Objective To analyze the levels of serum CTCs and ctDNA in NSCLC patients receiving first-line EGFR-TKI treatment, and to explore the clinical value of CTCs and ctDNA detection in assessing the efficacy of treatment for advanced lung cancer. Methods A total of 109 NSCLC patients receiving first-line EGFR-TKI treatment were enrolled. Serum tumor markers CEA, CTCs, and ctDNA were detected at baseline and after one month of treatment. Chest CT scans were performed, and treatment efficacy was evaluated based on RECIST1.1 criteria. CTCs were counted by enrichment-staining-computational algorithm to analyze malignant features, while ctDNA was assessed using digital PCR. Results Survival rate was low in patients with abnormal CEA and ctDNA tests at baseline and in patients with reduced serum CTCs after treatment. In the SD subgroup of patients with brain metastases and advanced stage, the PFS benefit was low. Conclusion Patients in the SD subgroup have significantly higher recurrence risks than those in the PR or CR subgroups. Therefore, CTC and ctDNA testing should be applied to patients in the SD subgroup to identify high-risk patients with poor response to EGFR-TKI treatment, intervene with additional treatment promptly, and obtain long progression-free survival.

Objective To investigate the mid- to long-term follow-up results of ascending aorta (AAO)-descending thoracic aorta (DTA) bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation. Methods A retrospective analysis was conducted on the clinical data of patients with complex aortic arch coarctation who underwent AAO-DTA bypass grafting via median sternotomy incision at the First Hospital of Tsinghua University from August 2004 to May 2017. Results A total of 7 patients were enrolled, including 4 males and 3 females, aged (13.3±4.6) years, and weighted (40.2±12.2) kg. Six (85.7%) patients had concomitant upper limb hypertension. Four patients were aortic arch coarctation combined with intracardiac malformations, two were post-operative restenosis, and 1 was post-operative restenosis combined with intracardiac malformation. All patients underwent surgery under cardiopulmonary bypass. There were no perioperative deaths or major complications. The pre-operative upper-lower limb pressure difference was (39.3±19.2) mm Hg, which decreased to (2.9±2.7) mm Hg post-operatively (P<0.01). The follow-up period was (14.9±5.9) years. There were no long-term deaths or artificial graft-related complications. Except for one patient who still had mild hypertension, the blood pressure of the remaining patients returned to normal. Conclusion AAO-DTA bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation can effectively reduce upper limb blood pressure and the upper-lower limb arterial pressure difference, has fewer complications, and demonstrates satisfactory mid- to long-term efficacy.

This comprehensive review synthesizes the latest advancements in understanding inflammatory disorders affecting cerebral small vessels, a distinct yet understudied category within cerebral small vessel diseases (SVD). Unlike classical SVD, these inflammatory conditions exhibit unique clinical presentations, imaging patterns, and pathophysiological mechanisms, posing significant diagnostic and therapeutic challenges. Highlighting their heterogeneity, this review spans primary angiitis of the central nervous system, cerebral amyloid angiopathy-related inflammation, systemic vasculitis, secondary vasculitis, and vasculitis in autoinflammatory diseases. Key discussions focus on emerging insights into immune-mediated processes, neuroimaging characteristics, and histopathological distinctions. Furthermore, this review underscores the importance of standardized diagnostic frameworks, individualized immunomodulation approaches, and novel targeted therapies to address unmet clinical demands.
Humans ; Cerebral Small Vessel Diseases/pathology* ; Inflammation/pathology* ; Cerebral Amyloid Angiopathy/pathology* ; Vasculitis, Central Nervous System/pathology* ; Vasculitis/pathology*

To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

Objective To provide foundational data for exploring the association between KIR genes and diseases by an-alyzing the frequency and polymorphism of killer-cell immunoglobulin-like receptor(KIR)genes in Han,Manchu and Kore-an populations in Jilin Province.Methods KIR gene typing was performed on 129 Manchu,198 Korean and 201 Han indi-viduals from Jilin using the polymerase chain reaction-sequence specific primers(PCR-SSP)technique.Results KIR3DL2,KIR3DL3,KIR3DP1 and KIR2DL4 were detected in all subjects.KIR2DL1,KIR2DL3,KIR2DS4,KIR3DL1 and KIR2DP1 genes had high detection frequencies,ranging from 93％to 98％across the three ethnic groups.In contrast,the detection rates of KIR2DL2,KIR2DL5,KIR3DS1,KIR2DS1,KIR2DS2,KIR2DS3 and KIR2DS5 were lower,ranging from 13％to 45％.Notably,the detection frequencies of KIR2DL5(17.83％)and KIR2DS1(17.83％)in the Manchu population were significantly lower than those in the Korean(42.93％,47.47％)and Han(33.83％,33.33％)populations in Jilin.The detection frequencies of KIR2DL5(42.93％)and KIR2DS1(47.47％)were significantly higher in the Korean popula-tion compared to the Han(33.83％,33.33％)and Manchu(17.83％,17.83％)population.The frequency of the KIRAA hap-lotype in the Han population was the highest among the three ethnic groups in Jilin at 61.19％,significantly higher than that in the Korean population(42.93％).Differences between the three groups were statistically significant(P＜0.05),and remained significant after Bonferroni correction(Pc＜0.05).Conclusion The distribution of KIR genes in the Korean,Manchu and Han population in Jilin reflects the polymorphism of KIR genes in the Chinese population and also showcases unique ethnic genetic and regional characteristics.

Arteriovenous malformations(AVMs)are a kind of high-flow vascular malformation.AVMs can be classified in many ways,including histo-embryological classification,hemodynamic classification,etc.At present,the two mainstream classification systems used to guide the embolization treatment of peripheral AVMs are proposed by Cho and Yakes respectively based on the angiographic morphology of the lesions.Interventional embolization is the first-line treatment for AVMs.Among the many embolization agents,absolute ethanol is a permanent liquid embolization agent.Absolute ethanol can directly destroy the vascular endothelial cells to achieve a good curative efficacy,therefore,it has been wildly used in the treatment of peripheral AVMs.Yakes classification combines the angiographic classification with absolute ethanol embolization therapy.During absolute ethanol treatment,close attention should be paid to the occurrence of complications such as elevated pulmonary artery pressure.Although there are challenges remaining in the treatment of AVMs,the rapid development of molecular genetics has made targeted drug adjunctive treatment for AVMs possible.Perhaps,the novel therapeutic mode of combination use of traditional therapy targeted drug may be able to make a breakthrough in the treatment of AVMs.

Purpose To explore the imaging features and clinical pathology characteristics of extraskeletal Ewing sarcoma(EES).Materials and Methods The clinical and imaging data and pathological findings of 14 patients with EES confirmed by operation and pathology were retrospectively analyzed.CT examination was performed in 7 cases(including 5 enhanced)and MRI was performed on 9 cases(including 8 enhanced).Results The anatomic locations of the 14 patients included paraspinal area(n=3),mediastinum(n=1),right supraclavicular(n=1),left thigh(n=1),left parapubic region(n=1),retroperitoneal(n=1),pelvic cavity(n=1),prostate(n=2),left kidney(n=1),pancreas(n=1)and liver(n=1).All 14 cases of EES showed single solid mass,13 cases were lumpy,and the maximum diameter of the lesion ranged from 48.0 mm to 180.0 mm.8 cases showed uneven density or signal,cystic degeneration and necrosis was seen.one case had calcification.After enhancement,8 cases showed uneven enhancement,12 cases showed severe or moderate enhancement.10 cases were irregular in shape,11 cases had peripheral organ or tissue invasion,3 cases had no peripheral organ or tissue invasion.5 cases had peripheral bone destruction.One case had left renal vein and inferior vena cava tumor thrombus and thrombus,iliac vein thrombus.Conclusion The clinical symptoms of EES are nonspecific.The imaging manifestations of EES are mostly massive solid masses in extraosseous soft tissue,with uneven density or signal,irregular shape,often accompanied by cystic degeneration and necrosis and invasion of surrounding organs or tissues.Imaging is of great value in preoperative diagnosis,clinical staging,treatment and efficacy evaluation.

Objective:To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods:This was a prospective study. Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 65-83 yr, weighing 50-80 kg, scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital, were divided into 2 groups ( n=30 each) using a random number table method: bupivacaine liposome group (LB group) and ropivacaine group (R group). Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia, bupivacaine liposome diluent 20 ml (133 mg) was injected in LB group, and 0.5% ropivacaine 20 ml was injected in R group. Patient-controlled intravenous analgesia was performed after operation, and tramadol was used for rescue analgesia when the visual analogue scale (VAS) score ≥3. VAS scores at rest and during activity were recorded at 8, 12, 24, 48 and 72 h after surgery. The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery. The quadriceps muscle strength was measured at 1 day before surgery and 12, 24, 48 and 72 h after surgery. The knee joint range of motion was assessed at 1 day before surgery and 24, 48 and 72 h after surgery. Patient′s satisfaction with analgesia was recorded at 72 h after surgery. The adverse reactions within 72 h after surgery were also recorded. Results:Compared with R group, VAS scores at rest and during activity were significantly decreased at 12, 24, 48 and 72 h after surgery, the time to the first pressing analgesia pump was prolonged, the rate of rescue analgesia after surgery was decreased, the score for the patient′s satisfaction with analgesia was increased, the knee joint range of motion was increased ( P<0.05), and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group ( P>0.05). Conclusions:Ultrasound-guided adductor canal block with bupivacaine liposome provides better analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.

Objective:To investigate the clinical and genetic features of the patient with neurodevelopmental disorders characterized by thickened corpus callosum caused by MAST1 gene mutation. Methods:Clinical data and auxiliary examination of a child with neurodevelopmental disorders caused by MAST1 gene mutation who was admitted to Henan Children′s Hospital in September 2022 were collected, and whole exome sequencing technology was applied to analyze the genetics of the child. Results:The patient was a 2 years and 8 months old male, with a clinical phenotype including intellectual, motor, and speech development disorders. Brain magnetic resonance imaging (MRI) showed thickened corpus callosum, nodular heterotopia of the left ventricle body.Whole exome sequencing showed the MAST1 gene with c.578T>G(p.Met193Arg) heterozygous missense variant, which was a unreported de novo pathogenic variant and both of his parents were wild-type. Conclusions:Diseases caused by MAST1 gene mutations are relatively rare, the main clinical features are neurodevelopmental disorders and brain structural abnormalities, and MRI shows an enlarged corpus callosum.The heterozygous missense variant c.578T>G(p.Met193Arg) of the MAST1 gene is the genetic cause of this case.

Objective:To summarize the features of stenosis or premature closure of fetal ductus arteriosus and to investigate the perinatal management strategies.Methods:Three cases diagnosed with stenosis or premature closure of fetal ductus arteriosus in Peking University First Hospital between January 2022 and June 2022 were retrospectively enrolled. Clinical features and perinatal management strategies were summarized.Results:Fetal cardiac abnormalities (right heart enlargement and tricuspid regurgitation) were detected in the three cases by routine prenatal ultrasound at the gestational weeks of 24, 30 and 23, respectively. Fetal echocardiography confirmed the diagnosis of stenosis or premature closure of fetal ductus arteriosus and no other structural anomalies were detected. All three pregnant women denied taking non-steroidal anti-inflammatory drugs. Case 1 and case 2 underwent emergency cesarean section due to suspected fetal cardiac dysfunction with a cardiovascular profile score of 6 and 5. The two neonates were transferred to the neonatal intensive care unit and discharged with good prognosis (normal cardiac function) on the 56th and 42nd day after birth. During a close monitoring, the stenosis of fetal ductus arteriosus improved in case 3 and a full-term neonate was delivered at 38 weeks by elective cesarean section because of a history of cesarean section.Conclusions:In the second and third trimesters of pregnancy, attention should be drawn to the fetal ductus arteriosus during ultrasound imaging, especially when right heart enlargement and tricuspid regurgitation were detected. For fetuses with suspected ductus arteriosus stenosis, a close monitor of the ductus arteriosus and the ultrasound findings indicating cardiac dysfunction is needed and the cardiovascular profile score should also be involved. Fetuses with premature closure of the ductus arteriosus should be delivered promptly and the postnatal cardiac outcomes are good.