Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital

This study investigated the effectiveness and accuracy of hands-free carotid ultrasound (CADFlow, Continuous Auto Doppler Flow, Sensus Medical, Suzhou, China) for monitoring carotid blood flow in assessing the return of spontaneous circulation (ROSC), in comparison to manual palpation of major arterial pulses. A total of 341 adult patients with in-hospital cardiac arrest were enrolled from five affiliated teaching hospitals of medical universities. Chest compression rate and depth were monitored using the Prehospital Advanced Life Support Manual Cardiopulmonary Resuscitation (PALMCPR, SunLife Science, Suzhou, China) system. In the CADFlow group, hands-free carotid ultrasound was used to monitor carotid pulsation, while the control group relied on manual palpation of the carotid artery to assess ROSC. The groups were compared in terms of ROSC success rates, time to ROSC determination, and ROSC misjudgment rates. Additionally, the relationships between chest compression parameters (depth and rate) and carotid blood flow were analyzed. The ROSC success rate was non-significantly higher in the CADFlow group than in the control group (43% vs. 33%, P=0.053), corresponding to a 10-percentage-point absolute increase The mean time required to assess carotid pulsation was significantly shorter in the CADFlow group (2.9 (SD 0.8)s vs. 7.2 (SD 1.3)s, P<0.001). Strong correlations were observed between chest compression depth and CADFlow parameters, suggesting that the system can effectively assess Cardiopulmonary Resuscitation (CPR) compression quality. The CADFlow hands-free carotid Doppler ultrasound system improves ROSC detection, shortens assessment time, and provides real-time feedback for CPR quality optimisation. This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR), with the registration number ChiCTR2200064633. The trial was registered on October 13, 2022. The full trial protocol is available upon request from the corresponding author.

Purpose To assess the prognostic value of artificial intelligence (AI)-derived high-risk features obtained from coronary CT angiography (CCTA) in nonculprit vessels of patients who have undergone percutaneous coronary intervention. Materials and Methods This retrospective study included patients who underwent CCTA at a tertiary hospital between June 2013 and June 2023 followed by percutaneous coronary intervention within 3 months. AI-derived high-risk CCTA features were evaluated, including significant stenosis, high-risk plaque, high plaque volume, low CT fractional flow reserve, and high pericoronary adipose tissue attenuation. The primary end point was nonculprit vessel-related major adverse cardiac events (MACE). The prognostic value of high-risk CCTA features was assessed using multivariable Cox regression analyses. Results A total of 1495 patients (mean age, 66 years ± 10; 1100 male patients) with 2014 nonculprit vessels were analyzed with a median follow-up of 3.3 years. MACE occurred in 100 vessels (5.0%). In a multivariable Cox analysis adjusted for high-risk features, vessel-specific CT fractional flow reserve (adjusted hazard ratio, 0.14; 95% CI: 0.03, 0.76; P = .02) and necrotic core volume (adjusted hazard ratio, 1.30; 95% CI: 1.06, 1.59; P = .01) were independent predictors of MACE and showed an incremental prognostic value when added to clinical risk factors (area under the receiver operating characteristic curve, 0.60 vs 0.67; P < .001). Conclusion AI-derived high-risk features at CCTA provided independent and incremental prognostic values for nonculprit vessel-related MACE. Keywords: Computed Tomographic Angiography, High-Risk Plaque, Percutaneous Coronary Intervention Supplemental material is available for this article. © RSNA, 2026.

To evaluate the effectiveness of tibial nerve transection with epineurial suture and division of the common plantar digital nerve branches in the treatment of congenital macrodactyly in children. A retrospective analysis was conducted on clinical data from 9 children with congenital macrodactyly who met the selection criteria and were admitted between January 2018 and December 2024. The cohort included 4 boys and 5 girls, aged 1-6 years (median, 3 years). Syndactyly of the second and third toes was present in 2 patients. Hypertrophy distribution was as follows: 1 case of single-ray involvement, 4 of double-ray, 1 of triple-ray, 1 of quadruple-ray, and 2 of quintuple-ray. Preoperatively, 7 cases exhibited limitations in both active and passive flexion and extension of the affected toes; in 2 cases, active movement was restricted while passive motion remained intact. All 9 children were unable to wear standard-sized footwear for the unaffected foot. Six presented with a limp, and 3 had difficulty walking. All 9 cases were moderate to severe progressive macrodactyly, and the growth rate of the affected foot was significantly faster than that of the healthy side. Six cases had undergone prior surgical interventions at other institutions, but disease progression continued postoperatively. All 9 patients underwent tibial nerve transection with epineurial suture and selective division of the common plantar digital nerve branches. At last follow-up, the foot growth rate was calculated (compared with that immediately after operation), and the changes of plantar pain sensation in the affected foot were detected before operation, immediately after operation, and at last follow-up, and the surgical efficacy was evaluated based on improvements in shoe fit and gait function. All 9 children were followed up 6-36 months, with an average of 18 months. All the incisions healed by first intention, and no infection or plantar ulceration occurred. At last follow-up, the growth rate of the affected foot was 0.10 (0.04, 0.14) cm/month, which was significantly slower than that of the healthy foot [0.14 (0.08, 0.18) cm/month] ( Z=3.951, P<0.001). Preoperatively, plantar pain sensation was absent in all cases; it was restored immediately after operation. At last follow-up, 6 patients had absent pain sensation, 2 had partial preservation (involving certain toes and central plantar regions), and 1 patient (with 3-year follow-up) exhibited regained sensation in multiple plantar areas. Gait improved in most cases, in which 8 children achieved normal ambulation, while 1 continued to limp due to leg-length discrepancy. Surgical efficacy were rated as excellent in 1 case, good in 7, and fair in 1. Tibial nerve transection with epineurial suture combined with selective division of the common plantar digital nerve branches effectively reduces the growth rate of congenital macrodactyly in children, has minimal impact on plantar sensory function, and does not result in plantar ulcers or impaired ambulation.

BACKGROUNDRefractory gastroesophageal reflux disease (GERD) constitutes a significant proportion of GERD cases and presents a considerable burden in clinical practice. However, the underlying risk factors contributing to persistent and refractory symptoms and the clinical characteristics of this disease remain poorly understood.AIMTo investigate the clinical features of refractory GERD and identify the associated risk factors.METHODSThis is a multicenter cross-sectional study on patients with GERD across 18 medical centers in Shanghai. All participants completed comprehensive questionnaires that assessed their demographic characteristics, lifestyle and dietary habits, clinical manifestations, somatic symptoms, mental and psychological health status, and quality of life. Univariate analysis was performed to identify significant differences between the patients with refractory and non-refractory GERD. Subsequently, stepwise regression analysis was employed to conduct a multivariate binary logistic regression for exploring the association between refractory GERD and various factors, including dietary habits, lifestyle, clinical symptoms, and mental and psychological status.RESULTSOur study included 911 patients diagnosed with GERD, of whom 256 (28.1%) had refractory GERD and 655 (71.9%) had non-refractory GERD. Compared to patients with non-refractory GERD, those with refractory GERD are older, have a longer disease duration, and exhibit higher scores for typical reflux symptoms. They are also more likely to present with atypical symptoms, more prone to overeating, more likely to experience somatic symptoms, comorbid anxiety, and depression, and report a lower quality of life. Binary logistic regression analysis identified disease duration and anxiety as significant risk factors and at least 90 minutes of moderate-intensity physical activity per week as a protective factor for refractory GERD.CONCLUSIONRefractory GERD is associated with a prolonged disease duration, anxiety status, and insufficient physical activity. These findings may afford valuable insights for the clinical management and development of non-pharmacological interventions for refractory GERD.

Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-invasive neuromodulation therapy for post-stroke disorders. This review synthesizes current evidence on the clinical efficacy and underlying mechanisms of taVNS in addressing a spectrum of post-stroke disorders, including motor, sensory, neuropsychiatric, and cognitive impairments. By targeting the auricular branch of the vagus nerve, taVNS modulates central pathways involved in neuroplasticity, anti-inflammation, angiogenesis, and blood–brain barrier protection, offering a multifaceted approach to stroke rehabilitation. Clinical studies demonstrate its potential to enhance functional recovery and improve quality of life, supported by its favorable safety profile and patient compliance. However, challenges such as parameter standardization, mechanistic elucidation, and individualized protocols remain. Future research should focus on large-scale trials, mechanistic exploration, and technological innovations to optimize taVNS applications in stroke care.

Osteoporosis is a common metabolic bone disease associated with increased fracture risk. Recently, its potential association with psychological conditions such as anxiety disorders has attracted growing attention. This study aimed to investigate the relationship between anxiety disorders and osteoporosis using National Health and Nutrition Examination Survey data and to develop a predictive model. A total of 2992 participants were included from 3 National Health and Nutrition Examination Survey cycles (1999–2004). Demographic and health-related information (such as age, sex, race, marital status, smoking, education, physical activity, and anxiety disorder symptoms) was collected. Osteoporosis status was assessed via self-reported questionnaires. Missing values were imputed using interpolation methods. Spearman correlation and multivariate logistic regression were applied to explore associated factors, and model performance was evaluated using receiver operating characteristic curves, calibration plots, and confusion matrices. Anxiety disorders were positively correlated with osteoporosis (R = 0.086, P < .001), while bone mineral density was negatively correlated (r = -0.474, P < .001). Individuals with mild anxiety disorder had a significantly higher risk of osteoporosis (odds ratios = 5.711, 95% confidence intervals: 3.827–8.520, P < .001). Other significant factors included age, sex, education level, marital status, race, and physical activity (all P < .001), whereas smoking status was not significantly associated. The predictive model demonstrated good performance, with an area under the curve of 0.87, accuracy of 82%, sensitivity of 83%, and F1 score of 82%. Anxiety disorder may be an important psychological risk factor for osteoporosis and should be considered in preventive strategies. The developed model shows good predictive capacity and may support early identification and personalized intervention for osteoporosis.