Objectives:To investigate the prognostic difference of different revascularization strategies in AMI patients with multi-vessel disease and diabetes.Methods:AMI patients with multi-vessel disease and diabetes admitted to the Department of Cardiology of the First Hospital of Lanzhou University from January 2022 to June 2024 were retrospectively included.Patients were divided into non complete revascularization(NCR)group(n=166),staged complete revascularization(SCR)group(n=152)and immediate complete revascularization(ICR)group(n=120).Baseline clinical characteristics,coronary angiography data and postoperative medication were compared among the groups.Primary endpoint was the major adverse cardiovascular and cerebrovascular events(MACCE)during follow-up.MACCE includes all-cause mortality,cardiogenic mortality,non-fatal myocardial infarction,unplanned revascularization and stroke.The log-rank test was used to analyze the significance of the differences in the cumulative incidence of MACCE among the three groups.Cox regression was used to explore the influencing factors of poor prognosis in patients.Results:There were statistically significant differences among NCR group,SCR group and ICR group in terms of the history of previous percutaneous coronary intervention,the use of intraoperative coronary intravascular ultrasound(IVUS)and the dosage of contrast agent(all P<0.05).During a median follow-up of 21(11,25)months,MACCE events occurred in 59 cases(35.5%)in the NCR group,26 cases(17.1%)in the SCR group,and 30 cases(25.0%)in the ICR group.The Kaplan-Meier curve showed that the differences in the cumulative incidence of MACCE among the three groups were statistically significant(log-rank P<0.001).Using the Bonferroni correction(adjusted α′=0.05/3≈0.0167),pairwise comparisons revealed statistically significant differences between the NCR and SCR groups(log-rank P<0.001)and between the NCR and ICR groups(log-rank P=0.011).However,no statistically significant difference was observed between the SCR and ICR groups(log-rank P=0.228).Cox multivariate regression analysis demonstrated that history of hypertension was an independent risk factor for MACCE in AMI patients with multivessel coronary artery disease and diabetes(HR=1.71,95%CI:1.10-2.64,P<0.05).The difference in the incidence of MACCE between the SCR group and the NCR group was statistically significant(HR=0.45,95%CI:0.28-0.73,P=0.001).Conclusions:Staged complete revascularization serves as the preferred revascularization strategy for AMI patients with multivessel coronary disease and diabetes mellitus.Additionally,for patients with concomitant hypertension,blood pressure management should be intensified to reduce the risk of MACCE.

Objective:To compare the efficacy of ustekinumab (UST) and vedolizumab (VDZ) in achieving transmural healing in active Crohn′s disease (CD).Methods:From March 1, 2020 to November 30, 2024, 112 patients with active CD treated with UST or VDZ at the Department of Gastroenterology, Tenth People′s Hospital of Tongji University were retrospectively enrolled. According to the medication regimen, the 112 patients were divided into UST group (61 cases) and VDZ group (51 cases). Collected the data at baseline, such as the disease phenotype, other medication history, and clinical indicators including C-creative protein (CRP), etc. Clinical disease activity and endoscopic disease activity were assessed by Harvey-Bradshaw index (HBI) and simplified endoscopic score for Crohn′s disease (SES-CD), respectively. Transmural healing was evaluated according to the intestinal wall thickness measured by intestinal imaging examination of the affected intestinal segment. Transmural healing was defined as bowel wall thickness <0.3 cm and 110 obvious signs of inflammation, clinical remission was defined as HBI≤4, and endoscopic remission was defined as a reduction in SES-CD ≥50% or a score of ≤2. The primary endpoint was transmural healing rate within one year after treatment. The secondary endpoints were endoscopic healing rate and clinical remission rate at 13 to 24th week and 30 to 52nd week after treatment. Chi-square test or Fisher′s exact test was used to compare the efficacy of the 2 medications.Results:There was no significant difference in transmural healing rate between UST group and VDZ group within 1 year after treatment (16.4% (10/61) vs. 23.5% (12/51), χ2=0.90, P=0.344). There were no significant differences in the healing rate between UST group and VDZ group in patients with specific baseline characteristics before treatment, including CD with stenosis, with perianal disease, no history of glucocorticoid use, secondary loss of response to anti-tumor necrosis factor (TNF)-α, SES-CD 7 to 15, decreased body mass index, and increased CRP (18.2%(6/33) vs. 19.4%(7/36), 17.9%(7/39) vs. 19.4%(6/31), 17.1%(6/35) vs. 24.2%(8/33), 20.0%(8/40) vs. 3/18, 14.3%(5/35) vs. 19.2%(5/26), 15.0%(3/20) vs. 3/10, 21.4%(6/28) vs. 5/16), all P>0.05). There was no significant difference in the clinical remission rate or endoscopic remission rate between the UST group and the VDZ group from 13 to 24th week (7/14 vs. 9/18, 3/14 vs. 7/18, RR=1.000 and 0.551, 95% confidence interval: 0.497to 2.011, 0.173to 1.755, χ2=<0.01, Fisher′s exact test, both P>0.05). There was no significant difference in clinical remission rate or endoscopic remission rate between UST group and VDZ group from week 30 to week 52 after treatment (68.5% (37/54) vs. 74.4% (32/43), 27.8% (15/54) vs. 32.6% (14/43), RR=0.921 and 0.853, 95% confidence interval: 0.716 to 1.184, 0.464 to 1.568, χ2=0.41 and 0.26, both P>0.05). In UST group, the proportion of patients with normal hemoglobin after transmural healing was higher than that of patients without transmural healing (9/10 vs. 45.1% (23/51), and the difference was statistically significant ( χ2=5.08, P=0.024). However, there were no significant differences in the proportion of patients with normal body mass index, CRP, platelet count, prealbumin, albumin, interleukin-6 or TNF-α levels after treatment between those who achieved transmural healing and those who did not in either UST group or VDZ group (all P>0.05). And in VDZ group there was no significant difference in the proportion of patients with normal hemoglobin between those who achieved transmural healing and who did not (all P>0.05). Conclusion:UST and VDZ exhibit similar efficacy in transmural healing within one year of treatment in patients with active CD.

Objectives:QT interval prolongation during treadmill test exercise is one of the clinical feature of patients with long QT syndrome(LQTS).This study aimed to explore the feasibility and efficacy of treadmill exercise testing as an auxiliary diagnosis tool for LQTS in clinical practice.Methods:We enrolled normal healthy individuals,common cardiovascular disease patients,and clinically diagnosed or suspected LQTS patients,who underwent treadmill exercise test from July 2023 to July 2024 at Fuwai Hospital.A special treadmill exercise testing procedure was designed to record the QT interval correction(QTc)intervals of the twelve lead electrocardiogram at 6 time points when performing the exercise tablet,including supine,sitting,standing,peak exercise,and recovery at 1-minute and 4-minute.The differences in QTc intervals among healthy group,cardiovascular diseases group,and suspected LQTS group were compared.Results:A total of 80 cases were consecutively enrolled,including 37 normal healthy controls,25 patients with common cardiovascular disease,and 18 patients with suspected LQTS.The QTc intervals at 6 points did not differ significantly between normal healthy controls and patients with cardiovascular disease,with QTc intervals less than 480 ms at all measurement.For patients with suspected LQTS,67.7%(12/18)of these patients presented a QTc interval≥480 ms at the 4-minute during recovery period.Among them,5 cases were confirmed to have pathogenic gene mutations of LQTS by genetic testing(including 1 case with a lying electrocardiogram QTc interval of 489 ms diagnosed with LQTS 1 type and a QTc interval of 636 ms during the 4-minute recovery period after exercise);5 clinically diagnosed patients(negative or undetectable in genetic testing)with a Schwartz score≥4,and the remaining 2 patients had a Schwartz score of 3.The remaining 5/18 patients,include 2 patients with clinical Schwartz scores≥4 and 3 patients with clinical suspicion(Schwartz scores 2-3)had a 4 min QTc interval of 445-480 ms during exercise recovery.Another patient with clinical suspicion(Schwartz score 3)had a 4 min QTc interval of<445 ms during exercise recovery and a negative genetic test at a later stage.Receiver operating characteristic curve analysis showed a sensitivity of 83.3%and specificity of 98.4%for QTc interval≥482 ms during the 4-minute recovery period of exercise as the LQTS diagnostic cutoff.Conclusions:This study results suggest that this special treadmill exercise testing protocol is effective in identifying LQTS and has strong feasibility and generalizability for clinical practice.

Objectives:To investigate the prognostic difference of different revascularization strategies in AMI patients with multi-vessel disease and diabetes.Methods:AMI patients with multi-vessel disease and diabetes admitted to the Department of Cardiology of the First Hospital of Lanzhou University from January 2022 to June 2024 were retrospectively included.Patients were divided into non complete revascularization(NCR)group(n=166),staged complete revascularization(SCR)group(n=152)and immediate complete revascularization(ICR)group(n=120).Baseline clinical characteristics,coronary angiography data and postoperative medication were compared among the groups.Primary endpoint was the major adverse cardiovascular and cerebrovascular events(MACCE)during follow-up.MACCE includes all-cause mortality,cardiogenic mortality,non-fatal myocardial infarction,unplanned revascularization and stroke.The log-rank test was used to analyze the significance of the differences in the cumulative incidence of MACCE among the three groups.Cox regression was used to explore the influencing factors of poor prognosis in patients.Results:There were statistically significant differences among NCR group,SCR group and ICR group in terms of the history of previous percutaneous coronary intervention,the use of intraoperative coronary intravascular ultrasound(IVUS)and the dosage of contrast agent(all P<0.05).During a median follow-up of 21(11,25)months,MACCE events occurred in 59 cases(35.5%)in the NCR group,26 cases(17.1%)in the SCR group,and 30 cases(25.0%)in the ICR group.The Kaplan-Meier curve showed that the differences in the cumulative incidence of MACCE among the three groups were statistically significant(log-rank P<0.001).Using the Bonferroni correction(adjusted α′=0.05/3≈0.0167),pairwise comparisons revealed statistically significant differences between the NCR and SCR groups(log-rank P<0.001)and between the NCR and ICR groups(log-rank P=0.011).However,no statistically significant difference was observed between the SCR and ICR groups(log-rank P=0.228).Cox multivariate regression analysis demonstrated that history of hypertension was an independent risk factor for MACCE in AMI patients with multivessel coronary artery disease and diabetes(HR=1.71,95%CI:1.10-2.64,P<0.05).The difference in the incidence of MACCE between the SCR group and the NCR group was statistically significant(HR=0.45,95%CI:0.28-0.73,P=0.001).Conclusions:Staged complete revascularization serves as the preferred revascularization strategy for AMI patients with multivessel coronary disease and diabetes mellitus.Additionally,for patients with concomitant hypertension,blood pressure management should be intensified to reduce the risk of MACCE.

Renal carcinoma，a common malignant tumor of the urinary system，poses a significant disease burden . With innovations in artificial intelligence（AI）deep learning algorithms and the expanded clinical use of domestically developed surgical robots，renal carcinoma diagnosis and treatment have seen multi-dimensional breakthroughs. In molecular imaging and pathology diagnosis，AI drives multi-omics fusion diagnosis，while molecular imaging guides precise treatment. In surgical technology，5G-enabled telesurgery transcends geographical limits，and immersive virtual reality technology boosts surgical accuracy. Targeted therapy and immunotherapy revolutionizes advanced renal carcinoma treatment and opens up new therapeutic frontiers. Radiotherapy and energy therapy have become more precise. Despite these advances，bottlenecks persist in diagnosis and treatment. Future progress requires focusing on technological integration，clinical translation，and exploration of energy-based therapies to transition from "precise" to "intelligence" in renal carcinoma diagnosis and treatment.

Objective:To investigate the risk factors for patients with hypertriglyceridemia-related acute pancreatitis (HTG-AP) developing into severe acute pancreatitis or experiencing organ failure.Methods:This retrospective cohort study collected clinical data from 2 429 patients diagnosed with acute pancreatitis from five hospitals in China between January 2019 and December 2023 using a pre-designed data collection form. The cohort included 1 516 males and 913 females,with an age of (50.2±16.5)years(range: 11 to 99 years). Among them,353 patients (16.1%) had HTG-AP,while 1 846 (83.9%) had non-HTG-AP. HTG-AP was defined as serum triglyceride levels>500 mg/dl with other etiologies excluded. Intergroup comparisons were performed using t-tests,Mann-Whitney U test or χ2 tests,respectively. Univariate and multivariate logistic regression analyses were conducted to assess risk factors for severe acute pancreatitis after adjusting for potential confounders,and a predictive model was developed and validated. Results:Compared with other etiologies,HTG-AP patients had a higher risk of progressing to SAP ( OR=1.415,95% CI: 0.866 to 2.312, P=0.017) and organ failure ( OR=1.256,95% CI: 1.015 to 1.554, P=0.036). Among HTG-AP patients,risk factors for SAP included body mass index ( OR=1.856,95% CI: 1.742 to 1.987, P=0.033),fasting blood glucose ( OR=1.128,95% CI: 1.036 to 1.229, P=0.006),white blood cell count( OR=1.162,95% CI: 1.055 to 1.281, P=0.002),and the presence of pleural effusion ( OR=13.151,95% CI: 4.330 to 19.946, P<0.01). A nomogram prediction model for SAP in HTG-AP was constructed based on these risk factors,demonstrating good discriminative ability with area under the curve values of 0.877 in the training set and 0.894 in the validation set,along with satisfactory calibration. Conclusions:HTG-AP patients are at higher risk of developing SAP and organ failure. The risk prediction model incorporating body mass index,fasting blood glucose,white blood cell count,and pleural effusion shows good predictive value for SAP.

Objective:To compare the efficacy of ustekinumab (UST) and vedolizumab (VDZ) in achieving transmural healing in active Crohn′s disease (CD).Methods:From March 1, 2020 to November 30, 2024, 112 patients with active CD treated with UST or VDZ at the Department of Gastroenterology, Tenth People′s Hospital of Tongji University were retrospectively enrolled. According to the medication regimen, the 112 patients were divided into UST group (61 cases) and VDZ group (51 cases). Collected the data at baseline, such as the disease phenotype, other medication history, and clinical indicators including C-creative protein (CRP), etc. Clinical disease activity and endoscopic disease activity were assessed by Harvey-Bradshaw index (HBI) and simplified endoscopic score for Crohn′s disease (SES-CD), respectively. Transmural healing was evaluated according to the intestinal wall thickness measured by intestinal imaging examination of the affected intestinal segment. Transmural healing was defined as bowel wall thickness <0.3 cm and 110 obvious signs of inflammation, clinical remission was defined as HBI≤4, and endoscopic remission was defined as a reduction in SES-CD ≥50% or a score of ≤2. The primary endpoint was transmural healing rate within one year after treatment. The secondary endpoints were endoscopic healing rate and clinical remission rate at 13 to 24th week and 30 to 52nd week after treatment. Chi-square test or Fisher′s exact test was used to compare the efficacy of the 2 medications.Results:There was no significant difference in transmural healing rate between UST group and VDZ group within 1 year after treatment (16.4% (10/61) vs. 23.5% (12/51), χ2=0.90, P=0.344). There were no significant differences in the healing rate between UST group and VDZ group in patients with specific baseline characteristics before treatment, including CD with stenosis, with perianal disease, no history of glucocorticoid use, secondary loss of response to anti-tumor necrosis factor (TNF)-α, SES-CD 7 to 15, decreased body mass index, and increased CRP (18.2%(6/33) vs. 19.4%(7/36), 17.9%(7/39) vs. 19.4%(6/31), 17.1%(6/35) vs. 24.2%(8/33), 20.0%(8/40) vs. 3/18, 14.3%(5/35) vs. 19.2%(5/26), 15.0%(3/20) vs. 3/10, 21.4%(6/28) vs. 5/16), all P>0.05). There was no significant difference in the clinical remission rate or endoscopic remission rate between the UST group and the VDZ group from 13 to 24th week (7/14 vs. 9/18, 3/14 vs. 7/18, RR=1.000 and 0.551, 95% confidence interval: 0.497to 2.011, 0.173to 1.755, χ2=<0.01, Fisher′s exact test, both P>0.05). There was no significant difference in clinical remission rate or endoscopic remission rate between UST group and VDZ group from week 30 to week 52 after treatment (68.5% (37/54) vs. 74.4% (32/43), 27.8% (15/54) vs. 32.6% (14/43), RR=0.921 and 0.853, 95% confidence interval: 0.716 to 1.184, 0.464 to 1.568, χ2=0.41 and 0.26, both P>0.05). In UST group, the proportion of patients with normal hemoglobin after transmural healing was higher than that of patients without transmural healing (9/10 vs. 45.1% (23/51), and the difference was statistically significant ( χ2=5.08, P=0.024). However, there were no significant differences in the proportion of patients with normal body mass index, CRP, platelet count, prealbumin, albumin, interleukin-6 or TNF-α levels after treatment between those who achieved transmural healing and those who did not in either UST group or VDZ group (all P>0.05). And in VDZ group there was no significant difference in the proportion of patients with normal hemoglobin between those who achieved transmural healing and who did not (all P>0.05). Conclusion:UST and VDZ exhibit similar efficacy in transmural healing within one year of treatment in patients with active CD.

Objective To explore the value of low contrast dose and low flow rate one-stop craniocervical CT angiography(CT A)-cerebral CT perfusion(CTP)for detecting carotid atherosclerosis(CAS).Methods Totally 117 CAS patients were prospectively enrolled and divided into group A(n=19),B(n=52),C(n=46),and low contrast dose and low flow rate one-stop craniocervical CTA-brain CTP scanning,low contrast dose and low flow rate craniocervical CT A scanning,as well as conventional craniocervical CT A scanning were performed,respectively.Virtual monoenergetic images(VMI)of 40,50 and 60 keV were reconstructed in group A and B.The subjective and objective evaluations of image quality were compared among 3 groups.Results Subjective scores of image quality and diagnostic confidence of 40 and 50 keV VMI,and the diagnostic confidence of 60 keV VMI in group A and B were not significant different compared with those in group C(all P＞0.05).Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of each segment of craniocervical blood vessels at 40 and 50 keV VMI in group A and B were all higher than those in group C(all P＜0.05).CNR of cavernous sinus segment of internal carotid artery(C5 segment),horizontal segment of middle cerebral artery(MCA)(A1 segment),lateral sulcus segment of MCA(M2 segment)and basilar artery(BA)segment in group A at 60 keV VMI were all higher than those in group C(all P＜0.05).SNR of C5 segment,A1 segment and BA segment,as well as CNR of BA segment of 60 keV VMI in group B were all higher than those in group C(all P＜0.05).Conclusion Low contrast dose and low flow rate one-stop craniocervical was feasible for detecting CAS.

Objective:To analyze the early family diet nursing guidance needs of patients with gastrointestinal polyps resection based on Kano model, further screen the needs and optimize nursing strategies.Methods:This was a cross-sectional study. A total of 215 patients who underwent gastrointestinal polypectomy in Yingtan 184 Hospital of China Rongtong Group Healthcare Co. Ltd from January 2022 to June 2024 were prospectively selected using the purposive sampling method. The Kano model combined with Delphi expert consultation method was used to design a questionnaire on the family dietary nursing guidance needs of patients with gastrointestinal polypectomy. The Kano model needs attribute classification, Better-Worse coefficient analysis and two-dimensional matrix analysis were used to determine the information needs attributes, and the most sensitive and most needed factors were screened out for strategy optimization.Results:In this study, 232 questionnaires were distributed, and 215 valid questionnaires were returned, with an effective return rate of 92.67%. The 215 patients ranged in age from 20 to 72 years, with a mean age of 40.92 ± 10.06 years, including 163 males and 52 females. Among the 16 items in the survey questionnaire, 15 items need to be improved first. These include 1 attractive demand, 7 basic demands and 7 expected demands. The top 3 most sensitive needs were the formulation of an early home diet plan, the evaluation of the current diet structure, and the avoidance of exacerbating negative emotions, with sensitivities of 0.380, 0.370 and 0.328, respectively.Conclusions:The follow-up recommendations focus on providing support for family diet nursing, strengthening education on healthy diet, helping patients build a reasonable diet structure and habits, preventing malnutrition in the process, so as to meet the needs of early family diet nursing guidance for such patients.

Objective:To identify risk factors for developing infected pancreatic necrosis (IPN) in female hypertriglyceridemia-induced acute pancreatitis (HTG-AP) patients with childbearing age.Methods:A retrospective analysis was conducted on clinical data from 460 female HTG-AP patients with childbearing age admitted to Eastern Theater General Hospital of the Chinese People's Liberation Army between December 2013 and December 2022. Patients were divided into the IPN group ( n=140) and non-IPN group ( n=320) based on the occurrence of IPN. General clinical data, laboratory test results and clinical outcomes were compared between the two groups. Univariate and multivariate logistic regression models were used to analyze the risk factors for IPN in reproductive-age HTG-AP patients. Results:Among the 460 patients, 140 (30.4%) developed IPN. Compared with the non-IPN group, the IPN group had a significantly higher proportion of pregnant patients (30.0% vs 10.9%, P<0.001) and a lower proportion with a history of acute pancreatitis (12.9% vs 31.3%, P<0.001). Laboratory findings showed that patients in the IPN group had lower levels of hemoglobin and albumin, but higher levels of blood urea nitrogen and serum creatinine. Clinical outcomes showed that the IPN group had significantly higher rates of severe acute pancreatitis and mortality compared to the non-IPN group. Additionally, the median length of ICU stay and total hospital stay in the IPN group were significantly longer, at 16.5 days and 32.0 days, respectively. Univariate logistic regression analyses showed that pregnancy, previous history of acute pancreatitis, and levels of hemoglobin, total bilirubin, albumin, blood urea nitrogen and creatinine were significantly associated with IPN. Multivariate logistic regression analysis revealed that pregnancy ( OR=2.617, 95% CI 1.494-4.210, P=0.001), a history of acute pancreatitis ( OR=0.339, 95% CI 0.189-0.711, P=0.002), hemoglobin level ( OR=0.945, 95% CI 0.939-0.987, P<0.001), and blood urea nitrogen level ( OR=1.173, 95% CI 1.056-1.198, P=0.004) were independently associated with the occurrence of IPN. Conclusions:Pregnancy, a first episode of acute pancreatitis, lower hemoglobin levels and higher blood urea nitrogen levels are independent risk factors for IPN in female HTG-AP patients with childbearing age.