AKI.Methods:This is a prospective study,a total of 100 patients with septic shock who were diagnosed and treated in our hospital between September 2022 and September 2023 were selected as the study subjects.They were divided into AKI group(35 cases)and non-AKI group(65 cases)according to the relative standards of＜Clinical Practice Guideline of Global Kidney Disease Prognosis for the Tissue of Acute Kidney Injury(2012)＞.The age,gender,body mass index(BMI),comorbidities,central venous pressure,serum creatinine,urea nitrogen,blood lactate,Acute Physiology And Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score of all patients were collected after they admitted to hospital.Ultrasound on kidney was used to detect the renal resistive index(RRI)and power Doppler ultrasound(PDU)scores for patients,and indicators included peak intensity(PI),mean transit time(MTT),and area under curve(AUCTC)of the time-intensity were collected.Results:After septic shock,the PI,AUCTC,MTT parameter and RRI score of AKI group were lower than those of non-AKI group,while the PUD score was higher than that of non-AKI group,and the differences of them between two groups were significant(t=5.391,8.978,5.664,2.626,5.102,P＜0.05).There were no significant differences in gender,age,BMI,comorbidities(diabetes,hypertension,coronary heart disease),blood lactate,APACHE II score,and SOFA score between the two groups(P＞0.05).After multiple confounding factors were rectified,the results showed that PI,AUCTC and PRI scores were independent influencing factors for occurring AKI in sepsis patients(OR=0.51,0.86,0.77,P＜0.05).The PI,AUCTC and RRI were used as continuous variable,and receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of PI,AUCTC and RRI for septic shock-induced AKI.The results indicated that the AUC values of PI,AUCTC and RRI were respectively 0.83(95%CI:0.75～0.91),0.79(95%CI:0.70～0.88)and 0.72(95%CI:0.62～0.82).Conclusion:Renal ultrasound-related indicators can effectively monitor renal hemodynamics and perfusion in patients with septic shock,and can further predict the risk of occurring AKI.It is suggested to promote that in clinical application.

Objective:To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOCO) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:From January 2019 to December 2021, 233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital. The median follow-up duration was 3.9 years. The 367 non-culprit vessels of the 233 patients were divided into the VOCO group (33 vessels, 9.0%) and the non-VOCO group (334 vessels, 91.0%). Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared. Receiver operating characteristic (ROC) curves were used to assess the correlation between hemodynamic pattern and VOCO, and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results:The 233 enrolled patients were aged (62.5±12.9) years, with 193 males (82.8%). In the VOCO group, the maximum quantitative flow ratio (QFR) decreased within 20 mm of the QFR-assessed segment, the difference in QFR across the entire vessel, the length of functionally significant vessel, and the maximum gradient of QFR decrease (dQFR/dsmax) were significantly greater than those in the non-VOCO group. ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.009 6 (area under the curve: 0.691, 95% CI: 0.606-0.775, P<0.001). Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO ( HR=1.199, 95% CI: 1.070-1.343, P=0.002). When anatomical and functional stenosis severities were included in the model, a high pullback pressure gradient (PPG) index ( HR=1.572, 95% CI: 1.052-2.351, P=0.027) emerged as an independent predictor of VOCO. Multivariable logistic regression analysis revealed that a low PPG index( OR=2.851, 95% CI: 1.945-4.178, P<0.001) was an independent predictor of QFR≤0.80 without long-term VOCO. Conclusion:In patients with STEMI, localized hemodynamic patterns of coronary artery stenosis, characterized by high dQFR/dsmax and high PPG index, are associated with long-term VOCO.

With the rapid development of medical big data and artificial intelligence,Clinical Prediction Models(CPMs)have become pivotal tools for disease prevention,diagnosis,and treatment.Current research predominantly focuses on the economic analysis of pharmacological or public health interventions,yet a comprehensive methodological framework for the economic evaluation of CPMs has been notably absent.The Guidelines for Economic Evaluation of Clinical Prediction Models(hereafter the Guidelines),jointly initiated by the Chinese Research Hospital Association and Peking University,Tsinghua University,and Capital Medical University,adheres to the WHO Handbook for Guideline Development and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards.A multidisciplinary collaboration,including a steering committee,expert panel,secretariat,and external review group,was established to develop the guideline following evidence-based principles and procedures.Consensus recommendations were formulated through the Delphi method.It describes the background,objectives,target group,and the development methodology and process,ensuring the entire compilation process of the Guidelines is transparent and standardized.Through comprehensive evidence retrieval,systematic evidence appraisal,and a scientific approach to forming recommendations,the scientific rigor and validity of the Guidelines were further enhanced.

With the rapid development of medical big data and artificial intelligence,Clinical Prediction Models(CPMs)have become pivotal tools for disease prevention,diagnosis,and treatment.Current research predominantly focuses on the economic analysis of pharmacological or public health interventions,yet a comprehensive methodological framework for the economic evaluation of CPMs has been notably absent.The Guidelines for Economic Evaluation of Clinical Prediction Models(hereafter the Guidelines),jointly initiated by the Chinese Research Hospital Association and Peking University,Tsinghua University,and Capital Medical University,adheres to the WHO Handbook for Guideline Development and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards.A multidisciplinary collaboration,including a steering committee,expert panel,secretariat,and external review group,was established to develop the guideline following evidence-based principles and procedures.Consensus recommendations were formulated through the Delphi method.It describes the background,objectives,target group,and the development methodology and process,ensuring the entire compilation process of the Guidelines is transparent and standardized.Through comprehensive evidence retrieval,systematic evidence appraisal,and a scientific approach to forming recommendations,the scientific rigor and validity of the Guidelines were further enhanced.

Objective:To investigate the diagnosis，therapeutic strategy and early prognosis of Scimitar syndrome in pediatric patients.Methods:Clinical data of 21 children with Scimitar syndrome admitted to the Department of Cardiothoracic Surgery of Shanghai Children's Medical Center from January 2014 to December 2021 were retrospectively analyzed，and divided into 11 cases in the infantile-type group and 10 cases in the adult-type group.Results:Twenty-one children with Scimitar syndrome，10 males and 11 females，aged 5 days to 10 years old. Compared with the adult-type group，the infant-type group had a high proportion of preoperative clinical symptoms( P<0.05)，a high concomitant rate of intracardiac malformations (100% vs. 40%， P=0.002)，a big size of aortopulmonary collateral(APC)[(0.77±0.25) mm/kg vs.(0.36±0.13) mm/kg， P=0.016]，a high incidence of pulmonary hypertension(91.0% vs. 50.0%， P=0.038), and a high proportion of severe pulmonary hypertension(50 % vs. 0). There was a high rate of postoperative complications of low cardiac output syndrome (36.4% vs. 0， P=0.034)，prolonged postoperative mechanical ventilation [(73.22±44.75) h vs. (19.5±12.79) h， P=0.007]，and prolonged length of ICU stay[(7.89±3.37) d vs. (2.50±1.26) d， P<0.001]. Eleven cases underwent surgical treatment only，and 10 cases received hybrid operation with APC occlusion. The survival rate of the whole group was 90.5%，and there was no case of pulmonary venous obstruction in the early postoperative period. Systolic pulmonary artery pressure/systolic artery pressure decreased significantly after surgery in 15 children with pulmonary arterial hypertension( P<0.01).Five cases in the infantile-type group still had pulmonary hypertension. Conclusion:Surgical effect of Scimitar syndrome in pediatric patients is satisfactory. Infants with Scimitar syndrome usually have more severe symptoms, higher incidence of severe pulmonary hypertension and relatively longer postoperative recovery time.

Objective:To study the differences of ultrasound on kidney in monitoring renal hemodynamics and renal perfusion of patients with septic shock-induced acute kidney injury(AKI),and the predictive value of ultrasound-related parameters on kidney for septic shock-induced AKI.Methods:This is a prospective study,a total of 100 patients with septic shock who were diagnosed and treated in our hospital between September 2022 and September 2023 were selected as the study subjects.They were divided into AKI group(35 cases)and non-AKI group(65 cases)according to the relative standards of＜Clinical Practice Guideline of Global Kidney Disease Prognosis for the Tissue of Acute Kidney Injury(2012)＞.The age,gender,body mass index(BMI),comorbidities,central venous pressure,serum creatinine,urea nitrogen,blood lactate,Acute Physiology And Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score of all patients were collected after they admitted to hospital.Ultrasound on kidney was used to detect the renal resistive index(RRI)and power Doppler ultrasound(PDU)scores for patients,and indicators included peak intensity(PI),mean transit time(MTT),and area under curve(AUCTC)of the time-intensity were collected.Results:After septic shock,the PI,AUCTC,MTT parameter and RRI score of AKI group were lower than those of non-AKI group,while the PUD score was higher than that of non-AKI group,and the differences of them between two groups were significant(t=5.391,8.978,5.664,2.626,5.102,P＜0.05).There were no significant differences in gender,age,BMI,comorbidities(diabetes,hypertension,coronary heart disease),blood lactate,APACHE II score,and SOFA score between the two groups(P＞0.05).After multiple confounding factors were rectified,the results showed that PI,AUCTC and PRI scores were independent influencing factors for occurring AKI in sepsis patients(OR=0.51,0.86,0.77,P＜0.05).The PI,AUCTC and RRI were used as continuous variable,and receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of PI,AUCTC and RRI for septic shock-induced AKI.The results indicated that the AUC values of PI,AUCTC and RRI were respectively 0.83(95%CI:0.75～0.91),0.79(95%CI:0.70～0.88)and 0.72(95%CI:0.62～0.82).Conclusion:Renal ultrasound-related indicators can effectively monitor renal hemodynamics and perfusion in patients with septic shock,and can further predict the risk of occurring AKI.It is suggested to promote that in clinical application.

Objective:To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOCO) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:From January 2019 to December 2021, 233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital. The median follow-up duration was 3.9 years. The 367 non-culprit vessels of the 233 patients were divided into the VOCO group (33 vessels, 9.0%) and the non-VOCO group (334 vessels, 91.0%). Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared. Receiver operating characteristic (ROC) curves were used to assess the correlation between hemodynamic pattern and VOCO, and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results:The 233 enrolled patients were aged (62.5±12.9) years, with 193 males (82.8%). In the VOCO group, the maximum quantitative flow ratio (QFR) decreased within 20 mm of the QFR-assessed segment, the difference in QFR across the entire vessel, the length of functionally significant vessel, and the maximum gradient of QFR decrease (dQFR/dsmax) were significantly greater than those in the non-VOCO group. ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.009 6 (area under the curve: 0.691, 95% CI: 0.606-0.775, P<0.001). Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO ( HR=1.199, 95% CI: 1.070-1.343, P=0.002). When anatomical and functional stenosis severities were included in the model, a high pullback pressure gradient (PPG) index ( HR=1.572, 95% CI: 1.052-2.351, P=0.027) emerged as an independent predictor of VOCO. Multivariable logistic regression analysis revealed that a low PPG index( OR=2.851, 95% CI: 1.945-4.178, P<0.001) was an independent predictor of QFR≤0.80 without long-term VOCO. Conclusion:In patients with STEMI, localized hemodynamic patterns of coronary artery stenosis, characterized by high dQFR/dsmax and high PPG index, are associated with long-term VOCO.

Objective To observe the impact of age and menstrual status on semi-quantitative parameters of breast dynamic enhanced MRI(DCE-MRI)in healthy adult women.Methods A total of 283 adult females who underwent MR examinations due to suspected breast mass or breast discomfort but no breast tumor was detected after 1 year's clinical follow-up were retrospectively collected.Meanwhile,49 healthy adult female subjects in the menstrual period(menstruating subgroup)were prospectively recruited.All the above 332 subjects were divided into low age group(n=107),middle age group(n=114)and high age group(n=111)according to age,while into postmenopausal group(n=112)and premenopausal group(n=220,including 49 in menstruating subgroup,77 in proliferating subgroup and 94 in secreting subgroup).DCE-MRI semi-quantitative parameters,including maximum enhancement rate(ERmax)and maximum slope of increasing(Slopemax)were compared among different groups and subgroups,and the variations were observed.Results Significant differences of ERmax and Slopemax were found between high and low age groups(both P＜0.05),while no significant difference of ERmax and Slopemax was found between middle and low age group,nor between middle and high age group(all P＞0.05).Both ERmax and Slopemax in postmenopausal group were lower than those in premenopausal group(both P＜0.05),while no significant difference of DCE-MRI semi-quantitative parameters was found among different menstrual cycle subgroups(all P＞0.05).The coefficient of variance(CV)of normal breast ERmax in low,middle and high age groups was 56.20％,44.02％and 50.97％,respectively,of Slopemax was 54.74％,81.78％and 76.93％,respectively.CV of normal breast ERmax was 50.12％and 46.02％in postmenopausal and premenopausal groups,respectively,while CV of Slopemax was 72.84％and 62.04％,respectively.Among different subgroups,CV of ERmax and Slopemax in proliferative period were both the largest(61.39％,82.54％),which in menstrual period were both the smallest(33.99％,42.33％).Conclusion Semi-quantitative parameters of breast DCE-MRI were different among healthy women of different age and menstrual status,and the individual variations were large.