70%). TCD monitored the microembolic signals (MES) and cerebral blood flow of middle cerebral artery (MCA) using M-Mode before, after and during CAS. TCD and color ultrasound duplex were examined and new vascular events recorded during the following-up. Results Except a large numbers of MES arising from the recent contrast injection, the most MES were detected during the phase of predilation (MES number=116) and stent placement (MES number=135, 91, 113, 90, 106, 125). The MES count during the phase of postdilation was relatively reduced (MES number=8, 14, 37, 16). The most MES were characterized by high intensity and over-loading in TCD spectrum. MCA blood flow velocity varied predominantly in phases of predilation (Vsys/Vmean=46/31 to 76/54) and postdilation (Vsys/Vmean=40/26 to 74/49, 0/0 to 114/69, 35/24 to 116/71, 50/36 to 137/86). MES recorded in 2 patients prior to CAS disappeared in post-procedure. MCA blood flow velocity was enhanced or MCA pulsative index increased after CAS. No complications occurred. Tissue debris was collected in one filter device. During 3 to 19 months following-up, only one patient had a new vascular event of cerebral infarction located in the contralateral side of the CAS. Conclusions TCD monitoring might evaluate the microemboli and cerebral blood flow before, after and during CAS with filter devices. Filter devices might reduce embolization by preventing the bigger particulate microembolism into the distal part of the cerebral vessel without influencing cerebral blood flow. The gaseous and the smaller particulate microembolism unfiltrated should not result in clinical symptoms in most cases.

Objective To investigate the clinical and radiological features of the patients with cryptogenic stroke as the first manifestation of pulmonary arteriovenous malformation (PAVM),and to explore the mechanism and summarize the diagnostic strategy.Methods Transcmnial Doppler (TCD) bubble tests,non-contrast or contrast-enhanced transthoracic and transesophageal echocardiography,contrast-enhanced thoracic CT and pulmonary angiography were performed in 2 patients with cryptogenic stroke for the detection of right to left shunt (RLS) and the diagnosis of PAVM.Then interventional catheter embolization of PAVM and postoperative follow-up were arranged.Results TCD bubble tests in these 2 patients showed the following characteristics indicating RLS:spontaneous continuous shunt at rest,earlystage shunt appeared rapidly after injection,considerable large amount of shunt volume as a shower of microbubble,the extent of shunt volume not attenuated by Valsalva Maneuver (VM).One patient was diagnosed as PAVM,the other was PAVM plus patent foramen ovale (PFO).Both patients of PAVM were successfully treated with interventional catheter embolizations.Then TCD bubble test was repeated and showed significantly decreased amount of RLS.They remained asymptomatic during the 3-year and 1-year follow-up.Conclusions In patients with cryptogenic stroke due to suspected paradoxical embolism,TCD bubble test should be performed for screening RLS.Besides PFO,a traditional access to intracardiac shunt,PAVM should be considered as a new access to extracardiac shunt in paradoxical embolism.

Keloid is a type of skin fibroproliferative disease, characterized by excessive deposition of collagen in the extracellular matrix. There are many therapies for treating keloids now. However, the outcome of keloids treatment is still unsatisfied due to high recurrence rate. In recent years, polypeptides have shown great potential for preventing and treating keloid. These polypeptides are derived from cytokines, hormones and in vivo protehydrolysis. Polypeptides may inhibit the activation of fibroblasts, reduce the deposition of collagen and other extracellular matrix through multiple mechanisms. The article reviews current research progress on the roles of polypeptides and underlying mechanisms in keloid and provides reference for relevant research.

Background::The causal relationship between visceral adipose tissue (VAT) and gout is still unclear. We aimed to examine the potential association between them using observational and Mendelian randomization (MR) analyses.Methods::In the observational analyses, a total of 11,967 participants (aged 39.5 ± 11.5 years) were included from the National Health and Nutrition Examination Survey. Logistic regression models were used to investigate the association between VAT mass and the risk of gout. In two-sample MR analyses, 211 VAT mass-related independent genetic variants (derived from genome-wide association studies in 325,153 UK biobank participants) were used as instrumental variables. The random-effects inverse-variance weighted (IVW) method was used as the primary analysis. Additional sensitivity analyses were also performed to validate our results.Results::Observational analyses found that an increase in VAT mass (per standard deviation) was associated with a higher risk of gout after controlling for confounding factors (odds ratio [OR] = 1.27, 95% confidence intervals [CI] = 1.11–1.45). The two-sample MR analyses demonstrated a causal relationship between increased VAT mass and the risk of gout in primary analyses (OR = 1.78, 95% CI = 1.57–2.03). Sensitivity analyses also showed similar findings, including MR-Egger, weighted median, simple mode, weighted mode, and leave-one-out analyses.Conclusions::Observational analyses showed a robust association of VAT mass with the risk of gout. Meanwhile, MR analyses also provided evidence of a causal relationship between them. In summary, our findings suggested that targeted interventions for VAT mass may be beneficial to prevent gout.

Keloid is a type of skin fibroproliferative disease, characterized by excessive deposition of collagen in the extracellular matrix. There are many therapies for treating keloids now. However, the outcome of keloids treatment is still unsatisfied due to high recurrence rate. In recent years, polypeptides have shown great potential for preventing and treating keloid. These polypeptides are derived from cytokines, hormones and in vivo protehydrolysis. Polypeptides may inhibit the activation of fibroblasts, reduce the deposition of collagen and other extracellular matrix through multiple mechanisms. The article reviews current research progress on the roles of polypeptides and underlying mechanisms in keloid and provides reference for relevant research.

Objective To investigate the diagnostic value of subtraction technique based coronary CT fractional flow reserve(CT-FFR)in detecting calcification-related hemodynamically signifi-cant stenosis.Methods A total of 22 patients(42 lesions)with known or suspected coronary ar-tery disease admitted in our hospital from March 2020 to March 2022 were recruited prospectively.Subtraction coronary computed tomography angiography(CCTA)was provided for the patients who were scheduled for invasive coronary angiography(ICA).CCTA image reconstruction algo-rithm was based on hybrid iterative reconstruction.FFR was detected in the patients with moder-ate-to-severe coronary stenosis caused by calcification.A FFR value ≤0.80 was defined as signifi-cant hemodynamic stenosis.With FFR as the reference standard,the diagnostic performance of CCTA,subtraction CCTA,CT-FFR,and subtraction CT-FFR in detecting calcification-related hemodynamically significant stenosis were evaluated.Results Lesion-based analysis showed that subtraction CT-FFR yielded the highest diagnostic performance among four groups of images,with a sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 100.0％,62.1％,54.2％,100.0％and 73.8％,respectively,and an AUC value of 0.83.Patient-based analysis showed subtraction CT-FFR performed best in diagnostic performance,with a sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 100.0％,33.3％,55.6％,100.0％and 63.6％,respectively,and an AUC value of 0.77.Conclusion Subtraction CT-FFR has the highest diagnostic performance for calcification-related hemodynamically signifi-cant stenosis,which expands the application of CT-FFR in severe calcification lesions,and is of good value in clinical application.

Objective To assess the association between human CYP1A1 gene polymorphisms and coronary artery disease (CAD) among the Uygur population of China.Methods Genotypes of CYP1A1 single nucleotide polymorphisms (SNPs:rs4886605,rs 12441817,rs4646422 and rs1048943) were detected by real-time PCR in 293 CAD patients and 408 controls.Results Among the Uygur group,distribution of genotypes and allele of rs4886605 were both significantly different between CAD and the controls (all P＜0.05).The dominant model (CC vs.CT + TT) of rs4886605 was significantly lower among CAD patients than in controls.Significant differences were retained after the adjustment was made in all the participants (OR=0.368,95％CI:0.185-0.530,P=0.018) and in men (OR=0.350,95％CI:0.235-0.568,P=0.015).Distributions of genotypes and allele of rs12441817 were both significantly different between CAD and the controls (all P＜0.05).The dominant model (TT vs.CT+CC) of rs12441817 was significantly lower among patients CAD than in controls.Significant difference were retained after the adjustment was made,in total participants (OR=0.253,95％ CI:0.231-0.546,P=0.016) and in men (OR=0.241,95％ CI:0.132-0.478,P=0.002).Conclusion Both rs4886605 and rs12441817 SNPs of the CYP1A1 gene were associated with CAD in the Uygur population of China.

Objective:To establish and evaluate a nomogram for long-term survival of patients with intrahepatic cholangiocarcinoma (ICC) after radical resection.Methods:The data of ICC patients who underwent radical resection for the first time at Zhongshan Hospital, Fudan University from January 2014 to December 2017 were retrospectively analyzed. Of 167 patients who were enrolled, there were 104 males and 63 females, with the age of (60.3±10.9) years. Tumor tissues were collected for immunohistochemical staining and interpretation. Univariate Cox regression, LASSO regression and multivariate Cox regression were used to analyze influencing factors of postoperative long-term survival after ICC. R software was used to construct a nomogram in predicting ICC prognosis.Results:Cox regression analysis showed that TNM staging, poorly differentiated tumor, positive resection margin, positive mucin 5 expression and abnormal P53 expression to be independent risk factors associated with poor long-term survival after radical resection. The prognostic nomogram model of ICC was constructed based on these factors. The C-index was 0.821. The nomogram model consistency index had a high degree of prognostic differentiation. The 45° diagonal of the 3-year postoperative calibration curve which represented the actual survival fitted well with the segmented line which represented the predicted survival of the nomogram. The area under the receiver operating characteristic curve of the nomogram model was higher than that of AJCC TNM staging (0.894 vs. 0.803, z=4.10, P<0.001). The nomogram model was more effective in predicting postoperative survival of ICC patients than the TNM staging. Conclusion:TNM staging, poorly differentiated tumor, positive resection margin, positive mucin 5 expression and abnormal P53 expression were independent risk factors for postoperative survival of ICC. The nomogram model could better evaluate long-term prognosis of ICC patients after radical resection than the traditional TNM staging system.

The diagnosis and treatment resources for rare diseases in China are highly imbalanced. The basic diagnosis and treatment capabilities are weak, the diagnosis period for patients is long, and the rates of missed diagnosis and misdiagnosis are relatively high. The establishment of a hierarchical diagnosis and treatment system is the inevitable approach to enhancing the diagnosis and treatment standards of rare diseases. Currently, the implementation of the domestic hierarchical diagnosis and treatment system for rare diseases still confronts numerous challenges, such as ambiguous referral standards and processes of primary medical institutions, and ineffective information interaction among institutions at all levels. Thus, it is essential to facilitate high-level information construction for the hierarchical diagnosis and treatment of rare diseases. This paper explores the process of constructing a multidisciplinary joint remote diagnosis and treatment platform and a health management platform through informatization, with the hope of establishing two closed loops of digital diagnosis and treatment services and health follow-up management for patients with rare diseases, as well as achieving timely diagnosis and lifelong health management for patients. It integrates and optimizes auxiliary diagnostic tools, promotes the rapid dissemination of rare disease diagnosis and treatment experiences to the grassroots, enhances the information construction level of the hierarchical diagnosis and treatment system, and endeavors to address the practical predicament of weak diagnosis and treatment capabilities of rare diseases in grassroots medical institutions. Additionally, this paper proposes an essential approach for multi-dimensional independent innovation to guide the popularization of efficient and high-quality rare disease diagnosis and treatment services. By encompassing innovating the rare disease diagnosis and treatment collaboration network and multidisciplinary diagnosis and treatment model, facilitating the application of the latest biomedical and informatics technologies to the grassroots, and constructing a national intelligent data platform for rare disease innovation, a new model for rare disease services with Chinese characteristics will be established. This will significantly enhance the medical treatment level of rare diseases in China and strive for more benefits for patients.