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 evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

Objective To translate the good death inventory-short form(GDI-SF)into Chinese and test its reliability and validity among bereaved family members of cancer patients.Methods A Chinese version of GDI-SF was created through translation,reconciliation,back translation,expert panel review and pilot testing.Then the inventory was administered to 699 bereaved family members of cancer patients recruited by convenience sampling.Reliability and validity were assessed.Results Toally 305 family members finished the study.The item-level content validity index(I-CVI)and average content validity index(S-CVI/Ave)were both 1.00.Exploratory factor analysis yielded 5 common factors:professional medical care(6 items),preparation for farewell(4 items),dignity and life value(4 items),natural death and moral support(2 items),and physical and mental comfort(2 items).These factors explained 52.176%of total variance.Overall Cronbach α coefficient of the Chinese version GDI-S was 0.779,and split-half reliability was 0.731.The Pearson correlation coefficient range between the score of each item of the Chinese version of GDI-SF and the score of its corresponding dimension was 0.591 to 0.769(P<0.01).Conclusion The Chinese version GDI-SF exhibits acceptable reliability and validity assessment of the quality of good dying in cancer patients from the perspective of bereaved family members.

BACKGROUND: Spicy food consumption has been reported to be inversely associated with mortality from multiple diseases. However, the effect of spicy food intake on the incidence of vascular diseases in the Chinese population remains unclear. This study was conducted to explore this association. METHODS: This study was performed using the large-scale China Kadoorie Biobank (CKB) prospective cohort of 486,335 participants. The primary outcomes were vascular disease, ischemic heart disease (IHD), major coronary events (MCEs), cerebrovascular disease, stroke, and non-stroke cerebrovascular disease. A Cox proportional hazards regression model was used to assess the association between spicy food consumption and incident vascular diseases. Subgroup analysis was also performed to evaluate the heterogeneity of the association between spicy food consumption and the risk of vascular disease stratified by several basic characteristics. In addition, the joint effects of spicy food consumption and the healthy lifestyle score on the risk of vascular disease were also evaluated, and sensitivity analyses were performed to assess the reliability of the association results. RESULTS: During a median follow-up time of 12.1 years, a total of 136,125 patients with vascular disease, 46,689 patients with IHD, 10,097 patients with MCEs, 80,114 patients with cerebrovascular disease, 56,726 patients with stroke, and 40,098 patients with non-stroke cerebrovascular disease were identified. Participants who consumed spicy food 1-2 days/week (hazard ratio [HR] = 0.95, 95% confidence interval [95% CI] = [0.93, 0.97], P <0.001), 3-5 days/week (HR = 0.96, 95% CI = [0.94, 0.99], P = 0.003), and 6-7 days/week (HR = 0.97, 95% CI = [0.95, 0.99], P = 0.002) had a significantly lower risk of vascular disease than those who consumed spicy food less than once a week ( Ptrend <0.001), especially in those who were younger and living in rural areas. Notably, the disease-based subgroup analysis indicated that the inverse associations remained in IHD ( Ptrend = 0.011) and MCEs ( Ptrend = 0.002) risk. Intriguingly, there was an interaction effect between spicy food consumption and the healthy lifestyle score on the risk of IHD ( Pinteraction = 0.037). CONCLUSIONS Our findings support an inverse association between spicy food consumption and vascular disease in the Chinese population, which may provide additional dietary guidance for the prevention of vascular diseases.
Humans ; Male ; Female ; Prospective Studies ; Middle Aged ; Aged ; Vascular Diseases/etiology* ; Risk Factors ; China/epidemiology* ; Adult ; Proportional Hazards Models ; Cerebrovascular Disorders/epidemiology* ; East Asian People

Objective To translate the good death inventory-short form(GDI-SF)into Chinese and test its reliability and validity among bereaved family members of cancer patients.Methods A Chinese version of GDI-SF was created through translation,reconciliation,back translation,expert panel review and pilot testing.Then the inventory was administered to 699 bereaved family members of cancer patients recruited by convenience sampling.Reliability and validity were assessed.Results Toally 305 family members finished the study.The item-level content validity index(I-CVI)and average content validity index(S-CVI/Ave)were both 1.00.Exploratory factor analysis yielded 5 common factors:professional medical care(6 items),preparation for farewell(4 items),dignity and life value(4 items),natural death and moral support(2 items),and physical and mental comfort(2 items).These factors explained 52.176%of total variance.Overall Cronbach α coefficient of the Chinese version GDI-S was 0.779,and split-half reliability was 0.731.The Pearson correlation coefficient range between the score of each item of the Chinese version of GDI-SF and the score of its corresponding dimension was 0.591 to 0.769(P<0.01).Conclusion The Chinese version GDI-SF exhibits acceptable reliability and validity assessment of the quality of good dying in cancer patients from the perspective of bereaved family members.

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 evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

Objective To observe the value of spectral CT parameters for evaluating T staging of advanced gastric cancer(AGC).Methods Totally 155 AGC patients were collected and divided into T2 stage(n=40)and T3/4a stage(n=115)according to postoperative pathology.CT values,water concentration(WC)and iodine concentration(IC)of AGC lesions on 40-140 keV arteriovenous phase single energy level images were measured,and the standardized IC(nIC)and spectral curve slopes k1 and k2 were calculated.Clinical variables and spectral quantitative parameters were compared between groups,and receiver operating characteristic curve was plotted,the area under the curve(AUC)was calculated to evaluate the value of each parameter and model for identifying T2 and T3/4a stage AGC.Results Tumor thickness,proportion of low differentiation degree,CT100kev,CT140kev,and WC values in T3/4a group were all significantly higher than those in T2 group(all P＜0.05).CT140keV of AGC lesions on venous phase images presented the highest discrimination efficacy among single parameters,with AUC of 0.782.AUC of clinical-arterial phase-venous phase model was 0.848,higher than that of clinical model and arterial phase model alone(both P＜0.05)but not significantly different compared with AUC of venous phase model(P＞0.05).Conclusion Spectral CT quantitative parameters,especially venous phase parameters could be used to effectively identify T stage of AGC.Multi-parameter combined models had higher diagnostic value.

Objective To investigate the influencing factors and pathways of fluid management adherence and interdialytic weight control in hemodialysis patients based on the health belief model.Methods Using convenience sampling,433 patients receiving hemodialysis were included from 4 hospitals in Guangdong province.The demographic and clinical data questionnaire,Health Belief Scale of Fluid Restriction,and Fluid Intake Adherence Scale were used.The relative-interdialytic weight gain(R-1DWG)was calculated.Results The mean score of patients'fluid management adherence was 3.08±0.97,indicating a moderate level,with 35.57％of patients exceeding the required R-IDWG standard.Regarding health beliefs,perceived benefits(β=0.161)and self-efficacy(β=0.685)of fluid restriction directly affected fluid adherence;perceived threats of poor fluid restriction indirectly affected fluid management adherence through perceptions of benefits and self-efficacy(β=0.235);perceived barriers were indirectly and negatively associated with fluid management adherence through self-efficacy(β=-0.246).Higher fluid management adherence was associated with better control of R-IDWG(β=-0.361).Regarding the coordinating factors,age,educational level,hemodialysis vintage and diabetes were influential factors of fluid management adherence(|β|:0.050-0.162)and R-IDWG control(|β |:0.049-0.309).The coefficients(β)of each path were statistically significant(P＜0.05).Conclusion Healthcare providers should comprehensively assess patients'health beliefs,focus on patients with lower educational levels and diabetes,and identify weakness in their fluid management to achieve the required R-IDWG standard.

Multiple rib fracture is a common chest injury that can cause severe pain and seriously affect life quality of the patients. The traditional pulmonary function test can only assess changes in total lung volume and ventilation of the multiple rib fracture, but fails to reveal regional ventilation status in rib fracture area and ventilation differences within the whole lung. Instead, pulmonary electrical impedance tomography (EIT), as a novel bedside technique for ventilation monitoring, has advantages of non-invasiveness, non-use of radiative rays and dynamic visualization of regional ventilation, enabling to quantify ventilation defects and heterogeneity in space and time. Starting with the assessment of ventilation changes and research status of ventilation function in multiple rib fracture and the characteristics of EIT, the authors review the research progress in the evaluation of ventilation function following multiple rib fracture based on EIT, with the aim to provide new insight into the research on ventilation changes after multiple rib fracture.