After ischemic stroke,intracranial cells experience stress due to ischemic and hypoxic injury,leading to a series of aseptic immune response processes.The oxidative stress process in microglias triggers the activation of the NLRP3 inflammasome,which promotes the release of inflammatory factors such as IL-1β and IL-18,contributing to the inflammatory reaction caused by isch-emic stroke.In addition,NLRP3 inflammasome is involved in the polarization,pyroptosis and autophagy of microglias,regulating the prognosis of ischemic stroke.This review summarizes the specific mechanisms of NLRP3 inflammasome in regulating microglial status and its involvement in ischemia-reperfusion injury.It also discusses the associated treatment strategies,identifies the current research focus and blanks,and provides some guidance and ideas for future research.

Objective To investigate the early clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) via left intercostal small incision for multivessel coronary artery disease. Methods The patients who received off-pump CABG in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group and a left intercostal small incision group. The clinical data of the two groups were compared. Results A total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left intercostal small incision group. The age of the patients in the left intercostal small incision group and the traditional midline sternotomy group was (63.8±8.0) years and (63.0±7.8) years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left intercostal small incision group were converted to thoracotomy. The patients in the left intercostal small incision group showed less postoperative drainage within postoperative 24 hours [(239.4±177.7) mL vs. (338.0±151.9) mL, P<0.001], lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay [(10.8±4.0) d vs. (13.1±5.3) d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. Conclusion Compared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.

Objective To compare perioperative outcomes of minimally invasive aortic valve surgery by a right anterior minithoracotomy (RAMT) and conventional sternotomy. Methods A retrospective analysis of patients who underwent isolated aortic valve surgeries in Central China Fuwai Hospital of Zhengzhou University between May 2021 and August 2023 with a minimal incision via the RAMT approach (a RAMT group) or conventional incision via the full sternotomy approach (a conventional group). A propensity score matching analysis was performed to balance preoperative data and compare perioperative data of the two groups. Results There were 58 patients in the RAMT group, including 46 males and 12 females with an average age of (52.0±14.1) years; 128 patients were enrolled in the conventional group, including 87 males and 41 females with an average age of (60.0±12.4) years. After propensity-score matching, there were 51 patients in each group. The RAMT group had a longer average operation time, cross-clamping time and cardiopulmonary bypass time compared to the conventional group (all P<0.05). However, ICU length of stay, ventilator-assisted time and postoperative hospital stay were significantly shorter in the RAMT group (all P<0.05). Patients in the RAMT group had lower 24 hour chest drain output (P<0.05). RAMT was associated with a trend towards a lower blood transfusion rate in comparison to the sternotomy group, although this was not statistically significant (P>0.05). The occurrence of all-cause death, and perioperative complications was also similar in both groups (P>0.05). Conclusion RAMT has less trauma, faster recovery, less postoperative drainage, and shorter hospital stay than conventional approach. RAMT in patients undergoing isolated aortic valve surgery is a safe approach.

After ischemic stroke,intracranial cells experience stress due to ischemic and hypoxic injury,leading to a series of aseptic immune response processes.The oxidative stress process in microglias triggers the activation of the NLRP3 inflammasome,which promotes the release of inflammatory factors such as IL-1β and IL-18,contributing to the inflammatory reaction caused by isch-emic stroke.In addition,NLRP3 inflammasome is involved in the polarization,pyroptosis and autophagy of microglias,regulating the prognosis of ischemic stroke.This review summarizes the specific mechanisms of NLRP3 inflammasome in regulating microglial status and its involvement in ischemia-reperfusion injury.It also discusses the associated treatment strategies,identifies the current research focus and blanks,and provides some guidance and ideas for future research.

As resident immune cells of central nervous system(CNS),microglia play a key role in immune surveillance and tissue repair.They can be activated by various types of pathological factors to form M1 or M2 phenotype,which mediates neuroinflam-mation or neuroprotective effects.At the same time,when the homeostasis of the microenvironment in which the neuron is located is broken,"signal"molecules are also released to induce microglial activation through ligand-receptor binding.Therefore,the regulation of microglia-neuron connection is of great significance for treatment of nervous system diseases.This article reviews the signaling mole-cules involved in the two-way interaction between microglial cells and neurons,and elucidates the immune mechanisms of microglia-neuron,thus providing a basis for targeted treatment of CNS diseases related to microglia activation.

Objective:To evaluate the scientificity, transparency and applicability of the Chinese guidelines and consensuses in medical imaging published in 2022 by the STAR scale.Methods:Medical imaging guidelines and consensuses were searched in CNKI, Wanfang data, CMB, Chinese Medical Journal Network, and Medline (PubMed). The publication date was selected from January 1 to December 31, 2022. Each guideline or consensus was independently evaluated and cross-checked by two evaluators using STAR scale.Results:A total of 65 guidelines and consensus that were published as Chinese or English were included, including 15 guidelines and 50 consensuses. Some guidelines and consensus have distinct disciplinary characteristics with topics such as artificial intelligence (4 articles) and Evidence-Based Medical Imaging-Medical Imaging Clinical Appropriateness (EB-MICA, 4 articles). In all guidelines and consensuses, the highest score was 89.9, the lowest was 3.6, and the M( Q1, Q3) was 25.0 (20.8, 35.4). There was no statistical difference in the scores of guidelines and consensuses ( P=0.383). The highest scoring areas were recommendation opinions (reporting rate of 56.0%), working groups (reporting rate of 38.2%), and clinical issues (reporting rate of 36.7%), while the lowest scoring areas were proposal (reporting rate of 9.6%), registration (reporting rate of 10.8%), and consensus methods (reporting rate of 21.8%). Conclusion:It is recommended that guidelines and consensuses initiators of medical imaging strengthen the learning of evidence-based medicine methods, such as STAR tools, in order to further improve the quality of guidelines and consensuses of medical imaging.

Humans ; Computed Tomography Angiography ; Deep Learning ; Coronary Angiography ; Coronary Artery Disease ; Tomography, X-Ray Computed ; Coronary Stenosis/diagnosis* ; Retrospective Studies ; Fractional Flow Reserve, Myocardial ; Predictive Value of Tests

Objective: To evaluate microstructural damage in high myopia (HM) patients using 3T diffusion kurtosis imaging (DKI). Materials and Methods: This prospective study included 30 HM patients and 33 age- and sex-matched healthy controls (HCs) with DKI. Kurtosis parameters including kurtosis fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), and radial kurtosis (RK) as well as diffusion metrics including FA, mean diffusivity, axial diffusivity (AD), and radial diffusivity derived from DKI were obtained. Group differences in these metrics were compared using tract-based spatial statistics. Partial correlation analysis was used to evaluate correlations between microstructural changes and disease duration. Results: Compared to HCs, HM patients showed significantly reduced AK, RK, MK, and FA and significantly increased AD, predominately in the bilateral corticospinal tract, right inferior longitudinal fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and left thalamus (all p < 0.05, threshold-free cluster enhancement corrected). In addition, DKI-derived kurtosis parameters (AK, RK, and MK) had negative correlations (r = -0.448 to -0.376, all p < 0.05) and diffusion parameter (AD) had positive correlations (r = 0.372 to 0.409, all p < 0.05) with disease duration. Conclusion HM patients showed microstructural alterations in the brain regions responsible for motor conduction and visionrelated functions. DKI is useful for detecting white matter abnormalities in HM patients, which might be helpful for exploring and monitoring the pathogenesis of the disease.

Objective: To evaluate microstructural damage in high myopia (HM) patients using 3T diffusion kurtosis imaging (DKI). Materials and Methods: This prospective study included 30 HM patients and 33 age- and sex-matched healthy controls (HCs) with DKI. Kurtosis parameters including kurtosis fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), and radial kurtosis (RK) as well as diffusion metrics including FA, mean diffusivity, axial diffusivity (AD), and radial diffusivity derived from DKI were obtained. Group differences in these metrics were compared using tract-based spatial statistics. Partial correlation analysis was used to evaluate correlations between microstructural changes and disease duration. Results: Compared to HCs, HM patients showed significantly reduced AK, RK, MK, and FA and significantly increased AD, predominately in the bilateral corticospinal tract, right inferior longitudinal fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and left thalamus (all p < 0.05, threshold-free cluster enhancement corrected). In addition, DKI-derived kurtosis parameters (AK, RK, and MK) had negative correlations (r = -0.448 to -0.376, all p < 0.05) and diffusion parameter (AD) had positive correlations (r = 0.372 to 0.409, all p < 0.05) with disease duration. Conclusion HM patients showed microstructural alterations in the brain regions responsible for motor conduction and visionrelated functions. DKI is useful for detecting white matter abnormalities in HM patients, which might be helpful for exploring and monitoring the pathogenesis of the disease.

Objective To assess the clinical diagnosis and treatment of 21-hydroxylase deficiency nonclassic congenital adrenal hyperplasia (NCCAH) complicated by testicular adrenal rest tumors (TART),thus to improve the recognition of the disease.Methods The clinical data of one patient of NCCAH with TART from our department in 2016 were retrospectively studied,and were analyzed combined with related literature,and the diagnosis was established for treatment.Results The patient was a 17 years old boy.At the age of seven began to appear the pubic hair,voice and other secondary sexual performance.More than their big penis development was significantly higher than their peers.At the age of 12 found bilateral testicular gradually enlarged and attendance.Physical examination:bilateral testicular swelling and a sense of nodules,hard texture,epididymis,normal bilateral varicocele.Laboratory exam indications showed increased levels of progesterone(P),adrenocorticotropic hormone(ACTH),17 hydroxyprogesterone(17α-OHP),aaldosterone(ALD),17-hydroxyl corticosteroids(17-OHCS),17-ketone corticosteroids(17-KS).By the ACTH stimulating test,17α-OHP was increased.Bilateral testes MRI:irregular bilateral testes,signal,see in space.Enhanced scan lesions uniform reinforcement,germ cell tumors to row.Adrenal CT:bilateral adrenal hyperplasia.Testicular biopsy:testicular adrenal genital syndrome tumor.Genetic testing:CYP21A2 heterozygous mutations.The above test results were diagnosed of NCCAH 21-OHD with TART.The patient was orally given 10mg/d prednisone 2 time.3 months after treatment,the 17α-OHP,CO and sex hormones returned to normal.Review the adrenal CT showed significant bilateral adrenal shrink,Pa/testis tubercle was narrow,but not obvious.Semen routine still suggested no sperm,considering the TART medical treatment effect was poor.Hence,further line tumor removed,followed up for 3 months without tumor recurrence at present.Conclusion NCCAH complex and varied clinical manifestations and hidden.Not easy to be noticed by patients and clinicians.For the early childhood in pubic hair growth accelerated leading to premature epiphyseal fusion and make the adult height is short stature consideration should be given to the disease.Further lines of sex hormones,adrenal related endocrine examination,genetic testing and ACTH stimulating test,etc.If concurrent bilateral testicular nodules,should consider to merge TART may.Testicular biopsy can be clear.Treatment can choose according to TART classification of glucocorticoid (a hormone steroid) or surgical treatment,concrete scheme should be individualized.