Objectives:To explore the predictive value of angiography-derived index of microcirculatory resistance(Angio-IMR)for early prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:This multicenter study enrolled 1 629 consecutive STEMI patients who underwent successful PCI at three grade A tertiary hospitals(The Second Affiliated Hospital,Zhejiang University School of Medicine;Shengjing Hospital of China Medical University;Renji Hospital,Shanghai Jiao Tong University School of Medicine)from June 1,2017,to May 31,2020.According to postoperative Angio-IMR,patients was stratified into two groups:the Angio-IMR>40 group(n=508)and the Angio-IMR≤40 group(n=1 121).The incidence of major adverse cardiovascular events(MACE;defined as a composite endpoint including cardiac death,heart failure rehospitalization,cardiogenic shock,malignant arrhythmia,cardiopulmonary resuscitation and stent thrombosis)within 1-month post-PCI was compared between the two groups.Results:The median Angio-IMR after PCI was 32.4(22.3,42.6).The cumulative incidence of early-term MACE was significantly higher in patients with Angio-IMR>40,compared to those with Angio-IMR≤40(5.5%vs.2.3%,log-rank P<0.001).Multivariate Cox regression analysis showed that Angio-IMR>40 was an independent predictor of early-term MACE(HR=2.07,95%CI:1.20-3.58,P=0.009).The addition of Angio-IMR enhanced the predicting performance of the clinical risk model to predict early adverse outcomes(AUC:0.820 vs.0.794,P=0.043).Conclusions:In patients with STEMI after PCI,Angio-IMR can predict the occurrence of early-term MACE.The incorporation of Angio-IMR to clinical models significantly improves the model ability to predict early adverse outcomes in these patients.

Objectives:To explore the predictive value of angiography-derived index of microcirculatory resistance(Angio-IMR)for early prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:This multicenter study enrolled 1 629 consecutive STEMI patients who underwent successful PCI at three grade A tertiary hospitals(The Second Affiliated Hospital,Zhejiang University School of Medicine;Shengjing Hospital of China Medical University;Renji Hospital,Shanghai Jiao Tong University School of Medicine)from June 1,2017,to May 31,2020.According to postoperative Angio-IMR,patients was stratified into two groups:the Angio-IMR>40 group(n=508)and the Angio-IMR≤40 group(n=1 121).The incidence of major adverse cardiovascular events(MACE;defined as a composite endpoint including cardiac death,heart failure rehospitalization,cardiogenic shock,malignant arrhythmia,cardiopulmonary resuscitation and stent thrombosis)within 1-month post-PCI was compared between the two groups.Results:The median Angio-IMR after PCI was 32.4(22.3,42.6).The cumulative incidence of early-term MACE was significantly higher in patients with Angio-IMR>40,compared to those with Angio-IMR≤40(5.5%vs.2.3%,log-rank P<0.001).Multivariate Cox regression analysis showed that Angio-IMR>40 was an independent predictor of early-term MACE(HR=2.07,95%CI:1.20-3.58,P=0.009).The addition of Angio-IMR enhanced the predicting performance of the clinical risk model to predict early adverse outcomes(AUC:0.820 vs.0.794,P=0.043).Conclusions:In patients with STEMI after PCI,Angio-IMR can predict the occurrence of early-term MACE.The incorporation of Angio-IMR to clinical models significantly improves the model ability to predict early adverse outcomes in these patients.

Objective:To evaluate the performance of the self-developed transcranial ultrasound patch probe as well as its stability and safety in clinical applications.Methods:This study was a cross-sectional study. Fifty healthy subjects in Tangdu Hospital from October to December 2023 were randomly and equally divided into two groups using a simple randomization method. The transcranial Doppler ultrasound (TCD) examinations were performed using the self-developed transcranial ultrasound patch probe and normal TCD probe alternatively in each group from squatting to sitting and then to standing posture. Two experienced sonographers (A, B) each completed one test for the same subject using the above two different probes. The differences of the ultrasound parameters of middle cerebral artery (MCA) blood flow measured by the self-developed transcranial ultrasound patch probe and the normal TCD probe in different postures (squatting, sitting, standing) were compared. At the same time, operator satisfaction with the use of the two probes was assessed in terms of time taken to obtain satisfactory images, operational comfort, and ease of handling. In addition, the subject's comfort during the examination was examined, and the signal acquisition stability of the two probes was comprehensively evaluated.Results:There was no significant difference in detection of various ultrasound parameters of MCA between using the transcranial patch probe and the normal TCD probe (all P>0.05). The overall satisfaction of transcranial ultrasound patch probe and normal TCD probe was quite similar. The transcranial ultrasound patch probe acquired favorable and stable signals. No subjects experienced adverse events/accidents during the examination of the subjects using the transcranial ultrasound patch probe as well as the normal TCD probe.Both probes had good and stable signal acquisition. Conclusions:TCD examinations could be well performed using the transcranial ultrasound patch probe, which might provide a potential new method for real-time monitoring and evaluating of cerebral blood flow of a moving subject.

Objective:To investigate the accuracy and reproducibility of a new method, Automatic Measurement of Arterial Stiffness(AMAS) system, for arterial stiffness automatic measurement based on regional pulse wave velocity (PWV).Methods:A total of 30 hypertensive patients who were hospitalized in the Department of Cardiology in Tangdu Hospital, Air Force Military Medical University from September 1 to 30, 2019 were enrolled as hypertensive group, while 30 healthy participants at the same time were collected as healthy group. Carotid-femoral PWV (cfPWV) was measured in all subjects by two independent observers using the conventional manual method and the AMAS system. The measurements were compared and the agreement was analyzed.Results:There was no significant difference of cfPWV between AMAS system and the manual method, and the intraclass correlation coefficient was 0.953 (95% CI=0.922-0.971). Bland-Altman plots showed good agreement [mean difference: -(0.08±0.40)m/s; limit of agreement: -0.87-0.71 m/s]. Time consumption for cfPWV measurement using the AMAS system was significantly less than that of conventional manual method, saving about 70% of the time. The cfPWV measured by AMAS showed good intra- and inter-observer reproducibility. Conclusions:AMAS system is accurate and reproducible in measuring arterial stiffness. It may provide a noninvasive, rapid, reliable approach for arterial stiffness evaluation in clinical settings.

Objective:To investigate the application of ultrasound imaging in evaluating the curative effect of patients with nutcracker syndrome (NCS) treated with three-dimensional(3D) printing extravascular titanium stents.Methods:From December 2015 to December 2018, a total of 41 NCS patients enrolled in the Second Affiliated Hospital of the Air Force Military Medical University to receive 3D-printing extravascular titanium stents treatment were included in this study. Ultrasound and CT angiography (CTA) were performed before and 1 week after operation to evaluate the compression of left renal vein and related hemodynamic changes.Results:Before the operative, the ultrasound examination showed that the angle between the abdominal aorta and superior mesenteric artery was (21.29±4.53)°, which was significantly improved in 1 week after treatment [(47.42±7.45)°, P<0.001]. Left renal vein was significantly compressed before treatment, with the smallest inner diameter of (1.51±0.49)mm and its peak blood flow velocity was (143.92±50.40)cm/s. Postoperative ultrasound images showed the significant expansion of left renal vein and no high velocity blood flow was observed. Ultrasound examination also showed that the diameter of left renal vein at renal hilum, blood flow velocity at renal hilum and inner diameter of spermatic vein were significantly improved after treatment ( P<0.001). Similar to ultrasound results, CTA also found that the angle between abdominal aorta and superior mesenteric artery increased significantly after treatment[(17.59±4.56)° vs (52.27±9.01)°, P<0.001]. CTA also showed the left renal vein was compressed before treatment, with the smallest inner diameter of (2.09±0.86)mm, and it was significantly expanded after operation. The inner diameter of left renal vein at renal hilum was also significantly reduced after treatment ( P<0.001). Conclusions:Ultrasound imaging can effectively evaluate the LRV compression and related hemodynamic changes before and after 3D printed stent implantation treatment in NCS patients and provide a reliable method to evaluate its clinical efficacy for these patients.

Objective:To evaluate the interobserver variation of pathologists in the morphological evaluation of non-invasive follicular thyroid neoplasm with papillary-like nuclear features(NIFTP).Methods:Nine pathologists from different regions in China were selected to evaluate the digital slides of 30 cases of NIFTP. Three score system was applied, including nuclear size and shape, membrane irregularity, and chromatin features. Individual histologic features were scored as either present(1)or absent(0). A total score of 0 or 1 was considered inadequate for the diagnosis of NIFTP and a total score of 2 or 3 was considered sufficient for the diagnosis of NIFTP.Results:Overall, 9 doctors had weak consistency in the interpretation of the 30 cases(Kappa value 0.081 4), in which the interpretation of the membrane irregularity had the best consistency(Kappa value 0.193 6)and the interpretation of nuclear size and shape revealed the worst consistency(Kappa value 0.102 2). The overall consistency of the evaluation from the 7 senior pathologists was better than that of all the pathologists(Kappa value 0.134 1), but it was still weak. The consistency of nuclear membrane irregularity(Kappa value 0.267 4)and nuclear chromatin features(Kappa value 0.257 3)was weak, but much better than that of nuclear size and shape(Kappa value 0.073 0). The interobserver consistency in our study was lower than that in Asian study generally. However, the judgement on membrane irregularity in our senior pathologists was better than that in Asian study.Conclusion:The interobserver variation on the evaluation of the nuclear features of NIFTP is probably due to the education level, working experience, personal understanding of the diagnostic criteria, the regional difference, and some uncertain reasons. There is overall a weak consistency in the interpretation of NIFTP by Chinese pathologists, and it is necessary to popularize the diagnostic criteria and specify the criteria in detail. It is important to exclude high-risk genetic mutation using immunohistochemical staining or molecular examination on those patients with morphology of NIFTP.

Objective    In this study, three-dimensional printed (3DP) titanium implants were used for skeletal reconstructions after wide excision of chest wall. 3DP titanium implants were expected to provide a valid option with perfect anatomic fitting and personalized design in chest wall reconstruction. Methods    There were 13 patients [mean age of 46 (24-78) years with 9 males and 4 females] who underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP titanium implants. Surgical data including patient demographic characteristics, perioperative clinical data and data from 1-year follow-up were collected and analyzed. Results    Six patients of rib tumors, six patients of sternal tumors and one patient of sternal pyogenic osteomyelitis were finally selected for the study. The chest wall defect area was 221.0±206.0 cm2. All patients were able to maintain the integrity of the chest wall after surgery, and no abnormal breathing was found, achieving personalized and anatomical repair. Thirteen patients were successfully discharged from the hospital. Two patients developed pneumonia in the perioperative period. During the follow-up period in the first year after surgery, no implant related adverse reaction was observed, including implant rupture, implant shift, rejection reaction and allergies. One patient had wound ulcer after chemotherapy. Three patients had tumor recurrence, with the recurrence rate of 25.0%. Two patients died of tumor recurrence, with a mortality rate of 16.7%. Conclusion    3DP titanium implant is a safe and effective material for chest wall reconstruction. 

Objective To explore the mechanism of intrathoracic pressure(ITP) influncing cardiac function and facilitate noninvasive determination of ventricular pressure theoretically.Methods With Valsalva and Mueller maneuver,two-dimension images of standard long axis views and the cross-sectional views were recorded in 20 volunteers,aged from 18 to 45 years,at the specific ITP levels(including-20 mmHg、-10 mmHg、0 mmHg、+ 10 mmHg and + 20 mmHg).The subjects were instructed to mantain for at least 10 s,and three successive measurements were recorded and averaged.The stroke volume(SV) and radius of curvature(R) were obtained from further off-line analysis.Results With the ITP maintaining at -20 mmHg,-10 mmHg,0 mmHg(end expiration),+ 10 mmHg and + 20 mmHg respectively,the corresponding radiuses of curvature were (2.35 ±0.24)cm,(2.25 ± 0.23)cm,(2.14 ± 0.21)cm,(2.02 ± 0.21) cm,(1.93 ± 0.19) cm,there were statistically significances between two groups (P =0.006,0.031,0.005 and ＜0.001,respectively].When the ITP were at 0 mmHg(end expiration),+ 10 mmHg and + 20 mmHg,the stroke volume were (71.54±8.81)ml,(73.20±9.52)ml and (78.81± 14.61)ml (P =0.674,0.135).When the intrathoracic pressure decreased from 0 mmHg to-20 mmHg,the stroke volume were (78.81±14.61)ml,(68.28 ±9.28)ml and (59.69±7.52)ml(P =0.029,0.037).Conclusions The ITP has different effects on the two ventricles,and subsequently generates a pressure gradient across the IVS which can alter its shape and position at end-diastole.With the IVS shifting,the preload and filling function of left ventricle gets changed acorrding to the Frank Starling principle.

Objective To observe the peripheral arterial Doppler flow velocity curve changes and elucidate the blood flow characteristics by adding extra pressure on the limbs,and to provide evidence for better diagnosis of peripheral arterial diseases by ultrasound.Methods Color Doppler ultrasound instrument was used to record the brachial artery(BA),radial artery(RA),common femoral artery(CFA) and popliteal artery(POA) Doppler flow velocity curves both at rest and under different grades of distal and proximal limb pressuring in 40 randomly selected healthy adults.The peak systolic and early diastolic reverse flow velocity(PSV,PRV) and the resistance index (RI) were measured and analyzed.Results Three-phase waveform was seen at rest.Significant changes were noticed in PRV and RI under distal pressuring,while no significant difference was seen in PSV between groups.Conclusions Normal peripheral arteries show pulsed step-by-step blood flow pattern along with the cardiac cycles.Peripheral arterial Doppler flow curves changes regularly with limb grading pressuring.