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.

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.