Objective To explore the value of pelvic CT angiography(CTA)digital three-dimensional reconstruction model(abbreviated as"three-dimensional model")in the diagnosis of female pelvic mass.Methods A total of 98 patients with pelvic mass who were hospitalized and operated in Xi'an People's Hos-pital(Xi'an Fourth Hospital)from January 2021 to April 2023 were selected.All patients underwent B-ultra-sound and CTA examination before operation,and the original data of CTA were collected.The digital three-dimensional model of pelvic mass was established by three-dimensional reconstruction software,and the source of pelvic mass was judged according to the blood supply of pelvic mass.Taking postoperative pathological di-agnosis as the gold standard,the coincidence rate between different preoperative diagnosis methods(B-ultra-sound,CTA examination and three-dimensional model)was compared.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of different preoperative diagnostic methods in judging the ovarian origin of pelvic tumors.Results A total of 130 pelvic masses were included in 98 patients,and the average maximum diameter of the mass was(71.61±3.03)mm,including 83 ovarian masses and 47 non-ovarian masses.Taking postoperative pathological diagnosis as the gold standard,the diagnostic coincidence rate of the preoperative three-dimensional model was 72.31％,which was higher than that of B-ultrasound(58.46％)and CTA(52.31％),and the differences were statistically significant(P＜0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Kappa value,and area under the ROC curve were 79.51％,91.49％,94.29％,71.67％,83.85％,0.67 and 0.855,respectively,when the three-dimensional model showed that the blood supply of the mass originated from ovarian artery or uterine artery-ovarian branch.Conclusion The three-dimensional model of pelvic CTA can directly display the blood supply source,characteristics of mass,and the relationship between mass and adjacent organs,which can guide the clinical treatment.It has certain clinical value to judge the ovarian origin of pelvic mass by using ovarian artery and uterine artery-ovarian branch.

Objective:To analyze the risk factors for postoperative cardiovascular events (PCE) after renal transplantation and their impact on transplant kidney function.Methods:The clinical data of 120 patients who underwent kidney transplant at Xuanwu Hospital, Capital Medical University from March 2020 to March 2022 were retrospectively analyzed. Among them, 23 cases occurred PCE (PCE group), and 97 cases did not occur PCE (non-PCE group). The relevant preoperative and postoperative data were recorded. Multivariate Logistic regression was used to analyze the independent risk factors of PCE in kidney transplant patients.Results:The incidence rate of PCE in kidney transplant patients was 19.17% (23/120). There were no statistical differences in the gender composition, preoperative dyslipidemia rate, preoperative hypertension rate and immunosuppressant use between two groups ( P>0.05); the age, preoperative body mass index>30 kg/m 2 rate, preoperative dialysis time>12 months rate, preoperative diabetes rate, preoperative cardiovascular disease rate, preoperative diabetic nephropathy rate, cadaver kidney transplant rate, postoperative dyslipidemia rate, postoperative serum creatinine >200 μmol/L rate, postoperative new-onset diabetes rate, postoperative delayed failure rate and postoperative acute reaction rate in PCE group were significantly higher than those in non-PCE group, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis showed that age, preoperative diabetes, preoperative cardiovascular disease, preoperative diabetic nephropathy, postoperative serum creatinine >200 μmol/L and postoperative acute reaction were independent risk factors of PCE in kidney transplant patients ( OR = 2.40, 3.42, 3.85, 1.98, 2.62 and 2.11; 95% CI 1.67 to 3.58, 1.61 to 7.05, 2.61 to 5.55, 1.05 to 3.85, 1.25 to 4.52 and 1.20 to 4.78; P<0.01 or <0.05). There was no statistically significant difference in serum creatinine 3 months after surgery between two groups ( P>0.05); the serum creatinine 6 and 12 months after surgery in PCE group was significantly higher than that in non-PCE group: (139.58 ± 31.54) μmol/L vs. (105.36 ± 21.05) μmol/L and (198.32 ± 40.12) μmol/L vs. (107.63 ± 24.64) μmol/L, and there were statistical differences ( P<0.01). Conclusions:The incidence of PCE in kidney transplant patients is higher, and there are many risk factors for PCE. If relevant measures are taken to correct or remove risk factors, it may reduce the incidence of PCE and prolong survival time in kidney transplant patients.

Objective:To investigate the relationship between body mass index (BMI) and gestational hypertension using two-sample Mendelian randomization analysis.Methods:The summary level data for BMI and gestational hypertension were obtained from the genome-wide association study (the deadline for data inclusion was October 31, 2023). All data were analyzed by inverse variance weighting, MR-Egger regression, weighted median, simple model and weighted model methods. Cochrane Q test was used to evaluate heterogeneity, MR-Egger regression intercept test and funnel plot were used to assess horizontal pleiotropy. Results:Inverse variance weighting result under fixed effects and random effects models showed that the risk of gestational hypertension increased with the increase of BMI ( OR = 1.62 and 1.62, 95% CI 1.39 to 1.88 and 1.39 to 1.88, P<0.01). Sensitivity analysis results including MR-Egger regression, weighted median and weighted model methods showed that BMI increased the risk of gestational hypertension ( OR = 1.51, 1.56 and 1.71; 95% CI 1.01 to 2.26, 1.23 to 1.99 and 1.09 to 2.69; P<0.05 or <0.01). Although Cochrane Q test result showed evidence of heterogeneity ( P = 0.04), inverse variance weighting under a random model suggested that BMI increased the risk of gestational hypertension. Horizontal pleiotropy was not observed in the above analysis ( P = 0.73). Conclusions:Obesity may increase the risk of gestational hypertension. Pregnant women should pay attention to weight control to decrease the risk of gestational hypertension.

Objective:To observe the occurrence of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis, and analyze the influencing factors of perioperative adverse events.Methods:The clinical data of 120 carotid artery stenosis patients underwent carotid endarterectomy from October 2021 to October 2022 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Among them, 42 patients experienced perioperative adverse events (adverse events group), and 78 patients did not experience perioperative adverse events (non-adverse events group). The baseline data, imaging findings, laboratory indexes, surgical indexes and postoperative complications were recorded. Multivariate Logistic regression was used to analyze the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis.Results:The rates of history of cerebrovascular disease, severe stenosis or occlusion of anterior cerebral artery, patch repair and plaque ulceration in adverse events group were significantly higher than those in non-adverse events group: 35.71% (15/42) vs. 15.38% (12/78), 52.38% (22/42) vs. 26.92% (21/78), 50.00% (21/42) vs. 20.51% (16/78) and 61.90% (26/42) vs. 24.36% (19/78), and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that the severe stenosis or occlusion of anterior cerebral artery, patch repair and plaque ulceration were the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis ( OR = 2.874, 2.632 and 3.214; 95% CI 1.421 to 3.654, 1.748 to 3.287 and 2.101 to 4.697; P<0.05 or <0.01). Conclusions:The severe stenosis or occlusion of anterior cerebral artery, patch repair and plaque ulceration are the independent risk factors of perioperative adverse events of carotid endarterectomy in patients with carotid artery stenosis. Identifying and taking effective measures to prevent the perioperative adverse events can effectively reduce disability and mortality rates.

In November 2023, the seventh National Nucleic Acid Vaccine Conference was held to deeply discuss the immune mechanism, safety risks, advantages, and disadvantages of nucleic acid vaccines, and review the safety and effectiveness of COVID-19 vaccines developed by nucleic acid vaccine technology. Some prospectives were formed in the meeting that in the post-pandemic era, nucleic acid vaccine technology will play a role in the following areas: dealing with pathogens that are difficult to be prevented by traditional vaccines, promoting the upgrading of traditional live attenuated vaccines, contributing to the development of multivalent and combined vaccines, and rapid response to emerging and re-emerging infectious diseases. These views point out the direction for the future development of nucleic acid vaccine technology.

Objective:To investigate the potential of the antineutrophil cytoplasmic antibody (ANCA) renal risk score (ARRS) in predicting the prognosis of children with ANCA-associated glomerulonephritis (AAGN).Methods:Laboratory testing, renal pathology results, treatment and prognosis of 61 children with AAGN diagnosed by renal biopsy from June 2007 to May 2022 in General Hospital of Eastern Theater Command were retrospectively analyzed.The Kaplan-Meier method was used to evaluate the overall and renal survival of children with AAGN, and risk factors of progression to end stage renal disease (ESRD) were analyzed by Cox regression analysis. Results:Among the 61 children with AAGN, there were 14 males and 47 females with the age of (15.65±3.74) years.According to ARRS, AAGN children were assigned into low-risk group (27 cases), medium-risk group (21 cases) and high-risk group (13 cases). During a median follow-up duration of 46.36 (14.58, 95.62) months, the number of ESRD cases in the high-risk group (9 cases) was significantly higher than that of low-risk group (2 cases) and medium-risk group (3 cases) ( χ2=13.079, P<0.001). Kaplan-Meier survival analysis showed that AAGN children in the high-risk group had the worst renal prognosis ( χ2=5.796, P=0.016), while no significant difference was detected in the overall survival among the 3 groups ( χ2=2.883, P=0.237). Multivariate Cox regression showed that estimate glomerular filtration rate(eGFR)≤15 mL/(min·1.73 m 2) ( HR=9.574, 95% CI: 4.205-25.187, P=0.015) and ARRS ( HR=2.115, 95% CI: 1.206-4.174, P=0.012) were independent risk factors for children with AAGN progress to ESRD.Receiver operating characteristic (ROC) curve analysis results showed that the area under the curve of ARRS for predicting the risk of progressing to ESRD in AAGN children was 0.880 (95% CI: 0.759-1.000), and the optimal cutoff value of ARRS was 5.50, with the sensitivity and specificity of 85.71% and 82.98%, respectively. Conclusions:ARRS was an independent risk factor for children with AAGN progress to ESRD, which had a predictive value for the progression of AAGN to ESRD.

Objective:To explore the diagnostic potential of magnetic resonance imaging (MRI) in children with nutcracker syndrome (NCS).Methods:A retrospective analysis was performed in patients with suspected NCS(155 cases) diagnosed in the Department of Pediatrics, General Hospital of Eastern Theater Command from January 2017 to July 2020.Suspected NCS was diagnosed primarily based on clinical signs or symptoms, laboratory testing, and imaging reports, and other conditions that may cause hematuria and/or proteinuria were excluded.MRI examination was performed in all patients.According to the diagnostic criteria of NCS, patients diagnosed as NCS with the compression of the left renal vein (LRV) were included in the NCS group(58 cases), and those without the compression of the LRV or with the compression of the LRV but was not consistent with the diagnosis of NCS were included in the control group(97 cases). t test, Mann- Whitney U test and χ2 test were used to compare the baseline characteristics, clinical characteristics and imaging characteristics of the children in the nutcracker group and the control group.Receiver operating characteristic curves were plotted to explore the diagnostic potential of MRI in children with NCS. Results:(1)The area under curve of the angle between the superior mesenteric artery (SMA) and the aorta, compression ratio (CR) and beak sign in diagnosing NCS in children were 0.870, 0.895 and 0.878, respectively.(2)The optimal cut-off values of the angle between the SMA and the aorta and CR were 36.8° and 3.99, respectively.(3)The specificity of the angle between the SMA and the aorta<36.8°, beak sign, CR>3.99, the angle between the SMA and the aorta combined with beak sign, the angle between the SMA and the aorta<36.8° combined with CR>3.99, and beak sign combined with CR>3.99 in diagnosing NCS in children were 82.5%, 93.8%, 93.5%, 97.9%, 95.9% and 97.9%, respectively.Conclusions:Children with the angle between the SMA and the aorta<36.8°, beak sign and CR>3.99 suggested on MRI scans should be highly suspected of NCS.The beak sign has the highest specificity in the diagnosis of NCS in children, and the combination of any two parameters has a higher specificity than a single parameter.

Relapsing is the clinical characteristic of nephrotic syndrome (NS) in children, and some steroid-sensitive NS (SSNS) children have frequently relapsing NS and steroid-dependent NS. The long-term and frequent uses of glucocorticoids, as well as the adverse effects of immunosuppressants, seriously affect the quality of life in children with NS. The International Pediatric Nephrology Association released the clinical practice recommendation for SSNS in children in 2022. Based on the guideline for the diagnosis and treatment of steroid-sensitive, frequently- relapsing/dependent NS in children (2016) formulated by the Nephrology Group of Pediatrics Society of Chinese Medical Association, we interpreted the guideline on clinical treatment and management suggestions of SSNS, to provide references for the diagnosis and treatment of SSNS in children.

The cleft lip and palate (CLP) is one of the most common craniofacial malformations in humans. We collected functional magnetic resonance data of 23 CLP patients before rehabilitation training (Bclp) and 23 CLP patients after rehabilitation training (Aclp), who were performing Chinese character pronunciation tasks, and performed brain activation analysis to explore the changes of brain mechanism in CLP patients after articulation disorder rehabilitation training. The study found that Aclp group had significant activation in the motor cortex, Broca area, Wernicke area and cerebellum. While the Bclp group had weak activation in the motor cortex with a small activation range. By comparing the differences and co-activated brain regions between the two groups, we found that rehabilitation training increased the activity level of negatively activated brain areas (cerebellum, left motor area, Wernicke area, etc.) to a positive level. At the same time, the activity level of weakly activated brain areas (right motor area, Broca area, etc.) was also increased. Rehabilitation training promoted the activity level of articulation-related brain regions. So that the activation intensity of articulation-related brain regions can be used as a quantifiable objective evaluation index to evaluate the effect of rehabilitation training, which is of great significance for the formulation of rehabilitation training programs.
Humans ; Articulation Disorders/therapy* ; Brain/diagnostic imaging* ; Cleft Lip/diagnostic imaging* ; Cleft Palate/diagnostic imaging* ; Magnetic Resonance Imaging ; Speech Therapy/psychology*

Objective:To assess the safety and efficiency of left atrial appendage closure (LAAC) combined delayed anticoagulant therapy in atrial fibrillation (AF) patients combined with cardiogenic stroke during anticoagulant therapy.Methods:Using prospective research methods, 35 AF patients combined with cardiogenic stroke during anticoagulant therapy from September 2020 to June 2022 in Xuanwu Hospital, Capital Medical University were selected. All patients were treated with LAAC and delayed anticoagulant therapy. The endpoints were the safety and efficacy of LAAC combined with delayed anticoagulant therapy. The primary endpoint of efficacy was the composite endpoint of postoperative death, myocardial infarction, hemorrhagic stroke and systemic embolism. The safety endpoint was major bleeding as defined by the International Society for Thrombosis and Hemostasis and clinically relevant non-major bleeding.Results:Among 35 patients, 21 were males and 14 were females; the age was (68.5 ± 9.3) years old; the CHA 2DS 2-VASc score was 5 (4, 6) scores; the time to the last stroke was 95 (42, 98) d; the National Institutes of Health stroke scale score at the time of stroke was 3 (1, 6) scores. All patients successfully completed LAAC without perioperative instrument-surface thrombosis, death, new stroke or bleeding events. Thirty-two patients continued oral anticoagulant therapy 45 d after LAAC. The patients were followed up for (12.6 ± 4.3) months, 1 patient experienced recurrent ischemic stroke, 2 patients endured mucosal bleeding, there were no adverse events such as all-cause death, cardiovascular death, systemic embolism and hemorrhagic stroke. Conclusions:The LAAC combined delayed anticoagulant therapy is efficient and safe in patients with AF. For AF patients combined with cardiogenic stroke during anticoagulant therapy, LAAC combined with delayed anticoagulation therapy may be considered to further prevent ischemic stroke events.