Objective:To investigate the clinical characteristics and the efficacy of thrombus aspiration in patients with early intrastent thrombosis (EST) following carotid artery stenting (CAS).Methods:This study is a retrospective case series, collecting clinical data of five patients who developed EST after CAS in the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University from January 2021 to September 2023.All patients were male, with an age of (64.0±11.9) years (range:48 to 77 years), accounting for 2.0% (5/244) of CAS procedures during the same period.Among them, three patients did not receive standard dual antiplatelet therapy before the procedure, and one had an inadequate ADP inhibition rate (45.6%).Four patients received XACT carotid stents, while one received a Wallstent carotid stent.All five patients showed significant residual stenosis ranging from 43% to 55% after CAS.Emergency thrombus aspiration was performed in all cases, and data regarding perioperative conditions, vascular patency, and clinical outcomes were collected.Results:The interval between CAS and the occurrence of EST ranged from 3 hours to 14 days.The main clinical symptoms included sudden onset of consciousness disorders and contralateral limb weakness.None of the patients received preoperative intravenous thrombolysis, and thrombus aspiration was performed during the procedure to restore vascular patency.Four cases underwent balloon angioplasty during the procedure, and two cases utilized overlapping stents.Two patients experienced intraoperative embolization of thrombus to the C 2 segment.In one case, the embolized thrombus was retrieved using an intracranial thrombectomy stent, while in another case, it was aspirated using a guiding catheter.Postoperatively, all patients had a thrombolysis in cerebral infarction grade of 3, and symptoms improved in four cases.One patient showed no improvement in symptoms, and MRI revealed extensive new infarction in the right frontal and insular regions, adjacent to the right lateral ventricle.Regular follow-up examinations after discharge did not reveal restenosis or embolism within the stent.The follow-up period ranged from 7.6 to 21.2 months, with modified Rankin scale scores of 0 to 1 point in four cases and 2 points in one case, indicating good recovery in all patients. Conclusions:Acute intrastent thrombosis is a rare complication after carotid artery stenting.The combined use of percutaneous thrombus aspiration and endovascular techniques, such as balloon angioplasty and stent overlapping, can rapidly restore vessel patency with favorable outcomes.However, further large-scale clinical studies are needed to confirm the effectiveness of these treatments for acute intrastent thrombosis.

Objective To design a mobile personnel radiation protection equipment for operation in environments with high radiation such as spent fuel reprocessing plants, to achieve simultaneous protection against γ radiation, neutron radiation, and radioactive aerosol, to reduce the internal and external exposure dose of radioactive workers, and to meet the requirement of operation for two hours. Methods The core parts of the mobile personnel radiation protection equipment included a shielding chamber and a respiratory maintenance system. An automated chassis was used for the movement and lifting of the shielding chamber. MCNP software was used to simulate and calculate the protective effects of shielding chamber made of different materials and material thicknesses. Experimental verification of the shielding chamber design was conducted. Mathematical models were established to describe the variations in the content of various gases in the chamber with personnel operation time. A respiratory maintenance system, a harmful gas absorption device, and an automated mobile chassis were designed. Results The shielding chamber made of polyethylene with a thickness of 80 mm achieved an 80% neutron shielding rate. The respiratory maintenance system could support workers for 2 hours of operation inside the equipment. The mobile chassis allowed operation of the equipment with one person. Conclusion This mobile personnel radiation protection equipment can solve the problem in simultaneous protection against γ radiation, neutron radiation, and radioactive aerosol. The equipment can provide radiation protection for radioactive workers, reduce exposure dose, and reduce personnel burden. This system provides technical means for the operation and maintenance of equipment in high-radiation sites such as spent fuel reprocessing plants.

Objective:To investigate the clinical characteristics and the efficacy of thrombus aspiration in patients with early intrastent thrombosis (EST) following carotid artery stenting (CAS).Methods:This study is a retrospective case series, collecting clinical data of five patients who developed EST after CAS in the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University from January 2021 to September 2023.All patients were male, with an age of (64.0±11.9) years (range:48 to 77 years), accounting for 2.0% (5/244) of CAS procedures during the same period.Among them, three patients did not receive standard dual antiplatelet therapy before the procedure, and one had an inadequate ADP inhibition rate (45.6%).Four patients received XACT carotid stents, while one received a Wallstent carotid stent.All five patients showed significant residual stenosis ranging from 43% to 55% after CAS.Emergency thrombus aspiration was performed in all cases, and data regarding perioperative conditions, vascular patency, and clinical outcomes were collected.Results:The interval between CAS and the occurrence of EST ranged from 3 hours to 14 days.The main clinical symptoms included sudden onset of consciousness disorders and contralateral limb weakness.None of the patients received preoperative intravenous thrombolysis, and thrombus aspiration was performed during the procedure to restore vascular patency.Four cases underwent balloon angioplasty during the procedure, and two cases utilized overlapping stents.Two patients experienced intraoperative embolization of thrombus to the C 2 segment.In one case, the embolized thrombus was retrieved using an intracranial thrombectomy stent, while in another case, it was aspirated using a guiding catheter.Postoperatively, all patients had a thrombolysis in cerebral infarction grade of 3, and symptoms improved in four cases.One patient showed no improvement in symptoms, and MRI revealed extensive new infarction in the right frontal and insular regions, adjacent to the right lateral ventricle.Regular follow-up examinations after discharge did not reveal restenosis or embolism within the stent.The follow-up period ranged from 7.6 to 21.2 months, with modified Rankin scale scores of 0 to 1 point in four cases and 2 points in one case, indicating good recovery in all patients. Conclusions:Acute intrastent thrombosis is a rare complication after carotid artery stenting.The combined use of percutaneous thrombus aspiration and endovascular techniques, such as balloon angioplasty and stent overlapping, can rapidly restore vessel patency with favorable outcomes.However, further large-scale clinical studies are needed to confirm the effectiveness of these treatments for acute intrastent thrombosis.

OBJECTIVE To establish a proteomic pre-processing protocol for low input samples (1×104 cells) in order to map the proteomic aging atlas of individual mouse antral follicles and elucidate the aging patterns of mouse antral follicles.METHODS Using cell lines and primary mouse cells,the protocol was developed by optimizing lysis buffers,enzymatic digestion,and ultrasonication for 1 × 104 cells (about 1 μg protein).The sample pre-processing protocol established in this study was evaluated by comparing it with two commercial sample preparation kits:iST kit,EasyPept-Ex (Ex kit),in terms of protein identification overlap,overall grand average of hydropathy (GRAVY),theoretical isoelectric points,and protein molecular weight.The sample suitability of the current sample pretreatment process was assessed using primary spleen and liver cell samples of mice at three different scales:100,1000,and 10000.Using this sample pre-processing approach in conjunction with the highly sensitive timsTOF Pro 2 mass spectrometer,proteome maps of individual antral follicles from young-aged (2 months),middle-aged (12 months),and old-aged (22 months) mice were generated.Differential and time-series analyses identified age-related proteins,and elucidated the aging patterns of mouse antral follicles.RESULTS A proteomic pre-processing protocol for 1 × 104 cell samples was established,requiring only one single-step operation for lysis,reduction,and alkylation,with enzymatic digestion not necessitating ultrasonication.We found that for cell samples on the order of 1 × 104,increasing the concentration of sodium deoxycholate in the lysis buffer from 1％ to 10％ enhanced the number of identified proteins from 4089 to 4389,demonstrating improved lysis efficiency (P＜0.05).The addition of ammonium bicar-bonate buffer (50 mmol·L-1,90 μL) to the lysis solution significantly increased the number of identified proteins from 2579 to 4389 (P＜0.01).Both single trypsin and mixed enzyme (trypsin/Lys-C) treatments yielded similar proteolytic outcomes,identifying approximately 3950 proteins each.Reducing the diges-tion time from overnight to 0.5 hours increased the number of identified proteins from 4299 to 4632 (P＜0.05),thus saving time while achieving higher protein identification yields.Compared to commercial kits,approximately 92.3％of the proteins identified by our protocol could also be identified by the iST kit or Ex kit.Our protocol demonstrated no significant bias in terms of hydrophobicity,theoretical isoelectric points or molecular weight,indicating robust performance.As the number of cells in the sample increased,the variety of identified proteins increased significantly.For instance,in samples containing 100,1000,and 10000 cells,525,1650,and 3210 proteins were identified in primary mouse spleen cells,respectively,compared with 366,1160,and 3590 proteins in primary mouse liver cells (P＜0.05).Finally,using this protocol,proteomic profiling of individual antral follicles from young,middle-aged,and old mice (three follicles per age group) was performed,with each follicle identifying over 7500 proteins on average.Based on this data,principal component analysis was conducted in this study,revealing significant differences in protein expression profiles of antral follicles at different age stages,confirming that age made a big difference to the physiological state of follicles.Additionally,we observed a signifi-cant downregulation of chromosome separation-associated proteins in aging mouse follicles (P＜0.01),suggesting potential disruptions in chromosome segregation and meiotic dysregulation.Further analysis revealed 739 proteins significantly correlated with age,among which 378 exhibited positive correlations and 361 negative correlations.CONCLUSION This study provides a low-cost,easy-to-operate,high-throughput,and highly sensitive proteomic sample pre-processing protocol for low input samples.It has constructed dynamic proteome maps of individual antral follicles at different ages in mice,offering high-quality data resources for basic research on follicular aging and providing new insights for exploring potential therapeutic targets for ovarian aging and the development of drugs to enhance fertility.

OBJECTIVE To establish a proteomic pre-processing protocol for low input samples (1×104 cells) in order to map the proteomic aging atlas of individual mouse antral follicles and elucidate the aging patterns of mouse antral follicles.METHODS Using cell lines and primary mouse cells,the protocol was developed by optimizing lysis buffers,enzymatic digestion,and ultrasonication for 1 × 104 cells (about 1 μg protein).The sample pre-processing protocol established in this study was evaluated by comparing it with two commercial sample preparation kits:iST kit,EasyPept-Ex (Ex kit),in terms of protein identification overlap,overall grand average of hydropathy (GRAVY),theoretical isoelectric points,and protein molecular weight.The sample suitability of the current sample pretreatment process was assessed using primary spleen and liver cell samples of mice at three different scales:100,1000,and 10000.Using this sample pre-processing approach in conjunction with the highly sensitive timsTOF Pro 2 mass spectrometer,proteome maps of individual antral follicles from young-aged (2 months),middle-aged (12 months),and old-aged (22 months) mice were generated.Differential and time-series analyses identified age-related proteins,and elucidated the aging patterns of mouse antral follicles.RESULTS A proteomic pre-processing protocol for 1 × 104 cell samples was established,requiring only one single-step operation for lysis,reduction,and alkylation,with enzymatic digestion not necessitating ultrasonication.We found that for cell samples on the order of 1 × 104,increasing the concentration of sodium deoxycholate in the lysis buffer from 1％ to 10％ enhanced the number of identified proteins from 4089 to 4389,demonstrating improved lysis efficiency (P＜0.05).The addition of ammonium bicar-bonate buffer (50 mmol·L-1,90 μL) to the lysis solution significantly increased the number of identified proteins from 2579 to 4389 (P＜0.01).Both single trypsin and mixed enzyme (trypsin/Lys-C) treatments yielded similar proteolytic outcomes,identifying approximately 3950 proteins each.Reducing the diges-tion time from overnight to 0.5 hours increased the number of identified proteins from 4299 to 4632 (P＜0.05),thus saving time while achieving higher protein identification yields.Compared to commercial kits,approximately 92.3％of the proteins identified by our protocol could also be identified by the iST kit or Ex kit.Our protocol demonstrated no significant bias in terms of hydrophobicity,theoretical isoelectric points or molecular weight,indicating robust performance.As the number of cells in the sample increased,the variety of identified proteins increased significantly.For instance,in samples containing 100,1000,and 10000 cells,525,1650,and 3210 proteins were identified in primary mouse spleen cells,respectively,compared with 366,1160,and 3590 proteins in primary mouse liver cells (P＜0.05).Finally,using this protocol,proteomic profiling of individual antral follicles from young,middle-aged,and old mice (three follicles per age group) was performed,with each follicle identifying over 7500 proteins on average.Based on this data,principal component analysis was conducted in this study,revealing significant differences in protein expression profiles of antral follicles at different age stages,confirming that age made a big difference to the physiological state of follicles.Additionally,we observed a signifi-cant downregulation of chromosome separation-associated proteins in aging mouse follicles (P＜0.01),suggesting potential disruptions in chromosome segregation and meiotic dysregulation.Further analysis revealed 739 proteins significantly correlated with age,among which 378 exhibited positive correlations and 361 negative correlations.CONCLUSION This study provides a low-cost,easy-to-operate,high-throughput,and highly sensitive proteomic sample pre-processing protocol for low input samples.It has constructed dynamic proteome maps of individual antral follicles at different ages in mice,offering high-quality data resources for basic research on follicular aging and providing new insights for exploring potential therapeutic targets for ovarian aging and the development of drugs to enhance fertility.

Objective:To investigate the clinical profile of primary bilateral macronodular adrenal hyperplasia(PBMAH) and sex difference.Methods:One hundred and forty cases of PBMAH were recruited in our center from 2014, and all patients were evaluated for hormone secretion, adrenal imaging, and metabolic parameters.Results:Overt Cushing′s syndrome accounted for 76.4% of PBMAH cohort and 47.9% were female. The overt group had higher serum cortisol and 24 h urinary free cortisol levels, lower adrenocorticotropic hormone, higher serum cortisol after low-dose dexamethasone suppression tests, larger total adrenal size, and a higher percentage of obesity, hypertension, diabetes mellitus, and hypokalemia than the subclinical group(all P<0.05). When compared with the male group, the female group had smaller adrenal size( P<0.001), lower HbA 1C( P=0.003), higher total cholesterol( P=0.005), and lower density lipoprotein-cholesterol levels( P=0.035). Further, 24 h urinary free cortisol in the male group was found to be positively correlated with diastolic blood pressure, fasting glucose, 2 h postprandial glucose after oral glucose tolerance test(OGTT), and HbA 1C after adjusted for age, body mass index, and onset duration, and was negatively correlated with body mass index and potassium levels. While 24 h urinary free cortisol in the female group was positively correlated only with diastolic blood pressure, fasting glucose, and 2 h postprandial glucose after OGTT(all P<0.05). During follow-up, 80.0% of patients achieved remission after unilateral adrenalectomy, with a recurrence rate of 17.9%. Conclusion:PBMAH related metabolic disorder is more pronounced in overt Cushing′s syndrome and males. Unilateral adrenalectomy as an effective treatment can benefit the majority of patients.

Objective To discuss the clinical characteristics of adrenal metastases,and summarize the experience of diagnosis and treatment.Methods From January 2008 to June 2018,the clinical data of 55 patients with adrenal metastases treated in our hospital were analyzed retrospectively.This study included 34 male patients and 21 female patients and the median age was 60 years old (ranged 55 to 84 years old).The median value of maximum diameter of adrenal metastases was 3 cm (ranged 1.9 to 10.3 cm);with 35 cases on the left side,13 cases right and 7 cases bilateral.The primary sites of malignant tumors were pancreas (18 cases,32.7％),lung (12 cases,21.8％),liver (6 cases,10.9％) and colorectum (6 cases,10.9％),respectively.Thirty-four cases were confirmed by pathology after adrenalectomy and 21 cases were confirmed by needle biopsy.Thirty cases were diagnosed synchronously with the primary tumor and 25 cases were metachronous.The median time from diagnosis of primary tumors was 13.3 months (ranged 2.0 to 97.4 months).42 cases of these 55 cases were diagnosed within one year.Treatment options for adrenal metastatic lesions included single adrenalectomy in 18 cases,adrenalectomy combined with radiotherapy 16 cases,single intravenous chemotherapy 10 cases,intravenous chemotherapy combined with non-operative treatment 10 cases and single radiotherapy 1 case.Results The main pathological types were adenocarcinoma (19 cases,34.5％),ductal adenocarcinoma (10 cases,18.2％),hepatocellular carcinoma (6 cases,10.9％) and clear cell carcinoma (4 cases,7.3％).Two cases were lost follow-up and the follow-up rate was 96％,the median follow-up time was 8 months (ranged 1 to 135 months).The median overall survival (OS) time of 55 patients was 5.3 months (ranged 1 to 134 months).The one-year survival rate was 23.6％ (13/55),the two-year survival rate was 12.7％ (7/55),the three-year survival rate was 9.1％ (5/55) and the five-year survival rate was 1.8％ (1/55).Conclusions Pancreatic cancer was the most common type of malignant tumor for adrenal metastases in our hospital.Most primary tumors and adrenal metastases were diagnosed synchronously or within one year.Comprehensive treatment with retroperitoneal adrenalectomy may improve the OS,however the overall prognosis is poor.

Objective To summarize operation experiences in applying microcoils embolization for the treatment of intracranial wide-necked aneurysms using the low-profile visualized intraluminal stent support (LVIS) in elderly patients.Methods We reviewed data of 47 elderly patients (48 aneurysms) with intracranial wide-necked aneurysms treated with LVIS stent-assisted microcoils embolization.Results Forty-seven aneurysms were embolized successfully,one stent was withdrawn because its midpiece failed to stretch.Instant Raymond classifications evaluation after the surgery showed Grade Ⅰ in 52.1％ (25/48 aneurysms),Grade Ⅱ in 37.5％ (18/48 aneurysms),and Grade Ⅲ in 8.3 ％ (4/48 aneurysms).Besides,the effective rate of aneurysms embolization was 91.5 ％.During 3 to 12-month follow-up with digital subtraction angiography (DSA) in 36 patients (36 aneurysms),mRS was scored 0 (best effectiveness) in 28 cases,scored 1 in 4 cases,scored 2 in 3 cases,and scored 3 in 1 case,and the total favorable rate was 97％.Conclusions LVIS stent-assisted microcoils embolization for the treatment of intracranial wide-necked aneurysms in elderly patients may avoid or reduce the incidence of complication.

Objective To discuss the treatment experience of adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The clinical data of 24 cases of AIMAH from August 1972 to December 2016 were retrospectively analyzed.The cases included 10 males and 14 females with a mean age of 43 (range 26 to 59) years.16 patients presented with typical Cushing syndrome (CS) and 8 patients had weight gain, hypertension or diabetes mellitus without any sign of CS.The circadian rhythm of serum cortisol was abnormal.Low and high dose dexamethasone suppression tests failed to suppress cortisol secretion.The preoperative CT scan showed bilateral enlargement of the adrenal glands with multiple macmnodules.14 patients underwent open surgery, including 5 cases of unilateral adrenalectomy, 6 cases of adrenalectomy combined with contralateral subtotal adrenalectomy and 3 cases of bilateral adrenalectomy simuhaneously.6 patients underwent conventional laparoscopic adrenalectomy,including 2 cases of unilateral adrenalectomy, 2 cases of adrenalectomy combined with contralateral subtotal adrenalectomy and 2 cases of bilateral adrenalectomy.4 patients underwent robot-assisted laparoscopic bilateral adrenalectomy.Results The postoperative pathological examination showed that all patients had bilateral adrenal macronodular or adenomatoid hyperplasia.During the mean follow-up of 68 months (range 3 to 192 months), the clinical symptoms of CS disappeared after surgery in all cases.7 patients who received unilateral adrenalectomy had urinary free cortisol and serum cortisol within normal ranges and no further enlargement of the contralateral gland was noticed.Among the 3 patients who received bilateral adrenalectomy simultaneously, 1 case died of adrenal crisis on the seventh day post-operation.The remaining 2 cases presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy.Nelson's syndrome was not observed in other patients.Conclusions The use of bilateral adrenalectomy to treat AIMAH may involve risk.Unilateral adrenalectomy is recommended for an alternative treatment for AIMAH.Controlateral adrenalectomy with lifelong corticosteroid replacement or contralateral subtotal adrenalectomy may be performed if the symptoms have not improved or recurred after unilateral adrenalectomy.

Objective To explore the efficacy and safety of minimal invasive adrenal sparing surgery for the treatment of Cushing syndrome caused by adrenocortical adenoma.Methods Patients who underwent minimal invasive adrenal surgery for adrenocortical adenoma in our institution from January 2010 to December 2015 were retrospectively analyzed.Preoperative, intraoperative, and postoperative variables were reviewed from the database.The mean patient age at diagnosis was 39 years and male:female ratio was 10:111.Of the 121 adenomas, 50 were located in the right adrenal and 71 in the left.The mean tumor size was 2.6 cm.84 cases had hypertension (69.4％), 36 cases had diabetes mellitus (29.8％), and 45 cases had obesity (37.2％).Postoperative follow-up was performed by evaluating adrenal gland function and imaging.Results Mininal invasive partial adrenalectomy was performed in 121 cases and the success rate of operation was 99.2％ (120/121).Sixty-two cases received operation through retroperitoneal approach,and 59 cases were through transperitoneal approach.The median operative time was 50 min with a median blood loss of 50 ml.The mean postoperative hospital stay were (5.0 ± 3.2) days.The vascular injury occurred in 2 cases (1 case in each surgical approach), while the abdominal organ injury occurred in 2 cases with 1 case of spleen injury and 1 case of liver injury (both in transperitoneal approach).Postoperative complications were observed in 6 cases:1 case of deep venous thrombosis, 1 case of wound hematoma, 4 cases of wound infection.Cortisol substitution was given in 2 to 12 months (mean 6.2 months)postoperatively.One year after operation, the remission rate of hypertension, diabetes and obesity was 58.3％ (49/84), 30.6％ (11/36) and 60.0％ (30/45), respectively.Conclusions Minimal invasive adrenal surgery using retroperitoneal and transperitoneal laparoscopic technique can be performed with low morbidity and achieve an excellent outcome.The perioperative hormone therapy may also play an important role.