Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

Objective To analyze the differential value of gastrointestinal stromal tumors and non-gastrointestinal stromal tumor by cytokeratin-19 fragment(CYFRA21-1),protein kinase B(PKB)and carbohydrate antigen 19-9(CA19-9)combined with endoscopic ultrasonography(EUS).Methods 69 patients with gastrointestinal stromal tumors from January 2020 to July 2023 were selected as the study group,and 78 patients with non-gastrointestinal stromal tumor(they were 25 cases of gastrointestinal leiomyoma and 53 cases of gastrointestinal schwannoma)were selected as the control group during the same period prospectively.The EUS indicators and tumor markers in the two groups were compared.Receiver operator characteristic curve(ROC curve)was drawn to analyze the diagnostic value of serum levels of CYFRA21-1,PKB and CA19-9 alone and in combination for gastrointestinal stromal tumors.Results Compared with the control group,the mean gray level,gray standard deviation and serum levels of CYFRA21-1,PKB and CA19-9 in the study group were higher(P<0.05).There was no significant difference in mean gray level,gray standard deviation and serum levels of CYFRA21-1,PKB and CA19-9 in patients with gastrointestinal stromal tumors of different genders and ages(P>0.05).Compared with patients with gastrointestinal stromal tumors with tumor diameter≤5 cm and pathological mitotic figure≤5/50 HPF,the mean gray level,gray standard deviation and serum levels of CYFRA21-1,PKB and CA19-9 were higher in patients with gastrointestinal stromal tumors with tumor diameter>5 cm and pathological mitotic figure>5/50 HPF(P<0.05).Gastrointestinal stromal tumors were included as positive and non-gastrointestinal stromal tumor as negative.ROC curve was drawn to analyze the diagnostic value of gray mean value,gray standard deviation,serum levels of CYFRA21-1,PKB,and CA19-9 alone and in combination for gastrointestinal stromal tumors,and the combined detection was the highest,area under the curve(AUC)was 0.936,the sensitivity was 82.61%,and the specificity was 91.03%.Conclusion With the occurrence and development of gastrointestinal stromal tumors,CYFRA21-1,PKB,CA19-9 levels,gray mean value and gray standard deviation increase,and levels of CYFRA21-1,PKB,CA19-9 combined with EUS are valuable in the diagnosis of gastrointestinal stromal tumors.

Pseudorabies virus(PRV)is the etiological agent of pseudorabies in pigs,which is char-acterized by dyspnea,reproductive disorders,and neurological diseases,and it spreads widely a-round the world.Since 2011,the newly emerged PRV variants have resulted in poor immunity pro-tection of traditional vaccine strains,and the original method of vaccine strain preparation is time-consuming and labor-intensive.Therefore,it is urgently needed to develop an efficient screening method of the vaccine strain at present.Using CRISPR/Cas9 gene editing technology in this study,two single guide RNAs(sgRNA)were designed targeting the virulence gene TK of PRV variant strain CH/JX/2016,and then the enhanced green fluorescent protein the reporter(EGFP)gene was inserted at the TK locus by a homologous repair plasmid.After multiple rounds of plaque puri-fication,the rPRV-ΔTK/EGFP strain was obtained.The results showed the cleavage efficiency of the two sgRNAs was extremely high.The preparation of rPRV-ΔTK/EGFP strain was succeed af-ter only three rounds of purification,and the EGFP expressed normally.The CRISPR/Cas9 system can edit the PRV gene simply,rapidly,and efficiently,and exhibits great potential in the construction of vaccine candidate strains.Meanwhile,the rescued rPRV-ΔTK/EGFP strain not only could be used as a tracer strain in PRV variant infection progresses,but also for subsequent antivi-ral drug screening.

Atheriosclerosis mainly occurs in middle-aged and elderly people, as well as in obese individuals. It is closely associated with the occurrence and progression of coronary heart disease, peripheral vascular disease, and stroke, severely affecting human health. 18F-NaF is commonly used for PET/CT imaging and has excellent performance in plaque imaging in atheriosclerosis. It can image the plaque calcification during the early stage, thereby assessing the plaque and making reasonable predictions for the prognosis. This article provides a review of the application of 18F-NaF PET/CT in the imaging of calcified plaques in atheriosclerosis.

Relapsing polychondritis is a rare systemic autoimmune disease, which involves a wide range of sites, has atypical symptoms, and has no specific means of examination, resulting in very difficult early diagnosis, which seriously affects the prognosis of patients. We report a case of an elderly female patient with respiratory symptoms, discomfort symptoms only appeared for more than 1 month, chest CT and laryngoscopy showed no obvious abnormalities. The effect of antibacterial, antiviral and anti-inflammatory treatment is not good. 18F-FDG PET/CT showed that trachea, bronchus, nasal cartilage, thyroid cartilage, cricoid cartilage were involved. After pathological examination, the patient was clinically diagnosed as relapsing polychondritis. After treatment with methylprednisolone and tripterygium glycoside tablets, the patient had no recurrence at present.

Objective To investigate the risk factors for intraoperative hypotension (IOH) in patients undergoing double plasma molecular adsorption system (DPMAS) artificial liver support therapy. Methods Clinical data were collected from 181 patients (670 cases in total) who underwent DPMAS artificial liver support therapy in Liver Disease Center of The First Affiliated Hospital of University of Science and Technology of China from October 1, 2017 to December 31, 2020, and according to the presence or absence of IOH during DPMAS therapy, they were divided into IOH group with 70 patients and non-IOH group with 111 patients.Clinical indicators were compared between the two groups and their association with IOH was analyzed; prognosis was analyzed at 12 and 24 weeks.The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors for IOH.The Kaplan-Meier method was used to plot receiver operating characteristic (ROC) curves, and the Z test was used for comparison of the area under the ROC curve (AUC) of independent risk factors. Results The univariate Logistic regression analysis showed that female individuals, individuals aged ≥50 years, and individuals with normal or low body mass index (BMI) tended to have a higher risk of IOH (all P < 0.05), and the multivariate analysis showed that normal or low BMI (odds ratio [ OR ]=3.290, 95% confidence interval [ CI ]: 1.523-7.108, P =0.002) and female sex ( OR =5.146, 95% CI : 2.316-11.432, P < 0.001) were independent risk factor for IOH in patients undergoing DPMAS artificial liver support therapy.The ROC curve analysis of female sex+BMI ≤24 kg/m 2 showed that it had an AUC of 0.639 in predicting IOH ( P =0.002).The patients experiencing IOH had a 12-week survival rate of 55.77%(29/52) and a 24-week survival rate of 50%(26/52), and there were significant differences between the two groups in 12-and 24-week survival rates (12-week: 76.53% vs 55.77%, χ 2 =6.887, P =0.009;24-week: 74.49% vs 50.00%, χ 2 =9.080, P =0.003). Conclusion The risk of hypotension was higher in female patients and that with normal or low BMI during DPMAS artificial liver therapy.Patients with IOH had poor survival prognosis at 24 weeks after DPMAS therapy.

Immunotherapy combined with targeted therapy can benefit the survival of patients with unresectable hepatocellular carcinoma. Atezolizumab combined with bevacizumab has achieved remarkable efficacy in patients with advanced hepatocellular carcinoma, but the efficacy of conversion therapy in patients with unresectable hepatocellular carcinoma still needs more evidences. The authors report the clinical efficacy of a case of unresectable hepatocellular carcinoma with hepatitis B virus related liver cirrhosis who was treated with immunotherapy plus targeted therapy combined with local treatment. Results show a good effect in patient without tumor recurrence after postoperative 9 months.

Emergence of the colistin resistance gene,mcr-1,has attracted worldwide attention.Despite the prevalence of mcr-1-positive Escherichia coli(MCRPEC)strains in human carriage showing a significant decrease between 2016 and 2019,genetic differences in MCRPEC strains remain largely unknown.We therefore conducted a comparative genomic study on MCRPEC strains from fecal samples of healthy human subjects in 2016 and 2019.We identified three major differences in MCRPEC strains between these two time points.First,the insertion sequenceISApll1 was often deleted and the percentage of mcr-1-carrying IncI2 plasmids was increased in MCRPEC strains in 2019.Second,the antibiotic resistance genes(ARGs),aac(3)-Ⅳa and blaCTX-M-1,emerged and coexisted with mcr-1 in 2019.Third,MCRPEC strains in 2019 contained more viru-lence genes,resulting in an increased proportion of extraintestinal pathogenic E.coli(ExPEC)strains(36.1％)in MCRPEC strains in 2019 compared to that in 2016(10.5％),implying that these strains could occupy intestinal ecological niches by competing with other commensal bacteria.Our results suggest that despite the significant reduction in the prevalence of MCRPEC strains in humans from 2016 to 2019,MCRPEC exhibits increased resistance to other clinically important ARGs and contains more virulence genes,which may pose a potential public health threat.

Primary liver cancer is a common digestive system malignant tumor. Positron emission tomography and computed tomography (PET/CT) is a new molecular imaging technique which can reflect the metabolic status of tumors and provide more biological information about tumors. Radiomics is used to extract and analyze quantitative features that can describe tumor features in medical images with a high throughput. This article reviews PET/CT radiomics and its application in the diagnosis and prognosis assessment of hepatocellular carcinoma.