[Objective] To evaluate the efficacy and practicality of autologous platelet-rich plasma (aPRP) in patients undergoing total aortic arch replacement for aortic dissection. [Methods] A retrospective analysis was performed on 483 patients diagnosed with type A aortic dissection who underwent total aortic arch replacement between January 2016 and November 2023. Patients were categorized into two groups based on whether they received aPRP. Baseline characteristics, intraoperative blood product usage and postoperative outcomes were compared between the two groups. [Results] The aPRP group exhibited reduced usage of allogeneic platelets (1.55±1.04 vs 1.60±1.27)U, allogeneic plasma (480.89±432.49 vs 746.50±508.81)mL, allogeneic RBC (red blood cell)(5.95±1.91 vs 6.17±3.52)U, bivalirudin (2.66±1.51 vs 3.31±1.59)U and coagulation factor Ⅶ (0.67±1.03 vs 1.22±1.43)mg compared to the non-aPRP group (P<0.05). The incidence of postoperative hypoxemia was lower in the aPRP group (43.98% vs 48.41%), and the duration of mechanical ventilation was significantly shorter[median 50.91 (interquartile range 18.71, 113.71) vs 83.40 (37.73, 151.98) hours]. There were no significant differences between the two groups in terms of postoperative mortality, continuous bedside hemofiltration, cerebral infarction, cerebral hemorrhage, paraplegia or re-exploration for hemostasis(P>0.05). [Conclusion] The application of aPRP in total aortic arch replacement effectively diminishes intraoperative blood product usage and the incidence of lung injury-related complications. However, it does not demonstrate significant benefits in terms of mortality, cerebral infarction and other complications.

Objective: To investigate an outbreak of acute gastroenteritis at a vocational and technical school in Shaanxi Province in 2024, ao as to provide the reference for the handling of school outbreaks. Methods: The conducted case searches, individual case investigations, and on-site hygienic investigations were established in accordance with the Guidelines on outbreak investigation, prevention and control of Norovirus infection (2015). The potential risk factors were analyzed by case-control study. Anal swab samples from cases and all canteen staff, as well as environmental swab samples were collected to detect common intestinal pathogens. All reserved food samples in canteen were collected to test for common pathogenic bacteria. Results: From October 26 to November 5, 2024, a cumulative total of 53 cases were reported, with an attack rate of 1.47%. The main clinical symptoms included vomiting (83.02%), abdominal pain (56.60%), diarrhea (30.19%), and fever (26.42%). The epidemic curve suggested an intermittent common-source outbreak, with no obvious clustering characteristics in terms of the population and spatial distribution of cases. The case-control analysis revealed that having dinner at the rice-with-dishes-on-top stall on the first floor of the canteen on October 28 was a risk factor for illness (OR=11.025, 95%CI: 2.186-55.601). GⅡ norovirus was detected as positive in anal swab samples from 6 cases and 2 asymptomatic infected canteen staff, as well as in 3 environmental swab samples from the rice-with-dishes-on-top stall. The test results for common pathogenic bacteria in the reserved food samples were all negative. Conclusions This outbreak was caused by an acute gastroenteritis epidemic induced by GⅡ norovirus infection, with a transmission pattern consistent with an intermittent homologous outbreak. The possible source of infection was asymptomatic infected canteen staff mainly through foodborne trasmission, and having meals at the rice-with-dishes-on-top stall was the primary risk factor for this outbreak.

The European Association for Cardio-Thoracic Surgery (EACTS) has recently updated and published the "2024 EACTS guidelines on perioperative medication in adult cardiac surgery". Based on the latest evidence, the guidelines have been updated in multiple aspects including underlying disease management, antithrombotic medication, arrhythmia treatment and other supportive care, etc. This paper aims to summarize and interpret the guidelines, in order to promote clinicians’ understanding and optimize perioperative medical treatment in adult cardiac surgery.

Recent advances in large models demonstrate significant prospects for transforming the field of medical imaging. These models, including large language models, large visual models, and multimodal large models, offer unprecedented capabilities in processing and interpreting complex medical data across various imaging modalities. By leveraging self-supervised pretraining on vast unlabeled datasets, cross-modal representation learning, and domain-specific medical knowledge adaptation through fine-tuning, large models can achieve higher diagnostic accuracy and more efficient workflows for key clinical tasks. This review summarizes the concepts, methods, and progress of large models in medical imaging, highlighting their potential in precision medicine. The article first outlines the integration of multimodal data under large model technologies, approaches for training large models with medical datasets, and the need for robust evaluation metrics. It then explores how large models can revolutionize applications in critical tasks such as image segmentation, disease diagnosis, personalized treatment strategies, and real-time interactive systems, thus pushing the boundaries of traditional imaging analysis. Despite their potential, the practical implementation of large models in medical imaging faces notable challenges, including the scarcity of high-quality medical data, the need for optimized perception of imaging phenotypes, safety considerations, and seamless integration with existing clinical workflows and equipment. As research progresses, the development of more efficient, interpretable, and generalizable models will be critical to ensuring their reliable deployment across diverse clinical environments. This review aims to provide insights into the current state of the field and provide directions for future research to facilitate the broader adoption of large models in clinical practice.
Humans ; Diagnostic Imaging/methods* ; Precision Medicine/methods* ; Image Processing, Computer-Assisted/methods*

Objective:To summarized the clinical characteristics and surgical management of anterior cervical enterogenic in pediatric patients. Methods:Clinical data were retrospectively analyzed for 9 children with pathologically confirmed anterior cervical enterogenic cysts（including bronchogenic and esophagogenic subtypes） treated at the Children's Hospital of Shandong University（Jinan Children's Hospital） between January 1, 2020, and November 30, 2023. Results:Nine patients（6 males and 3 females） were involved in this study, aged 14 days to 10 years old. There were 4 cases on the left side, 4 on the right side, and 1 in the middle of the neck. All patients presented with neck masses. The patients were followed up from 3 months to 35 months after surgery and recovered well, with no recurrence or complications observed. Conclusion:①Anterior intestinal cysts in children are rare and easy to be misdiagnosed. ②Concurrent branchial cleft fistulas or associated anomalies may coexist, necessitating comprehensive evaluation. ③Preoperative diagnosis is not easy and mainly depends on pathological diagnosis. ④The treatment of anterior cervical enterogenic cysts in children is surgical resection of the lesion.
Humans ; Male ; Female ; Child ; Retrospective Studies ; Child, Preschool ; Infant ; Neck ; Cysts/surgery*

Objective: To establish a progressive research strategy for “colonic components analysis - efficacy verification and mechanism exploration - gut microbiota”, screen pharmacodynamic substances, and investigate their mechanism via gut microbiota. Methods: The pharmacodynamics of Gegen Qinlian decoction (GQD) were assessed using a mouse model of dextran sulfate sodium-induced ulcerative colitis (UC). Ultra-performance liquid chromatography-quadrupole-orbitrap mass spectrometer was used to identify the prototype and metabolic components of GQD in the colon during UC. To analyze the structure and function of characteristic genera of GQD and its active components, 16S rRNA sequencing was performed. Results: We identified 67 prototypic and 14 metabolic components of GQD in the UC colon. The primary prototype components are flavonoids and alkaloids, including puerarin (PUE), baicalin (BAI), and berberine (BER). The metabolism was predominantly sulfonation. Efficacy verification showed that the main active components, puerarin, baicalin, and berberine, had good therapeutic effects on UC. The results of 16S rRNA gene sequencing showed that GQD improved UC by regulating the structure and function of the gut microbiota. The abundance of gut microbiota involved in the metabolism of the prototype components was influenced by the corresponding components. The function prediction results showed that PUE was the most comparable to GQD, with 24 consistent pathways. BAI and BER showed comparable gut microbiota regulation pathways. Characteristic pathways of BER include glucometabolic processes. Conclusion This study focused on the key issues in the gut microbiota pathway and developed a progressive research strategy to understand the transformation mechanisms of colonic components. This research systematically analyzed the active components and metabolic transformation of GQD in the colon during the pathological state of UC, as well as changes in the structure and function of the gut microbiota, clarified the mechanism of GQD and its active components in improving UC via the gut microbiota pathway.

Objective The amplitude of low-frequency fluctuation(ALFF)resting state functional magnetic resonance imaging(rs-fMRI)was used to investigate the signals image in the brain functional areas of overactive bladder(OAB)patients.Methods OAB patients treated in 3 participating hospitals during Mar.2021 and Mar.2023 were selected as the OAB group(n=14).Healthy subjects matching the gender,age and years of education of the patients in the OAB group were collected as the control group(NC group,n=14).Changes in the over active bladder symptom score(OABSS),quality of life scale(QoL),self-rating depression scale(SDS),self-rating anxiety scale(SAS)were analyzed.All subjects underwent rs-fMRI to collect blood oxygen level dependent magnetic resonance signals,which were then processed with ALFF.Two-sample t-test was conducted on the results to obtain the different brain regions.Results The OABSS[(8.07±0.37)vs.(1.21±0.18)],QoL[(4.85±0.21)vs.(0.64±0.13)],SAS[(60.14±1.40)vs.(37.64±1.57)]and SDS[(52.50±1.29)vs.(36.14±0.34)]scores of the OAB group were higher than those of the NC group,with significant differences(P＜0.05).The brain regions with significant differences in ALFF were located in the left supplementary motor area,left medial superior frontal gyrus and right anterior central gyrus(P＜0.000 1).Conclusion The abnormal spontaneous activity and coordination ability of the brain in resting state may lead to OAB symptoms,which are displayed in the abnormal functions of the left supplementary motor area,left medial superior frontal gyrus and right anterior central gyrus.

The research focus of diabetes, a common chronic metabolic disease, has shifted from individual factors to environmental factors at the population level. Epidemiological studies suggest an association between exposure to environmental pollutants and the risk of diabetes. Major environmental pollutants include organochlorine pesticides, polychlorinated biphenyls, phthalates and their metabolites, and arsenics, which primarily enter the human body through the skin, respiratory tract, and digestive system. Long-term exposure to these pollutants can affect the pathology of diabetes through various mechanisms, such as promoting insulin resistance, causing insulin secretion deficiencies, inducing oxidative stress-induced glucose metabolism disorders, and affecting DNA methylation. However, the potential damaging mechanism of the impact of environmental pollutants on diabetes remain unclear. Limitations such as insufficient sample sizes, uncertainties regarding exposure time and dosage, and differences between single and co-exposures. In the future, it is necessary to focus on exploring and analyzing the mechanisms of environmental pollutant exposure on diabetes to develop effective prevention strategies, control and reduce the incidence and development of diabetes, and provide new insights into its diagnosis and treatment.

Objective:To explore the prognosis efficacy of psycho-cardiological therapy and management on patients with coronary atherosclerosis disease (CAD).Methods:This was a clinical randomized controlled study. This study included inpatients with CAD at the cardiology department in Beijing Anzhen Hospital, Capital Medical University from August 2021 to January 2024. The patients enrolled in this study were asked for basic information, and received measurements for depression, anxiety, sleep quality and living quality by the scales of Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder scale-7 (GAD-7), Athens Insomnia Scale (AIS), EuroQol 5-dimension 5-level (EQ-5D-5L) respectively. The patients were randomly grouped into a regular treatment group and a psycho-cardiological treatment group which included WeChat management or antidepressant/antianxiety medical therapy according to the situation. After the patients discharging from hospital for 2, 4, 12, 24, 48, 72, and 96 weeks, professional cardiovascular doctors would follow up by telephone, WeChat, and outpatient department, including scales (2-48 weeks), and cardiac events (2-96 weeks). Kaplan-Meier survival curve and multivariate Cox proportional hazards model were used for analyzing the association between psycho-cardiological treatment and cardiac events.Results:This study recruited a total of 552 patients with CAD, aged 61.0(54.0, 67.0) years, and 379 (68.7%) were male. There were 279(50.5%) in the regular treatment group and 273(49.5%) in the psycho-cardiological treatment group. After treatment for 4, 12 and 48 weeks, the PHQ-9 score in psycho-cardiological was significantly lower than the regular treatment group; After treatment for 12 weeks, the EQ-5D-5L effective value in psycho-cardiological group was higher than the regular treatment group; After treatment for 2, 4, 12, 24 and 48 weeks, the EQ-5D-5L VAS score in psycho-cardiological group was higher than the regular therapy group (all P<0.05). The Kaplan-Meier survival curve showed that, during the different follow-up periods, the rate of cardiac events in psycho-cardiological treatment group was lower than regular treatment group (log-rank P<0.001). The multivariate Cox proportional hazards model adjusted the factor of age, the psycho-cardiological treatment contributed to reducing the cardiac events rate by 80.3% ( HR=0.197, 95% CI: 0.067-0.582, P=0.003). Conclusion:Psycho-cardiological treatment is beneficial for improving psychological stress, living quality, and reducing cardiac events, and helps to improve prognosis and psycho-cardiological rehabilitation in CAD patients.

Objective:To establish an animal model of trans-sutural distraction osteogenesis in SD rats.Methods:A self-designed V-shaped distraction device(distractor)was fabricated with the traction force(N)of 0,1.3,2.2,3.0,4.3 and 5.0 corresponding to the distraction length(mm)of 5,4,3,2,1 and 0 respectively,meeting the trans-sutural distraction osteogenesis requirements in skull of 5-week-old SD rats.The distractor was plased into the sagittal suture of 12 SD rats.Continuous sampling was conducted 1,3,5 and 7 days respectively(n=3)after operation.The tissue changes in the trans-sutural distraction area were observed by HE and Masson's trichrome staining.Inflammation levels were determined using Arg-1 immunofluorescence staining.The early angiogenesis was clarified through co-staining with CD31 and EMCN.Results:A stable trans-sutural distraction osteogenesis model was estab-lished,5 mm distraction osteogenesis width was observed completely within 7 days of distraction.Significant new bone formation was observed at 7 days after operation.Arg-1 expression increased and was concentrated at the bone margins,overlapping with the areas of new bone formation.EMCN expression gradually decreased,and by day 7 CD31 was predominant,indicating the basic maturation of blood vessels.Conclusion:This study successfully constructed a stable and effective trans-sutural distraction osteogenesis animal model,and provides an experimental basis for the investigation of its early continuous histological changes.