PURPOSE: To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis. METHODS: This is a single-center retrospective cohort study. Patients who received TEVAR for BTAI at our institution from October 2016 to September 2023 were divided into 2 categories depending on the injury severity score (ISS) (≤ 25 vs. > 25) and when the TEVAR was performed for BTAI (within 24 h vs. after 24 h), respectively. The analysis included all patients who received TEVAR treatment after being diagnosed with BTAI through whole-body CT angiography. Patients treated with open repair and non-operative management were excluded. After propensity-score matching for various factors, outcomes during hospitalization and follow-up were compared. These factors included demographics, comorbidities, concomitant injuries, cause and location of aortic injury, Glasgow coma scale score, society for vascular surgery grading, hemoglobin concentration, creatinine concentration, shock, systolic blood pressure, and heart rate at admission. The comparison was conducted using SPSS 26 software. Continuous variables were presented as either the mean ± standard deviation or median (Q₁, Q₃), and were compared using either the t-test or the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 2 groups using the χ² test or Fisher's exact test. Statistical significance was defined as a 2-sided p < 0.05. RESULTS: In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores > 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS > 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) vs. 2 (4.4%), p < 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q₁, Q₃)) compared to the immediate group (15 (12, 15) vs. 13.5 (9, 15), p = 0.039), while the creatinine concentration (median (Q₁, Q₃)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) vs. 71.5 (58.3, 80.8), p = 0.012). The final sample included 52 matched patients. Complications occurred significantly less frequently in the elective group compared to the immediate group (16 (50.0%) vs. 3 (10.0%), p < 0.001). Single-factor analysis of variance showed that complications in hospitalized patients were significantly associated with immediate TEVAR as the sole independent risk factor (odds ratio: 9.000, 95% confidence interval: 2.266-35.752, p = 0.002). CONCLUSION In this propensity-score matched analysis of patients undergoing TEVAR for BTAI, elective TEVAR was significantly associated with a lower risk of complication rates. In this study using propensity-score matching, patients who underwent elective TEVAR for BTAI had lower complication rates than immediate TEVAR.
Humans ; Retrospective Studies ; Male ; Aorta, Thoracic/surgery* ; Female ; Endovascular Procedures/methods* ; Wounds, Nonpenetrating/mortality* ; Middle Aged ; Adult ; Aged ; Injury Severity Score ; Elective Surgical Procedures ; Time Factors ; Treatment Outcome ; Endovascular Aneurysm Repair

Traditional Chinese medicine (TCM) represents a paradigmatic approach to personalized medicine, developed through the systematic accumulation and refinement of clinical empirical data over more than 2000 years, and now encompasses large-scale electronic medical records (EMR) and experimental molecular data. Artificial intelligence (AI) has demonstrated its utility in medicine through the development of various expert systems (e.g., MYCIN) since the 1970s. With the emergence of deep learning and large language models (LLMs), AI's potential in medicine shows considerable promise. Consequently, the integration of AI and TCM from both clinical and scientific perspectives presents a fundamental and promising research direction. This survey provides an insightful overview of TCM AI research, summarizing related research tasks from three perspectives: systems-level biological mechanism elucidation, real-world clinical evidence inference, and personalized clinical decision support. The review highlights representative AI methodologies alongside their applications in both TCM scientific inquiry and clinical practice. To critically assess the current state of the field, this work identifies major challenges and opportunities that constrain the development of robust research capabilities-particularly in the mechanistic understanding of TCM syndromes and herbal formulations, novel drug discovery, and the delivery of high-quality, patient-centered clinical care. The findings underscore that future advancements in AI-driven TCM research will rely on the development of high-quality, large-scale data repositories; the construction of comprehensive and domain-specific knowledge graphs (KGs); deeper insights into the biological mechanisms underpinning clinical efficacy; rigorous causal inference frameworks; and intelligent, personalized decision support systems.
Medicine, Chinese Traditional/methods* ; Artificial Intelligence ; Humans ; Precision Medicine ; Decision Support Systems, Clinical

Objective:To analyze the methylation characteristics of the lymphocyte-specific protein-tyrosine kinase (LCK) promoter region in the peripheral blood circulation of rheumatoid arthritis (RA) patients and its correlation with clinical indicators.Methods:Targeted methylation sequencing was used to compare the methylation levels of 7 CpG sites in the LCK promoter region in the peripheral blood of RA patients with healthy controls (HC) and osteoarthritis (OA) patients. Correlation analysis and ROC curve construction were performed with clinical information.Results:Non-parametric tests revealed that compared with HC [0.53(0.50, 0.57)] and OA patients [0.59(0.54, 0.62), H=47.17, P<0.001], RA patients [0.63(0.59, 0.68)] exhibited an overall increase in methylation levels. Simultaneously, when compared with the HC group [0.38(0.35, 0.41), 0.59(0.55, 0.63), 0.60(0.55, 0.64), 0.59(0.55, 0.63), 0.58(0.53, 0.62), 0.45(0.43, 0.49), 0.57(0.54, 0.61)], the RA group [0.46(0.42, 0.49), 0.70(0.65, 0.75), 0.70(0.66, 0.76), 0.70(0.65, 0.75), 0.69(0.64, 0.74), 0.55(0.51, 0.59), 0.68(0.63, 0.73)] showed a significant elevation in methylation levels at CpG sites cg05350315_60, cg05350315_80, cg05350315_95, cg05350315_101, cg05350315_104, cg05350315_128, and cg05350315_142, with statistically significant differences ( Z=-5.63, -5.89, -5.91, -5.89, -5.98, -5.95, -5.95, all P<0.001). Compared with the OA group [0.65(0.59, 0.69), 0.65(0.60, 0.69), 0.64(0.58, 0.68), 0.50(0.45, 0.54), 0.63(0.58, 0.67)], the RA group [0.70(0.66, 0.76), 0.70(0.65, 0.75), 0.69(0.64, 0.74), 0.55(0.51, 0.59), 0.68(0.63, 0.73)] exhibited a significant increase in methylation levels at CpG sites cg05350315_95, cg05350315_101, cg05350315_104, cg05350315_128, and cg05350315_142, with statistically significant differences ( Z=-3.56, -3.52, -3.60, -3.67, -3.62; P=0.036, 0.042, 0.031, 0.030, 0.030). Furthermore, Pearson correlation coefficient analysis revealed a positive correlation between the overall methylation level in this region and C-reactive protein (CRP) ( r=0.19, P=0.004) and erythrocyte sedimentation rate ( r=0.14, P=0.035). The overall methylation level of the LCK promoter region in the CRP (low) group [0.63 (0.58, 0.68)] was higher than that in the CRP (high) group [0.65(0.61, 0.70)], with statistically significant differences ( Z=2.60, P=0.009). Finally, by constru-cting a ROC curve, the discriminatory efficacy of peripheral blood LCK promoter region methylation levels for identifying RA patients, especially seronegative RA patients, from HC and OA groups was validated, with an AUC value of 0.78 (95% CI: 0.63, 0.93). Conclusion:This study provides insights into the methylation status and methylation haplotype patterns of the LCK promoter region in the peripheral blood of RA patients. The overall methylation level in this region is positively correlated with the level of inflammation and can be used to differentiate seronegative RA patients from the HC and OA patients.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair (F/B-EVAR) for endovascular repair of abdominal aortic diseases.Methods:From Feb 2018 to Mar 2023, The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.Results:The mean follow-up time of the patients was 23 months (2-60 months), and 24 cases were lost to follow up, the follow-up rate was 92.4% (292/316), the mean postoperative hospitalization time was (8.2±4.9) days. A total of 944 main abdominal branch arteries were reconstructed. Intraoperative reconstruction of 11 branches failed, with a success rate of 98.8% (933/944). Within 30 days after surgery, 8 patients died (2.5%), and 6 patients died during follow-up, a total of 14 patients died (4.4%). There were 11 cases (3.5%) of spinal cord ischemia and no patient suffered from permanent paraplegia. There were 19 patients (6.0%) with postoperative renal function injury. Internal leakage was found in 26 patients, and the rate of internal leakage was 8.2%.Conclusion:3D printing technology can accurately locate the location of branch arteries, simplifing the surgical process, shortening the learning curve , and improving clinical efficacy.

Objective:To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair (F/B-TEVAR) in patients with complex aortic arch disease.Methods:The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed .Results:There were 46 cases suffering from postoperative complications (22.8%). The risk factors with statistical significance included aortic atherosclerotic plaque [ OR=2.843; 95% CI (1.4-5.6); P<0.01], aortic intramural thrombosis [ OR=2.358; 95% CI (1.2-4.6), P=0.011], the aortic dilatation [ OR=4.219; 95% CI (1.6-11.3), P<0.01], the history of stroke [ OR=2.088; 95% CI (1.1-4.1), P=0.032], smoking history [ OR=2.680; 95% CI: (1.3-5.5); P<0.01], duration of surgery [ OR=1.9; 95% CI: (1.2-2.9); P=0.042].While the application of 3D printing assistive technology [ OR=0.392; 95% CI: (0.2-0.9); P=0.048] was in a negative correlation with postoperative complication. Conclusions:The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque, aortic intramural thrombosis, the aortic dilatation, the history of stroke, smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

Objective To analyze the correlation between vertebral artery asymmetry and vertebral artery origin stenosis(VAOS)lesions in population without risk factors for cardiovascular and cerebrovascular diseases.Methods A total of 6 423 participants without cardiovascular and cerebrovascular high-risk factors who underwent cervical atherosclerosis ultrasound screening in the"standardized evaluation database for cerebral vascular ultrasound screening in the high-risk population of stroke"from December 2019 to December 2021 were consecutively enrolled.The general information of the participants was collected before the examination,including gender,age,body mass index(BMI),and bilateral vertebral artery ultrasound parameters,i.e.,the internal diameter of the intervertebral segment(V2 segment)and the degree of VAOS(mild,moderate,severe,and occlusion)assessed by hemodynamic parameters(peak systolic flow velocity[PSV],end-diastolic flow velocity[EDV],and PSVinitiation/PSVintervertebral segment).According to the ultrasound results,the participants were divided into VAOS group and no stenosis group(non-VAOS group).Vertebral artery diameter ≤ 2.0 mm was defined as vertebral artery hypoplasia(VAH).According to the difference in the inner diameter of the V2 segment of the bilateral vertebral arteries,the participants were classified as vertebral artery dominance(VAD)group(inner diameter difference ≥1.2 mm)and non-VAD group(inner diameter difference＜1.2 mm).In the final statistical analysis,if there is a side involved,each group will be counted by the number of cases,and if no side differentiation is involved,each group will be counted by the number of cases.Taking the occurrence of VAOS as the dependent variable,the general information and anatomical factors(VAH,VAD)were analyzed by univariate Logistic regression.The item of P＜0.05 was used as the independent variable,and the independent influencing factors of VAOS were further analyzed by multivariate Logistic regression.Results A total of 6 423 participants were included,including 1 985 males and 4 438 females,with an average age of(43±13)years from 19 to 80 years.There were 628 cases in the VAD group and 5 795 cases in the non-VAD group.(1)Compared with the VAD group,the proportion of females in the non-VAD group was higher(69.9％vs.61.3％,P＜0.01),and the age was younger([43±13]vs.[45±14]years,P＜0.01),and the proportion of those aged＜40 years was higher than that in the VAD group(46.3％vs.38.4％,P＜0.01).The proportion of VAH patients and the incidence of VAOS were lower than those in the VAD group(0.6％vs.17.2％and 1.5％vs.4.0％,respectively,both P＜0.01).(2)Univariate Logistic regression analysis of the incidence of VAOS among participants without cardiovascular and cerebrovascular risk factors showed that the proportion of male,age,BMI,VAH and VAD ratios in the VAOS group were higher than those in the non-VAOS group,with statistical significance(all P＜0.05).Multivariate Logistic regression analysis showed that male(OR,1.92,95％CI 1.30-2.85,P=0.001),age(OR,1.12,95％CI1.10-1.14,P＜0.01)and VAD(OR,2.14,95％CI 1.30-3.40,P=0.002)were independent risk factors for VAOS in participants without cardiovascular and cerebrovascular risk factors.Conclusions The occurrence of VAD is affected by gender and age.VAD is an independent risk factor for VAOS in population without cardiovascular and cerebrovascular risk factors.

Objective To investigate the association between vertebral artery origin stenosis(VAOS)and the degree of bilateral vertebral artery diameter asymmetry caused by vertebral artery dominance(VAD)in patients cardiovascular and cerebrovascular disease risk factors and the optimal diameter difference(△D)cutoff value for diagnosing VAD.Methods A total of 6 404 subjects without vertebral artery occlusion and risks factors of cerebrovascular disease including hyperlipidemia,hypertension,diabetes,obesity(body mass index[BMI]≥ 28 kg/m2),smoking history,and drinking history were retrospectively enrolled from the Standardized Evaluation Database for Screening of High-risk Groups for Stroke from December 2019 to December 2021.The age,sex,BMI,bilateral vertebral artery△D,and VAOS evaluated by the systolic peak velocity and end-diastolic velocity of the vertebral artery origin and intervertebral segment were collected.Subjects with stenosis rate≥50％were divided into VAOS group,and the rest were divided into control group.The general data and △D of the two groups were compared.The items with statistically significant differences were enrolled into multivariable Logistic regression analysis in which ≥50％VAOS was used as the dependent variable.The VAOS group and the control group were matched at a ratio of 1∶5 using propensity score matching.The receiver operating characteristic(ROC)curve was drawn based on ≥50％VAOS as the outcome indicator and △D as the independent variable after matching.The area under the curve(AUC)was calculated.The Youden index was used to calculate the optimal cutoff value of △D.Results Among the 6 404 patients included,there were 1 975 males and 4 429 females.Among them,46 patients were in the VAOS group,and the incidence of VAOS was 0.72％.(1)The results of univariate Logistic regression analysis showed that the male proportion,age,BMI and △D in the VAOS group were higher than those in the control group(P＜0.05).The above variables were further included in the multivariate Logistic regression analysis and the results showed that male(OR,2.49,95％CI 1.36-4.67,P=0.003),age(OR,1.14,95％CI 1.11-1.17,P＜0.01)and △ D(OR,1.81,95％CI 1.06-2.97,P=0.024)were risk factors for VAOS.(2)After propensity score matching,46 cases were included in the VAOS group and 230 cases were included in the control group,for a total of 276 cases.The inter-group comparison showed that the △D in the VAOS group was higher than that in the control group(0.65[0.30,1.20]mm vs.0.40[0.20,0.80]mm,P=0.009).There were no significant differences in the other baseline data between the groups(P＞0.05).(3)Based on 276 subjects matched by propensity score,the ROC curve analysis with the occurrence of VAOS as the outcome indicator and △D as the independent variable showed that the AUC of △D for predicting ≥50％VAOS was 0.622,the optimal cutoff value was 0.800 mm,the specificity was 78.3％,and the sensitivity was 41.3％.Conclusions The difference in the diameter of the bilateral vertebral arteries in patients without cardiovascular and cerebrovascular disease risk factors is associated with the occurrence of ≥50％VAOS.The optimal cutoff value of the diameter difference is 0.800 mm,which can be used as a reference standard for defining VAD.The diameter difference 0.800mm indicates a higher risk of VAOS with stenosis rate ≥50％(specificity 78.3％,sensitivity 41.3％).The results of this study need to be further verified.

OBJECTIVE: To investigate the expression and clinical significance of T helper cell 9 (Th9) and its cytokine interleukin 9(IL-9) in peripheral blood of patients with chronic lymphocytic leukemia(CLL). METHODS: A total of 43 newly diagnosed patients with chronic lymphocytic leukemia in the First Affiliated Hospital of Xinjiang Medical University from June 2021 to June 2022 were selected as the case group. The patients were divided into Binet A group (13 cases), Binet B group (20 cases) and Binet C group (10 cases) by Binet staging system, and 20 healthy volunteers who underwent physical examinationin in our hospital in the same period served as control group. The proportion of Th9 cells in peripheral blood was detected by flow cytometry, the expression level of Th9 specific transcription factors PU.1 and IRF4 was detected by Western blot, and the expression level of serum cytokine IL-9 was detected by ELISA. The proportion of Th9, the expression of PU.1, IRF4 and IL-9 in each group were compared, and the correlation between the proportion of Th9, IL-9 and clinicopathological indexes of CLL patients was analyzed. RESULTS: The proportion of Th9, the expression of PU.1, IRF4 and IL-9 in CLL group were significantly higher than those in control group (P<0.05), the proportion of Th9 and the expression of IL-9 in Binet B and C group were higher than those in Binet A group (P<0.05), but there was no significant difference in the proportion of Th9 cells between Binet B group and C group (P>0.05). The expression of IL-9 in Binet C group was significantly higher than that in Binet B group (P<0.05) . The proportion of Th9 cells and IL-9 were highly expression in patients with β2 microglobulin abnormality, IGHV unmutation, P53 abnormality and hepatosplenic lymph node enlargement(P<0.05), but not related to age and sex (P>0.05). The results of Spearman correlation analysis showed that the proportion of Th9 in patients with CLL was negatively correlated with the lymphocytic account and lymphocyte proportion(r_s=-0.32，r_s=-0.34). The proportion of Th9 and IL-9 were positively correlated with Binet stage, Rai stage and CLL-IPI Scoring (r_s=0.79，r_s=0.54，r_s=0.58； r_s=0.72，r_s=0.63，r_s=0.45), but not with WBC, CD4⁺ T cells and CD8⁺T cells (P>0.05). The proportion of Th9 was positively correlated with IL-9 (r_s=0.53). CONCLUSION Th9 cells and IL-9 are abnormally highly expressed in CLL, which is related to the poor prognosis of CLL.
Humans ; Leukemia, Lymphocytic, Chronic, B-Cell/genetics* ; Interleukin-9 ; Clinical Relevance ; T-Lymphocytes, Helper-Inducer/pathology* ; Cytokines