BACKGROUND: The potential impact of pre-existing coronary artery stenosis (CAS) on right ventricular (RV) function during acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and RV dysfunction in patients with acute PE. METHODS: In this multicenter, case-control study, 89 cases and 176 controls matched for age were enrolled at three study centers (Peking Union Medical College Hospital, Fuwai Hospital, and the Second Affiliated Hospital of Harbin Medical University) from January 2016 to December 2020. The cases were patients with acute PE with CAS, and the controls were patients with acute PE without CAS. Coronary artery assessment was performed using coronary computed tomographic angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression analysis was used to evaluate the association between CAS and RV dysfunction. RESULTS: The percentages of RV dysfunction (19.1% [17/89] vs. 44.6% [78/176], P <0.001) and elevated systolic pulmonary artery pressure (sPAP) (19.3% [17/89] vs. 39.5% [68/176], P = 0.001) were significantly lower in the case group than those in the control group. In the multivariable logistic regression model, CAS was independently and negatively associated with RV dysfunction (adjusted odds ratio [OR]: 0.367; 95% confidence interval [CI]: 0.185-0.728; P = 0.004), and elevated sPAP (OR: 0.490; 95% CI: 0.252-0.980; P = 0.035), respectively. CONCLUSIONS Pre-existing CAS was significantly and negatively associated with RV dysfunction and elevated sPAP in patients with acute PE. This finding provides new insights into RV dysfunction in patients with acute PE with pre-existing CAS.
Humans ; Pulmonary Embolism/complications* ; Case-Control Studies ; Male ; Ventricular Dysfunction, Right/physiopathology* ; Female ; Middle Aged ; Aged ; Coronary Stenosis/complications* ; Logistic Models ; Adult

Objective To explore the medication patterns of the"phlegm-stasis co-treatment"in the treatment of stroke and the regulatory mechanisms of its key components.Methods The relevant literature on the treatment of stroke with intertwined phlegm and blood stasis pattern by traditional Chinese medicine in CNKI,Wanfang Data Knowledge Service Platform and VIP was collected.Excel 2019 and SPSS Modeler 18.0 were applied to statistically analyze the nature,taste,meridian tropism and frequency of the drugs included in the prescriptions.The Apriori algorithm was used to perform association rule analysis and cluster analysis.The potential mechanism of action of the core drug pair was explored by using the network pharmacology method.Results A total of 69 prescriptions involving 161 herbs with 902 cumulative frequency uses were included.The four natures were mainly warm,neutral and cold,the five flavors were mainly bitter,sweet and pungent.and channel tropism were mainly liver meridian and spleen meridian.The analysis of association rules indicates that there was a strong correlation among chuanxiong,Taoren,Dannanxing,Dilong,Honghua,Shichangpu and Fuling.The main active components of the drug combination were quercetin,gallic acid,baicalein and hederagenin.They can regulate signaling pathways such as hypoxia-inducible factor-1,advanced glycation end product/advanced glycation end product receptor,nuclear factor κB,and mixed lineage kinase 3 by acting on genes such as STAT3,SRC,JUN,TP53,and MAPK1.Conclusion The core drugs of"phlegm-stasis co-treatment"method can act on multiple targets and pathways through components such as quercetin,gallic acid,baicalein and hederagenin,thereby exerting a therapeutic effect on stroke.

Objective:To assess the safety of a novel domestically developed direct visualization system of peroral cholangiopancreatoscopy for the exploration of biliary tract.Methods:Clinical data from 384 patients with biliary tract diseases who underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Endoscopy Center of Shanghai Xuhui District Central Hospital from November 2017 to December 2022 were retrospectively analyzed. Patients were categorized into 2 groups based on the type of cholangioscope: the novel cholangiopancreatoscopy system group ( n=159) and the SpyGlass group ( n=225). In the novel cholangiopancreatoscopy system group, the new direct visualization system of China-made peroral cholangiopancreatoscopy was used for bile duct exploration, while the SpyGlass group utilized the SpyGlass system for bile duct inspection. Propensity score matching (PSM) was used as a nearest-neighbor method with a caliper of 0.01 to minimize confounding factors, resulting in a balanced sample of 122 patients in each group after matching. The primary outcome was the incidence of short-term complications, with secondary outcomes including technical success rates and post-treatment outcomes. Results:After PSM, there were no significant differences in baseline characteristics between the two groups ( P>0.05). Regarding short-term postoperative complications, pancreatitis occurred in 1.6% (2/122) of patients in the novel cholangiopancreatoscopy system group and 7.4% (9/122) in the SpyGlass group. The new system significantly reduced the incidence of post-procedure pancreatitis ( χ2=4.665, P=0.031). The cholecystitis was absent in the novel cholangiopancreatoscopy system group, while it occurred in 0.8% (1/122) cases in the SpyGlass group, with no significant difference between the two groups after the procedure ( P=1.000). Regarding technical success rate, the novel system group achieved a rate of 99.2% (121/122), while the SpyGlass group achieved 97.5% (119/122) ( P=0.622). A slightly higher success rate was observed in the novel system group.There were 81 cases of postoperative biliary drainage in the novel cholangiopancreatoscopy system group and 74 cases in the SpyGlass group. Conclusion:The novel direct visualization system of peroral cholangiopancreatoscopy is safer than SpyGlass in the exploration of biliary system diseases. Endoscopists are encouraged to choose the appropriate cholangioscopy system based on individual patient characteristics for the direct visualization, diagnosis, and treatment of biliary diseases.

Objective To explore the medication patterns of the"phlegm-stasis co-treatment"in the treatment of stroke and the regulatory mechanisms of its key components.Methods The relevant literature on the treatment of stroke with intertwined phlegm and blood stasis pattern by traditional Chinese medicine in CNKI,Wanfang Data Knowledge Service Platform and VIP was collected.Excel 2019 and SPSS Modeler 18.0 were applied to statistically analyze the nature,taste,meridian tropism and frequency of the drugs included in the prescriptions.The Apriori algorithm was used to perform association rule analysis and cluster analysis.The potential mechanism of action of the core drug pair was explored by using the network pharmacology method.Results A total of 69 prescriptions involving 161 herbs with 902 cumulative frequency uses were included.The four natures were mainly warm,neutral and cold,the five flavors were mainly bitter,sweet and pungent.and channel tropism were mainly liver meridian and spleen meridian.The analysis of association rules indicates that there was a strong correlation among chuanxiong,Taoren,Dannanxing,Dilong,Honghua,Shichangpu and Fuling.The main active components of the drug combination were quercetin,gallic acid,baicalein and hederagenin.They can regulate signaling pathways such as hypoxia-inducible factor-1,advanced glycation end product/advanced glycation end product receptor,nuclear factor κB,and mixed lineage kinase 3 by acting on genes such as STAT3,SRC,JUN,TP53,and MAPK1.Conclusion The core drugs of"phlegm-stasis co-treatment"method can act on multiple targets and pathways through components such as quercetin,gallic acid,baicalein and hederagenin,thereby exerting a therapeutic effect on stroke.

Objective:To assess the safety of a novel domestically developed direct visualization system of peroral cholangiopancreatoscopy for the exploration of biliary tract.Methods:Clinical data from 384 patients with biliary tract diseases who underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Endoscopy Center of Shanghai Xuhui District Central Hospital from November 2017 to December 2022 were retrospectively analyzed. Patients were categorized into 2 groups based on the type of cholangioscope: the novel cholangiopancreatoscopy system group ( n=159) and the SpyGlass group ( n=225). In the novel cholangiopancreatoscopy system group, the new direct visualization system of China-made peroral cholangiopancreatoscopy was used for bile duct exploration, while the SpyGlass group utilized the SpyGlass system for bile duct inspection. Propensity score matching (PSM) was used as a nearest-neighbor method with a caliper of 0.01 to minimize confounding factors, resulting in a balanced sample of 122 patients in each group after matching. The primary outcome was the incidence of short-term complications, with secondary outcomes including technical success rates and post-treatment outcomes. Results:After PSM, there were no significant differences in baseline characteristics between the two groups ( P>0.05). Regarding short-term postoperative complications, pancreatitis occurred in 1.6% (2/122) of patients in the novel cholangiopancreatoscopy system group and 7.4% (9/122) in the SpyGlass group. The new system significantly reduced the incidence of post-procedure pancreatitis ( χ2=4.665, P=0.031). The cholecystitis was absent in the novel cholangiopancreatoscopy system group, while it occurred in 0.8% (1/122) cases in the SpyGlass group, with no significant difference between the two groups after the procedure ( P=1.000). Regarding technical success rate, the novel system group achieved a rate of 99.2% (121/122), while the SpyGlass group achieved 97.5% (119/122) ( P=0.622). A slightly higher success rate was observed in the novel system group.There were 81 cases of postoperative biliary drainage in the novel cholangiopancreatoscopy system group and 74 cases in the SpyGlass group. Conclusion:The novel direct visualization system of peroral cholangiopancreatoscopy is safer than SpyGlass in the exploration of biliary system diseases. Endoscopists are encouraged to choose the appropriate cholangioscopy system based on individual patient characteristics for the direct visualization, diagnosis, and treatment of biliary diseases.

Background::Coronavirus disease 2019 (COVID-19) has potential risks for both clinically worsening pulmonary hypertension (PH) and increasing mortality. However, the data regarding the protective role of vaccination in this population are still lacking. This study aimed to assess the safety of approved vaccination for patients with PH.Methods::In this national prospective cohort study, patients diagnosed with PH (World Health Organization [WHO] groups 1 and 4) were enrolled from October 2021 to April 2022. The primary outcome was the composite of PH-related major adverse events. We used an inverse probability weighting (IPW) approach to control for possible confounding factors in the baseline characteristics of patients.Results::In total, 706 patients with PH participated in this study (mean age, 40.3 years; mean duration after diagnosis of PH, 8.2 years). All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China. Among them, 278 patients did not receive vaccination, whereas 428 patients completed the vaccination series. None of the participants were infected with COVID-19 during our study period. Overall, 398 patients received inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, whereas 30 received recombinant protein subunit vaccine. After adjusting for baseline covariates using the IPW approach, the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase (27/428 [6.3%] vs. 24/278 [8.6%], odds ratio = 0.72, P = 0.302). Approximately half of the vaccinated patients reported at least one post-vaccination side effects, most of which were mild, including pain at the injection site (159/428, 37.1%), fever (11/428, 2.6%), and fatigue (26/428, 6.1%). Conclusions::COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH, although there were some tolerable side effects. A large-scale randomized controlled trial is warranted to confirm this finding. The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.

Background::The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE.Methods::In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results::The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P = 0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243–5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056–5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792–30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467–8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288–36.484) were independently associated with elevated hs-cTnI. Conclusions::CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

Purpose To explore the value of deep learning feature prediction based on the ResNet50 deep residual network model for predicting early hematoma expansion in spontaneous intracerebral hemorrhage without traditional imaging manifestations. Materials and Methods A retrospective study was performed on 235 patients with spontaneous intracerebral hemorrhage in Jiangdu People's Hospital Affiliated to Yangzhou University from January 2019 and December 2022. These patients had undergone their initial plain cranial CT scan within 6 hours of symptom onset and a subsequent follow-up scan within 24 hours of admission. They were randomly assigned to a training set consisting of 188 cases and a test set of 47 cases,using an 8︰2 ratio. The region of interest (ROI) of hematoma was traced layer by layer on the first plain head CT,and image genomics features were extracted. The maximum two-dimensional cross-sectional ROI of the hematoma 3D-ROI,as well as ROI images at 1 mm and 2 mm above and below the maximum two-dimensional cross-sectional ROI,were then cut and input into the pre-trained ResNet50 model for feature extraction. The image genomics features were then fused with the extracted deep learning features using a least absolute shrinkage and selection operator regression model. A support vector machine classifier was used to construct a prediction model,which was evaluated using receiver operating characteristic curves and decision curve analysis. Results In the training set,the area under curve (AUC) of the deep learning feature model was 0.972,which was higher than that of the image genomics feature model (0.951) and the fused feature model (0.968),but this difference was not statistically significant (P>0.05). In the testing set,the AUCs of the deep learning feature model and the fused feature model were 0.867 and 0.895,respectively,which were significantly higher than that of the image genomics feature model (0.833),with statistically significant differences (Z=-1.794,-2.191,both P<0.05). The AUC of the fused feature model showed an improvement compared to the deep learning feature model,but the difference was not statistically significant (P>0.05). In the test set,decision curve analysis revealed that the fused feature model yielded greater benefits compared to both the deep learning feature model and the radiomic feature model. Conclusion The deep learning feature model based on ResNet50 deep residual network shows better performance in predicting early hematoma expansion than the image genomics feature model,and the fused feature model has a beneficial effect on predicting hematoma expansion. This deep learning approach provides a prediction tool with supervisory capability for clinical decision-making.

Purpose To explore the value of deep learning feature prediction based on the ResNet50 deep residual network model for predicting early hematoma expansion in spontaneous intracerebral hemorrhage without traditional imaging manifestations. Materials and Methods A retrospective study was performed on 235 patients with spontaneous intracerebral hemorrhage in Jiangdu People's Hospital Affiliated to Yangzhou University from January 2019 and December 2022. These patients had undergone their initial plain cranial CT scan within 6 hours of symptom onset and a subsequent follow-up scan within 24 hours of admission. They were randomly assigned to a training set consisting of 188 cases and a test set of 47 cases,using an 8︰2 ratio. The region of interest (ROI) of hematoma was traced layer by layer on the first plain head CT,and image genomics features were extracted. The maximum two-dimensional cross-sectional ROI of the hematoma 3D-ROI,as well as ROI images at 1 mm and 2 mm above and below the maximum two-dimensional cross-sectional ROI,were then cut and input into the pre-trained ResNet50 model for feature extraction. The image genomics features were then fused with the extracted deep learning features using a least absolute shrinkage and selection operator regression model. A support vector machine classifier was used to construct a prediction model,which was evaluated using receiver operating characteristic curves and decision curve analysis. Results In the training set,the area under curve (AUC) of the deep learning feature model was 0.972,which was higher than that of the image genomics feature model (0.951) and the fused feature model (0.968),but this difference was not statistically significant (P>0.05). In the testing set,the AUCs of the deep learning feature model and the fused feature model were 0.867 and 0.895,respectively,which were significantly higher than that of the image genomics feature model (0.833),with statistically significant differences (Z=-1.794,-2.191,both P<0.05). The AUC of the fused feature model showed an improvement compared to the deep learning feature model,but the difference was not statistically significant (P>0.05). In the test set,decision curve analysis revealed that the fused feature model yielded greater benefits compared to both the deep learning feature model and the radiomic feature model. Conclusion The deep learning feature model based on ResNet50 deep residual network shows better performance in predicting early hematoma expansion than the image genomics feature model,and the fused feature model has a beneficial effect on predicting hematoma expansion. This deep learning approach provides a prediction tool with supervisory capability for clinical decision-making.

Objective To observe the value of subregional non-contrast CT(NCCT)radiomics features based on habitat imaging technology for predicting hematoma expansion(HE)in patients with spontaneous intracranial hemorrhage(sICH).Methods Data of 228 sICH patients with negative conventional imaging signs were retrospectively analyzed and divided into HE group(n=99)or non HE(NHE)group(n=129)based on the occurrence of HE nor not.also divided into training set(n=182)or test set(n=46)at a ratio of 8:2.Clinical data,NCCT data and laboratory examination results were compared between groups.Logistic regressive analysis was performed to screen the impact factors of HE.ROI of whole hematoma(ROIwhole)was sketched and clustered into 3 sub-regions(ROIsub1,ROIsub2 and ROIsub3,the latter located in the critical area between hematoma and brain tissue)with habitat imaging technology,and radiomics features of ROI were extracted and screened.Then 4 prediction models were constructed based on the above 4 ROI,and the efficacy of each model for predicting HE was analyzed.Results The fasting blood glucose in HE group was higher than that in NHE group(t=2.047,P=0.041),which was not independent impact factor for predicting HE in sICH patients(P=0.070)according to logistic regression analysis.The area under the curve of ROIsub3 radiomics model for predicting sICH HE in training and test set was 0.945 and 0.863,respectively,not significantly different with that of ROIwhole(0.921,0.813),ROIsub1(0.925,0.807)nor ROIsub2(0.909,0.720)(all P＞0.05).Decision curve analysis showed that ROIsub3 radiomics model could bring greater benefits than the other 3 models.Conclusion NCCT radiomics features of the critical area between hematoma and brain tissue based on habitat imaging technology had high value for predicting HE in sICH patients.