Objectives:To investigate the predictive value of Murray's law-based quantitative flow ratio(μQFR)in side branches for long-term clinical prognosis in patients with non-left main bifurcation lesions who underwent simple main branch stenting,and to provide a potential functional assessment standard for intervention decision-making on coronary bifurcation lesions.Methods:A retrospective analysis was conducted in 408 patients with non-left main bifurcation lesions who underwent simple main branch stenting at Lianyungang First People's Hospital and Nanjing First Hospital between July 2018 and January 2021.The study utilized third-generation QFR software to analyze pre-and post-procedure anatomical and functional parameters of the target lesion's main branch and key branches.The primary endpoint was target vessel failure(TVF)events during the 3-year follow-up.Patients were stratified into TVF and non-TVF groups.Baseline characteristics,procedural data,and pre-/post-procedural parameters of target vessels were compared between groups.Multivariable Cox regression was performed to identify predictors of TVF.Diagnostic efficacy of predictors was evaluated using area under the receiver operating characteristic(ROC)curve(AUC)with DeLong's method for comparison.Patients were dichotomized based on the optimal cutoffof post-procedural side branch μQFR,with TVF incidence rates compared via Cox regression and Kaplan-Meier analysis.Results:During 3-year follow-up,54 patients(13.2%)experienced TVF(TVF group),data were compared with 354 patients(86.76%)without TVF(non-TVF group).The TVF group showed higher post-procedural side branch diameter stenosis([32.93±17.80]%vs.[22.62±11.96]%,P<0.001)and lower μQFR(0.80±0.10 vs.0.89±0.07,P<0.001).Multivariate Cox regression identified higher post-procedural side branch μQFR as an independent protective factor against 3-year TVF(per 0.01 increase:HR=0.903,95%CI:0.850-0.959,P<0.001).ROC curves indicated that post-procedural side branch μQFR had moderate diagnostic efficacy for predicting 3-year TVF(AUC=0.769,95%CI:0.678-0.861,P<0.001),with a significantly higher AUC value than post-operative side branch area stenosis and minimal lumen diameter(both P<0.001),the optimal cutoffvalue was 0.84.Multivariate Cox regression and Kaplan-Meier survival analysis revealed markedly higher 3-year TVF rates in patients with μQFR≤0.84 compared to patients with μQFR>0.84(HR=4.007,95%CI:2.342-6.855,P<0.001;28.3%vs.7.9%,log-rank P<0.001).Conclusions:For patients with bifurcation lesions not involving the left main,the immediate post-procedural side branch μQFR could better predict 3-year TVF than anatomical indices.Maintaining post-stenting side branch μQFR>0.84 may optimize clinical outcomes when using a single-stent strategy.

Aim To investigate the predictive value of the Murray law-based quantitative flow ratio(μQFR)after target vessel pretreatment for vascular-related adverse events in patients with de novo coronary lesions treated with drug-coated balloon.Methods This retrospective study included 223 lesions from 223 patients who underwent drug-coated balloon-only strategy and completed 2-year clinical follow-up.Coronary angiographic images of target vessels pre-procedure,post-balloon and post-procedure were collected,and analyzed using a novel Murray's law-based algorithm.The μQFR analysis of each target vessel included not only the μQFR value of the target vessel,but also the length of the target vessel,the degree of vessel diameter stenosis,the reference lumen diameter,the minimum lumen diameter and blood flow velocity.The primary endpoint was defined as the postoperative vessel-oriented composite endpoint(VOCE).Results During the2-year clinical follow-up period,a total of 25 patients(11.2%)experienced VOCE events.Com-pared with the control group,patients with VOCE events after pretreatment showed a decrease in μQFR(P<0.001).Multivariate Logistic analysis showed that a lower target vessel μQFR after pretreatment(OR=0.931,95%CI:0.894～0.969,P<0.001)was an independent predictor of VOCE events.ROC curve analysis showed that the cut-off value for predicting 2-year VOCE events using preprocessed μQFR was 0.83(95%CI:0.727～0.840),with a sensitivity of 72.7%and a specificity of 84.0%(AUC=0.773,95%CI:0.676～0.870,P<0.001).Survival analysis showed that compared with patients with μQFR>0.83,patients with μQFR≤0.83 had a significantly higher incidence of VOCE events at 1 and 2 years,increasing to 3.909 times(16.9%vs.4.6%,HR=3.909,95%CI:1.539～9.930,P=0.004)and 2.867 times(19.7%vs.7.2%,HR=2.867,95%CI:1.301～6.316,P=0.009).After adjusting for potential con-founds,patients with pretreated μQFR≤0.83 had a 2.567 times in 2-year incidence of VOCE events(HR=2.567,95%CI:1.151～5.727,P=0.021)and a 3.712 times in 1-year incidence of VOCE events(HR=3.712,95%CI:1.478～9.810,P=0.006)compared to patients with good pretreatment.Conclusions For patients with in situ coronary artery disease,a lower μQFR after pretreatment increases the risk of postoperative adverse clinical events.μQFR≤0.83 may be used to evaluate the effectiveness of lesion pretreatment.

Objective:To analyze the effect of continuous positive airway pressure (CPAP) on maternal and neonatal outcomes in pregnant women with obstructive sleep apnea syndrome (OSAS), especially on the incidence of hypertensive disorder in pregnancy (HDP) in women with moderate to severe OSAS.Methods:A total of 180 pregnant women with OSAS who were diagnosed through sleep monitoring during pregnancy due to high-risk factors of OSAS and registered in Peking University People′s Hospital from January 2021 to May 2024 were selected as the study subjects. Clinical data were collected from medical records for retrospective analysis. According to whether they received standardized treatment with CPAP, they were divided into the CPAP treatment group (42 cases) and the control group (138 cases). The CPAP treatment group consisted of 9 pregnant women with moderate to severe OSAS, while the control group consisted of 34 pregnant women with moderate to severe OSAS. The maternal and neonatal outcomes, the incidence of HDP, placental weight after delivery and placental weight/neonatal birth weight ratio were compared between the two groups.Results:(1) The average gestational age of pregnant women in the CPAP treatment group was higher than that in the control group [(38.7±1.0) vs (38.0±1.4) weeks], the proportion of infants small for gestational age (SGA) in the CPAP treatment group was lower [0 (0/42) vs 12.3% (17/138)], and the birth weight of infants in the CPAP treatment group was bigger [(3 396±475) vs (3 082±710) g); the differences between the two groups were statistically significant (all P<0.05). There were no significant differences between the CPAP treatment group and the control group in terms of delivery mode, rates of postpartum hemorrhage and preterm birth, umbilical artery blood gas analysis pH<7.1, lactate≥6.0 mmol/L, base excess<-12.0 mmol/L and the incidence of gestational diabetes mellitus and HDP (all P>0.05). (2) The placental weight of the CPAP treatment group was significantly lower than that of the control group [(554.0±70.6) vs (615.7±119.1) g], the placental weight/newborn birth weight ratio of the CPAP treatment group was significantly lower than that of the control group (median: 0.17 vs 0.19), and the differences were statistically significant (all P<0.05). (3) The incidence of HDP in pregnant women with moderate to severe OSAS in the CPAP treatment group was lower than that in the control group [1/9 vs 61.8% (21/34)], and the difference was statistically significant ( P<0.05). Conclusions:CPAP treatment could prolong the gestational age in pregnant women with OSAS, reduce the incidence of SGA, increase the birth weight of infants, and reduce the incidence of HDP in pregnant women with moderate to severe OSAS, and is worth promoting in clinical practice. The improvement of neonatal outcomes by CPAP treatment is closely related to the placenta, which is worthy of further exploration.

Aim To investigate the predictive value of the Murray law-based quantitative flow ratio(μQFR)after target vessel pretreatment for vascular-related adverse events in patients with de novo coronary lesions treated with drug-coated balloon.Methods This retrospective study included 223 lesions from 223 patients who underwent drug-coated balloon-only strategy and completed 2-year clinical follow-up.Coronary angiographic images of target vessels pre-procedure,post-balloon and post-procedure were collected,and analyzed using a novel Murray's law-based algorithm.The μQFR analysis of each target vessel included not only the μQFR value of the target vessel,but also the length of the target vessel,the degree of vessel diameter stenosis,the reference lumen diameter,the minimum lumen diameter and blood flow velocity.The primary endpoint was defined as the postoperative vessel-oriented composite endpoint(VOCE).Results During the2-year clinical follow-up period,a total of 25 patients(11.2%)experienced VOCE events.Com-pared with the control group,patients with VOCE events after pretreatment showed a decrease in μQFR(P<0.001).Multivariate Logistic analysis showed that a lower target vessel μQFR after pretreatment(OR=0.931,95%CI:0.894～0.969,P<0.001)was an independent predictor of VOCE events.ROC curve analysis showed that the cut-off value for predicting 2-year VOCE events using preprocessed μQFR was 0.83(95%CI:0.727～0.840),with a sensitivity of 72.7%and a specificity of 84.0%(AUC=0.773,95%CI:0.676～0.870,P<0.001).Survival analysis showed that compared with patients with μQFR>0.83,patients with μQFR≤0.83 had a significantly higher incidence of VOCE events at 1 and 2 years,increasing to 3.909 times(16.9%vs.4.6%,HR=3.909,95%CI:1.539～9.930,P=0.004)and 2.867 times(19.7%vs.7.2%,HR=2.867,95%CI:1.301～6.316,P=0.009).After adjusting for potential con-founds,patients with pretreated μQFR≤0.83 had a 2.567 times in 2-year incidence of VOCE events(HR=2.567,95%CI:1.151～5.727,P=0.021)and a 3.712 times in 1-year incidence of VOCE events(HR=3.712,95%CI:1.478～9.810,P=0.006)compared to patients with good pretreatment.Conclusions For patients with in situ coronary artery disease,a lower μQFR after pretreatment increases the risk of postoperative adverse clinical events.μQFR≤0.83 may be used to evaluate the effectiveness of lesion pretreatment.

AIM: To investigate the application of optical coherence tomography angiography(OCTA)in observing the relationship between corneal topographic changes and retinal vessel density and thickness in myopic adolescents after wearing orthokeratology lenses.METHODS:Myopic adolescents who treated and wore orthokeratology lenses in our hospital between January and December 2023 were selected for the study, and their clinical data were retrospectively analyzed. Totally 50 cases(50 eyes)of toric orthokeratology lenses(toric group)and 50 cases(50 eyes)of spherical orthokeratology lenses(spherical group)were selected. Changes in corneal topographic indices, retinal vascular density and retinal thickness were examined in the two groups before and at 3 and 6 mo after wear. The relationship between corneal topographic indexes and retinal vessel density and thickness was analyzed.RESULTS: Compared with the pre-wear, average value of ks and kf(Avek)was significantly lower(all P<0.05), and surface regularity index(SRI)and surface asymmetry index(SAI)were significantly increased(both P<0.05)in the two groups at 3 and 6 mo post-wear. Compared with the pre-wearing period, deep retinal vessel density in whole macular area and superficial retinal vessel density in paracentral retina of macula were significantly higher in the two groups at 3 and 6 mo after wearing(both P<0.05), and the superficial retinal vessel density in macular fovea and paracentral fovea of macula of the toric group was significantly higher(all P<0.05), and the superficial retinal vessel density in paracentral macular fovea of the spherical group was significantly increased(all P<0.05). Compared with the pre-wearing period, the thickness of retina in whole macula and paracentral retina of the macula was significantly increased in the both groups at 3 and 6 mo post-wearing(all P<0.05). After wearing lenses for 3 mo, the Avek of the toric group was negatively correlated with the deep vascular density in whole macular area and paracentral macular fovea, the superficial vascular density in macular fovea and paracentral macular fovea, and the thickness of whole macular and paracentral macular fovea(all P<0.05). The SRI and SAI were positively correlated with the superficial retinal vascular density in macular fovea and paracentral macular fovea, and the retinal thickness in whole macular area and paracentral macular fovea(all P<0.05). The spherical group showed a negative correlation between Avek and the deep retinal vessel density in whole macular area and paracentral macular fovea, as well as the superficial retinal vessel density in paracentral macular fovea after wearing lenses for 3 mo(all P<0.05). SRI and SAI were positively correlated with the deep retinal vessel density in whole macular area, macular fovea and paracentral macular fovea, and the superficial retinal vessel density in paracentral macular fovea(all P<0.05). SRI was positively correlated with the retinal thickness in whole macular area(P<0.05), and SAI was positively correlated with the retinal thickness in paracentral macular fovea(P<0.05).CONCLUSION: After wearing toric and spherical corneal orthokeratology lenses, the corneal topography of myopic adolescents changes, and the retinal blood flow density and retinal thickness increase significantly, improving retinal blood circulation. Moreover, there is a significant correlation between changes in corneal topography and retinal blood flow density and retinal thickness, which has certain guiding significance for the control of myopia.

Objective:To explore the efficacy and prognosis of preoperative treatment based on arterial infusion chemotherapy (PTAC) in patients with advanced gastric cancer.Methods:Clinical and follow-up data of 821 patients with advanced gastric cancer who received PTAC treatment at the General Hospital of the Eastern Theater Command of the People's Liberation Army from January 2001 to January 2021 were collected. According to the treatment regimen, patients were divided into the FLEEOX group (89 cases), the XEEOX group (196 cases), the SEEOX group (406 cases), and the SEEOX+PD-1 group (130 cases). The primary endpoint was the 3-year progression-free survival rate. Secondary endpoints included the 3-year overall survival rate, objective response rate, radical resection rate, major pathological response rate, and incidence of treatment associated adverse events.Results:After PTAC treatment, the objective response rate was 74.9% (615/821). A total of 671 patients underwent radical surgery, with a radical resection rate of 81.7% and an R0 resection rate of 70.2% (576/821). The pathological complete response rate was 16.7% (112/671), and the major pathological response rate was 32.2% (216/671). With an average follow-up of 27.7 months, the 3-year progression-free survival rate was 52.2%, and the 3-year overall survival rate was 55.8%. The 3-year progression-free survival rate of patients in the SEEOX+PD-1 group was 66.9%, the objective response rate was 83.8% (109/130), the major pathological response rate was 45.3% (53/117), and the radical resection rate was 90.0% (117/130), all of which were better than those in the XEEOX and SEEOX groups (all P＜0.05). However, during the treatment period, three patients in the SEEOX+PD-1 group died from immune-related adverse events. Conclusion:PTAC treatment is an effective preoperative treatment method for advanced gastric cancer, and is expected to further improve the treatment effect when combined with immunotherapy such as PD-1 monoclonal antibodies.

Blood lipid variability is closely associated with the incidence and recurrence risk of ischemic stroke, and controlling blood lipid stability is crucial for precise prevention and treatment of ischemic stroke. Therefore, while emphasizing the magnitude of lipid-lowering, attention should also be paid to ensuring that blood lipids are stable and reach the target. This article reviews the research progress on the correlation between different blood lipid variability and ischemic stroke.

[Objective]To clearly identify the difference between rescue injuries and agonal injuries and to avoid duplicate identifications and misidentifications.[Methods]Based on the forensic pathological data of 5 923 cases of death cause identification from 2013 to 2022 in Sun Yat-sen University Forensic Identification Center and Guangzhou Tianhe District Branch of Guangzhou Public Security Bureau,this study retrospectively studied the characteristics of rescue injuries and agonal injuries seen in cause of death identification and their influence on cause of death identification.[Results]Among all the 5 923 cases,640 cases were found to have rescue injuries or agonal injuries,and 624 cases received treatment,of which 609 cases were found to have rescue injuries(97.60%),44 cases were found to have agonal injuries,and 13 cases were found to have both types of injuries.Among the 640 cases,441 were male and 199 were female.The age of death was discontinuously distributed from 0 to 95 years old.The leading cause of death was disease,followed by mechanical injury and asphyxia.The main manifestations of rescue injuries were rib and sternum fractures,soft tissue injuries in the prechest area or face,and pericardial rupture.The most common injuries in agonal stage were falling after unconsciousness,inhalation of foreign body in respiratory tract or multiple violent injuries.Among the 640 cases,19 cases were repeatedly identified,including 15 cases of rescue injuries,6 cases of agonal injuries,and 2 cases of both types of injuries.Compared with the cases where neither type of injuries was detected,the repeated identification rate of treatment injuries and agonal injuries was significantly increased(χ2=4.04,P=0.044;χ2=43.49,P<0.001).Among the 640 cases,11 cases(1.72%)were misidentified as the initial injuries in the first identification,and 13 cases had combined rescue injuries or agonal injuries that were involved in death.[Conclusions]By elucidating the epidemiological characteristics of the two types of injuries,this study proved that the two types of injuries were associated with higher rates of repeated identification and misidentification,which provided a reference for reducing repeated identification and misidentification and improving the accuracy of cause of death identification.

Objective:To assess the safety and efficacy of Blinatumomab in treating children with acute B-lymphoblastic leukemia（B-ALL）.Methods:The clinical data of 10 B-ALL children who were admitted to the Department of Pediatrics，the First Affiliated Hospital of Xi’an Jiaotong University from May 2022 to April 2024 and treated with Blinatumomab were analyzed retrospectively.Results:All the 10 cases had a complete remission of bone marrow and all minimal residual disease（MRD）were negative. Serious adverse events were reported after chemotherapy，including intracranial venous sinus thrombosis with acute cerebral infarction，acute pancreatitis，paralytic ileus，syndrome of abnormal secretion of antidiuretic hormone，severe pneumonia，liver injury，sepsis（β-lactamase resistant Escherichia coli，Pseudomonas aeruginosa），oral mucositis，persistent agranulocytosis with bloodstream infection. All patients interrupted chemotherapy and received Blinatumomab injections for 14 days. During treatment，there was hematological toxicity，which resulted in grade 3-4 neutropenia in 5 cases within the first 7 days. Transient low-grade fever was observed in 4 cases of non-hematological toxicity during days 1-3 of treatment. One patient experienced a headache on the 7th day of treatment，which worsened on the 14th day，but it improved with mannitol treatment. Mild liver injury was present in 3 cases. Interleukin-6 reached a peak of 71.86 pg/mL on the second day of treatment in one case，whereas it was normal in others. All patients were found to be free of cytokine release syndrome. T lymphocyte count increased in 5 patients after 14 days of Blinatumomab treatment，but B lymphocyte count and serum immunoglobulin levels declined in 10 patients. Hypogammaglobulinemia was observed in 3 of these patients. The median follow-up time was 7.8（3.0-24.0）months. All patients achieved MRD-negative complete remission and 6-month overall survival rate and progression-free survival were both 100%.Conclusion:Children with B-ALL can benefit from using Blinatumomab，which is safer than conventional chemotherapy，as a new treatment strategy for those who cannot tolerate traditional chemotherapy.

Objective:To investigate the flow cytometry cell sorting regimen for M1 macrophages and the association between M1 mac-rophage polarization and nonalcoholic fatty liver disease(NAFLD).Methods:High-fat diet(HFD)was used to establish a mouse model of NAFLD.Twelve C57BL/6 mice were randomly divided into control group(normal diet)and HFD group using a random num-ber table and were fed for 24 weeks.Metabolic markers including blood glucose and blood lipids were measured;quantitative real-time PCR was used to measure the factors associated with M1 macrophages in mice;HE staining was used to observe liver pathology.The Percoll gradient centrifugation method was used to collect liver Kupffer cells,and flow cytometry was used to measure M1 macro-phages in mouse liver(sorting regimen:FSC-A/SSC-A for grouping and removing red blood cells and impurities in the liver;FITC CD45(+)/PE-cy7 CD11clow for grouping leukocytes;APC CD115(+)/Percp cy5.5 CD11bhigh for the screening of monocytes;Apc-cy7 F4/80low/PE Ly-6Chigh for separating M1 macrophages).Results:Com-pared with the control group at week 24,the HFD group had signifi-cant increases in the indicators of body weight[(28.35±1.71)g vs.(38.43±4.41)g,P<0.001),liver weight[(1.03±0.18)g vs.(1.85±0.41)g,P=0.003),fasting blood glucose[(10.23±1.58)mmol/L vs.(7.07±0.58)mmol/L,P＜0.001)],insulin[(18.62±3.84)pg/mL vs.(28.84±8.3)pg/mL,P＜0.001)],triglyceride[(2.97±0.67)mmol/L vs.(4.05±0.99)mmol/L,P=0.01)],cholesterol[(0.23±0.06)mmol/L vs.(0.55±0.17)mmol/L,P<0.001)],alanine aminotransferase[5.67(3.16,9.23)U/L vs.35.86(19.68,58.33)U/L,P=0.003],and aspartate aminotransferase[53.14(38.18,64.40)U/L vs.155.10(113.60,192.20)U/L,P<0.001],and there was a significant increase in M1 macrophage polarization in NAFLD mice[42.00%(26.50,45.50)vs.9.95%(3.1,12),P=0.003].There were significant increases in the mRNA levels of IL-β,IL-6,F4/80,and TNF-α in the liver of mice induced by HFD.Conclusion:The flow cytometry sorting regimen can be used to measure M1 macrophages in the liver.Significant aggravation of inflammatory response is observed in NAFLD,and M1 macrophage polarization is positively correlated with the onset of NAFLD.