Objective To evaluate the application of high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)in identifying high-risk features of intracranial atherosclerotic plaques,and to analyze the correlation between plaque characteristics and stroke recurrence under varying degrees of stenosis.Methods The data from 368 patients with intracranial atherosclerotic stenosis(ICAS)across two centers were retrospectively analyzed.Based on the degree of stenosis,all patients were categorized into mild-to-moderate stenosis group(luminal stenosis<70%,n=155)and severe stenosis group(luminal stenosis≥70%,n=213).HRMR-VWI images and clinical information of the patients were collected and analyzed,and the culprit plaques were quantitatively analyzed.Univariate and multivariate logistic regression analyses were employed to identify the risk factors for stroke recurrence,and the predictive performance was evaluated using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results Higher normalized wall index(NWI)[odds ratio(OR)=1.082,95%confidence interval(CI)1.050-1.118,P<0.05]and the presence of intraplaque hemorrhage(IPH)(OR=1.843,95%CI 1.120-3.036,P<0.05)were risk factors for stroke recurrence in all patients.And these two factors were also significant in the mild-to-moderate stenosis group(NWI:OR=1.088,95%CI 1.009-1.186,P<0.05;IPH:OR=4.049,95%CI 1.227-16.065,P<0.05).A predictive model for stroke recurrence was constructed using the combination of IPH and NWI,with the best performance in the mild-to-moderate stenosis group(AUC=0.813,95%CI 0.723-0.906).Conclusion In patients with luminal stenosis<70%,the increase of NWI and the presence of IPH have been validated as significant and effective indicators for predicting stroke recurrence,demonstrating notable predictive performance.In contrast,among patients with luminal stenosis≥70%,the utility of plaque characteristics in predicting stroke recurrence is relatively lower,indicating that the correlation between plaque characteristics and stroke recurrence varies across different degrees of stenosis.

Objective To observe the value of the integrated model of MR high-resolution vascular wall imaging(HR-VWI)and attention mechanism for predicting stroke recurrence in symptomatic intracranial atherosclerotic stenosis(sICAS)patients.Methods A total of 363 patients with sICAS who underwent HR-VWI were enrolled and stratified into training set(n=254)and validation set(n=109)according to their origins.Employing a radiomics model that utilized HR-VWI T1 and contrast-enhanced sequences for feature extraction,image data were captured from relevant plaques.Subsequently,a Trans model was developed by integrating the Transformer attention mechanism.The predictive performance and clinical utility of conventional radiomics models and Trans models for forecasting stroke recurrence among patients with sICAS were evaluated.Results In training set and validation set,the area under the curve of Trans model for predicting stroke recurrence in sICAS patients was 0.992 and 0.988,respectively,both superior to that of T1 model,T1 enhanced model and dual sequence model(all P＜0.05).The calibration curve and decision curve analysis showed that Trans model had good predictive probability and clinical practicality.Conclusion The obtained integrated model of HR-VWI radiomics combined with attention mechanism had certain value for predicting stroke recurrence in patients with sICAS.

Objective:To investigate the clinicopathological and genetic features of infantile rhabdomyofibrosarcoma (IRFS) with EGFR kinase domain duplication (EGFR-KDD).Methods:The clinical, morphological and immunohistochemical features of three IRFS with EGFR-KDD diagnosed from January 2022 to January 2024 at Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed using PCR or next generation sequencing technique; and related literature was reviewed.Results:There were 1 male and 2 females, aged at presentation ranging from 1 to 4 years. The tumor occurred in the left thigh, right maxillofacial region, and right popliteal space. The presenting symptom was a painless mass which was accidentally discovered. The maximum diameter of tumors ranged from 3 to 5 cm. Microscopically, the tumors were poorly defined and composed of relatively monomorphic spindle cells, arranged in diffuse, fascicular growth patterns, with moderate pale eosinophilic cytoplasm. Mitoses were abundant. A few round rhabdomyoblastic tumor cells with abundant eosinophilic cytoplasm were found. There was no evidence of hemorrhage or necrosis. The tumor cells expressed vimentin, SMA, MSA, desmin, MyoD1 and myogenin; and the Ki-67 proliferation index was 10%-60%. RT-PCR showed EGFR-KDD in all three cases. Gene fusion was detected in three cases based on next generation sequencing, but only one case had EGFR-KDD. Follow-up data for 12 to 36 months showed two patients died of the disease and one patient was alive without recurrences and metastasis.Conclusions:IRFS is a rare soft tissue tumor that resembles infantile fibrosarcoma but has immunohistochemical evidence of rhabdomyoblastic differentiation. It more commonly occurs in infants and tends to appear in limbs and torso with poor prognosis. Aggressive multimodality treatment is recommended for these patients. EGFR-KDD may be a genetic driver to IRFS. Clinical response to EGFR targeted therapy might be promising in the future.

Objective To evaluate the application of high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)in identifying high-risk features of intracranial atherosclerotic plaques,and to analyze the correlation between plaque characteristics and stroke recurrence under varying degrees of stenosis.Methods The data from 368 patients with intracranial atherosclerotic stenosis(ICAS)across two centers were retrospectively analyzed.Based on the degree of stenosis,all patients were categorized into mild-to-moderate stenosis group(luminal stenosis<70%,n=155)and severe stenosis group(luminal stenosis≥70%,n=213).HRMR-VWI images and clinical information of the patients were collected and analyzed,and the culprit plaques were quantitatively analyzed.Univariate and multivariate logistic regression analyses were employed to identify the risk factors for stroke recurrence,and the predictive performance was evaluated using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results Higher normalized wall index(NWI)[odds ratio(OR)=1.082,95%confidence interval(CI)1.050-1.118,P<0.05]and the presence of intraplaque hemorrhage(IPH)(OR=1.843,95%CI 1.120-3.036,P<0.05)were risk factors for stroke recurrence in all patients.And these two factors were also significant in the mild-to-moderate stenosis group(NWI:OR=1.088,95%CI 1.009-1.186,P<0.05;IPH:OR=4.049,95%CI 1.227-16.065,P<0.05).A predictive model for stroke recurrence was constructed using the combination of IPH and NWI,with the best performance in the mild-to-moderate stenosis group(AUC=0.813,95%CI 0.723-0.906).Conclusion In patients with luminal stenosis<70%,the increase of NWI and the presence of IPH have been validated as significant and effective indicators for predicting stroke recurrence,demonstrating notable predictive performance.In contrast,among patients with luminal stenosis≥70%,the utility of plaque characteristics in predicting stroke recurrence is relatively lower,indicating that the correlation between plaque characteristics and stroke recurrence varies across different degrees of stenosis.

[Objective]To explore the characteristics of moxibustion application in Chuanya Waibian by ZHAO Xuemin,a doctor in Qing Dynasty,in order to provide ideas for the expansion of the application range of moxibustion and the design of new moxibustion tools.[Methods]By studying and analyzing the discussion about moxibustion in Chuanya Waibian,the author summarized the principle and experience of using moxibustion to treat diseases.[Results]Chuanya Waibian was written by ZHAO Xuemin on the basis of inheriting the essence of the theories of the ancients and combining with the medical practice experience of the folk doctors.The philosophy of moxibustion is"harmony between human and nature,treatment in line with the change of climate";in the treatment"selecting acupoints essentially,applying moxibustion moderately""using various materials of moxibustion,not confined to moxa",and characterized by"extensive clinical symptoms,good treatment of emergency"and"distinguishing Yin and Yang in the treatment of carbuncle and ulcer".[Conclusion]Chuanya Waibian reflects the characteristics of the clinical diagnosis and treatment of the folk doctors in the region of Jiangsu and Zhejiang in the Qing Dynasty,and to a certain extent embodies ZHAO Xuemin's academic thought of traditional Chinese medicine.Summarizing the rules of using moxibustion to treat diseases in this book can provide new ideas and methods for clinical diagnosis and treatment,as well as reference value for the innovation of moxa sticks and the design of new moxibustion equipment.

Objective To observe the value of the integrated model of MR high-resolution vascular wall imaging(HR-VWI)and attention mechanism for predicting stroke recurrence in symptomatic intracranial atherosclerotic stenosis(sICAS)patients.Methods A total of 363 patients with sICAS who underwent HR-VWI were enrolled and stratified into training set(n=254)and validation set(n=109)according to their origins.Employing a radiomics model that utilized HR-VWI T1 and contrast-enhanced sequences for feature extraction,image data were captured from relevant plaques.Subsequently,a Trans model was developed by integrating the Transformer attention mechanism.The predictive performance and clinical utility of conventional radiomics models and Trans models for forecasting stroke recurrence among patients with sICAS were evaluated.Results In training set and validation set,the area under the curve of Trans model for predicting stroke recurrence in sICAS patients was 0.992 and 0.988,respectively,both superior to that of T1 model,T1 enhanced model and dual sequence model(all P＜0.05).The calibration curve and decision curve analysis showed that Trans model had good predictive probability and clinical practicality.Conclusion The obtained integrated model of HR-VWI radiomics combined with attention mechanism had certain value for predicting stroke recurrence in patients with sICAS.

Objective:To investigate the clinicopathological and genetic features of infantile rhabdomyofibrosarcoma (IRFS) with EGFR kinase domain duplication (EGFR-KDD).Methods:The clinical, morphological and immunohistochemical features of three IRFS with EGFR-KDD diagnosed from January 2022 to January 2024 at Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed using PCR or next generation sequencing technique; and related literature was reviewed.Results:There were 1 male and 2 females, aged at presentation ranging from 1 to 4 years. The tumor occurred in the left thigh, right maxillofacial region, and right popliteal space. The presenting symptom was a painless mass which was accidentally discovered. The maximum diameter of tumors ranged from 3 to 5 cm. Microscopically, the tumors were poorly defined and composed of relatively monomorphic spindle cells, arranged in diffuse, fascicular growth patterns, with moderate pale eosinophilic cytoplasm. Mitoses were abundant. A few round rhabdomyoblastic tumor cells with abundant eosinophilic cytoplasm were found. There was no evidence of hemorrhage or necrosis. The tumor cells expressed vimentin, SMA, MSA, desmin, MyoD1 and myogenin; and the Ki-67 proliferation index was 10%-60%. RT-PCR showed EGFR-KDD in all three cases. Gene fusion was detected in three cases based on next generation sequencing, but only one case had EGFR-KDD. Follow-up data for 12 to 36 months showed two patients died of the disease and one patient was alive without recurrences and metastasis.Conclusions:IRFS is a rare soft tissue tumor that resembles infantile fibrosarcoma but has immunohistochemical evidence of rhabdomyoblastic differentiation. It more commonly occurs in infants and tends to appear in limbs and torso with poor prognosis. Aggressive multimodality treatment is recommended for these patients. EGFR-KDD may be a genetic driver to IRFS. Clinical response to EGFR targeted therapy might be promising in the future.

Objective:To investigate the current status of real time application of domestic and imported medical device in the real-world in Liaoning province,and provide data support for the promotion and application of domestic medical device.Methods:Data of the usage of medical device were collected from 77 medical institutions at all levels in 9 urban-rural demonstration regions with representativeness in Liaoning Province from November 2017 to June 2020.Descriptive analysis was used to characterize the distribution of medical device,which data were collected in urban-rural medical institutions at all levels in Liaoning Province.The total amount of receiving test of medical device,and the tested amount of each device in each month in urban-rural medical institutions at all levels were calculated.The median value of monthly average number of persons who received test of various kind of domestic and imported medical device in each month in hospitals with third level and secondary level were also calculated.Results:The total number of device that were collected from 77 medical institutions in 9 demonstration regions in Liaoning province was 325,among of which there were 153 domestic device(accounting for 47.1%)and 172 imported devices(accounting for 52.9%).A total of 6,261,000 person-time valid records were collected from 77 medical institutions,which average test number was 5,562 person-time in each device and each month.The total number of person-times of domestic device in diagnosis and treatment was 1,380,000 person-times(accounting for 22.0%),and that of imported devices was 4,881,000 person-times(accounting for 78.0%).The average test number of each device of domestic device in each month was 2,334 person-times(accounting for 42.0%),and that of imported device in each month was 3,228 person-times(accounting for 58.0%).In urban regions,imported device were dominant,while domestic medical device were dominant in rural regions in Liaoning province.The overall usage frequency of imported medical device was higher in hospitals with third level or secondary level,while the usage frequency of domestic medical device was higher in grassroots medical institutions.Conclusion:There are differences in the real time usage between domestic and imported medical device among 77 medical institutions at all levels in 9 demonstration regions in Liaoning province.Urban regions mainly tend to use imported device,while rural regions more tent to use domestic device.

Objective:To investigate the current status of real time application of domestic and imported medical device in the real-world in Liaoning province,and provide data support for the promotion and application of domestic medical device.Methods:Data of the usage of medical device were collected from 77 medical institutions at all levels in 9 urban-rural demonstration regions with representativeness in Liaoning Province from November 2017 to June 2020.Descriptive analysis was used to characterize the distribution of medical device,which data were collected in urban-rural medical institutions at all levels in Liaoning Province.The total amount of receiving test of medical device,and the tested amount of each device in each month in urban-rural medical institutions at all levels were calculated.The median value of monthly average number of persons who received test of various kind of domestic and imported medical device in each month in hospitals with third level and secondary level were also calculated.Results:The total number of device that were collected from 77 medical institutions in 9 demonstration regions in Liaoning province was 325,among of which there were 153 domestic device(accounting for 47.1%)and 172 imported devices(accounting for 52.9%).A total of 6,261,000 person-time valid records were collected from 77 medical institutions,which average test number was 5,562 person-time in each device and each month.The total number of person-times of domestic device in diagnosis and treatment was 1,380,000 person-times(accounting for 22.0%),and that of imported devices was 4,881,000 person-times(accounting for 78.0%).The average test number of each device of domestic device in each month was 2,334 person-times(accounting for 42.0%),and that of imported device in each month was 3,228 person-times(accounting for 58.0%).In urban regions,imported device were dominant,while domestic medical device were dominant in rural regions in Liaoning province.The overall usage frequency of imported medical device was higher in hospitals with third level or secondary level,while the usage frequency of domestic medical device was higher in grassroots medical institutions.Conclusion:There are differences in the real time usage between domestic and imported medical device among 77 medical institutions at all levels in 9 demonstration regions in Liaoning province.Urban regions mainly tend to use imported device,while rural regions more tent to use domestic device.

[Objective]To explore the characteristics of moxibustion application in Chuanya Waibian by ZHAO Xuemin,a doctor in Qing Dynasty,in order to provide ideas for the expansion of the application range of moxibustion and the design of new moxibustion tools.[Methods]By studying and analyzing the discussion about moxibustion in Chuanya Waibian,the author summarized the principle and experience of using moxibustion to treat diseases.[Results]Chuanya Waibian was written by ZHAO Xuemin on the basis of inheriting the essence of the theories of the ancients and combining with the medical practice experience of the folk doctors.The philosophy of moxibustion is"harmony between human and nature,treatment in line with the change of climate";in the treatment"selecting acupoints essentially,applying moxibustion moderately""using various materials of moxibustion,not confined to moxa",and characterized by"extensive clinical symptoms,good treatment of emergency"and"distinguishing Yin and Yang in the treatment of carbuncle and ulcer".[Conclusion]Chuanya Waibian reflects the characteristics of the clinical diagnosis and treatment of the folk doctors in the region of Jiangsu and Zhejiang in the Qing Dynasty,and to a certain extent embodies ZHAO Xuemin's academic thought of traditional Chinese medicine.Summarizing the rules of using moxibustion to treat diseases in this book can provide new ideas and methods for clinical diagnosis and treatment,as well as reference value for the innovation of moxa sticks and the design of new moxibustion equipment.