Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor,with an increasing incidence worldwide,particularly in Asia.Although radical surgical resection is currently the only potentially curative treatment,the high recurrence rate and low postoperative overall survival(OS)rate of ICC remain major clinical challenges.Adjuvant therapy(AT)and neoadjuvant therapy(NAT)are important strategies to reduce postoperative recurrence and prolong OS.Several studies have shown certain efficacy of these treatments.However,the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation.This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis,so as to provide scientific evidence for optimizing treatment strategies.Methods:The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected.Patients were grouped based on their treatment modality:NAT+AT group,AT group,and non-NAT/AT group.The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching(PSM)to balance baseline data.The Kaplan-Meier method was used to analyze OS and disease-free survival(DFS),and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results:A total of 395 ICC patients were included in the final analysis,with 42 patients(10.6%)in the NAT+AT group,62 patients(15.7%)in the AT group,and 291 patients(73.7%)in the non-NAT/AT group.Before PSM,significant differences were observed between groups in terms of CA19-9,liver function Child-Pugh classification,intraoperative blood loss,surgical margin,differentiation grade,vascular invasion,ECOG score,and lymph node dissection ratio(all P<0.05).After PSM,there were no significant differences in baseline characteristics between the groups(all P>0.05).After matching,the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups(both P<0.05),while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups(both P>0.05).Subgroup analysis showed that in TNM stage I patients,DFS in the NAT+AT group was significantly better than in the non-NAT/AT group(P<0.05),but OS was not significantly different(P>0.05).In TNM stage Ⅱ and Ⅲ patients,both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group(both P<0.05),and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients(P<0.05).Conclusion:NAT combined with AT provides better survival benefits for patients with locally advanced ICC,but its benefit for early-stage ICC patients is limited.However,the retrospective design and sample size limitations of this study may affect the stability of the results,and future large-sample,multicenter,prospective studies are needed for further validation.

Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor,with an increasing incidence worldwide,particularly in Asia.Although radical surgical resection is currently the only potentially curative treatment,the high recurrence rate and low postoperative overall survival(OS)rate of ICC remain major clinical challenges.Adjuvant therapy(AT)and neoadjuvant therapy(NAT)are important strategies to reduce postoperative recurrence and prolong OS.Several studies have shown certain efficacy of these treatments.However,the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation.This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis,so as to provide scientific evidence for optimizing treatment strategies.Methods:The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected.Patients were grouped based on their treatment modality:NAT+AT group,AT group,and non-NAT/AT group.The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching(PSM)to balance baseline data.The Kaplan-Meier method was used to analyze OS and disease-free survival(DFS),and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results:A total of 395 ICC patients were included in the final analysis,with 42 patients(10.6%)in the NAT+AT group,62 patients(15.7%)in the AT group,and 291 patients(73.7%)in the non-NAT/AT group.Before PSM,significant differences were observed between groups in terms of CA19-9,liver function Child-Pugh classification,intraoperative blood loss,surgical margin,differentiation grade,vascular invasion,ECOG score,and lymph node dissection ratio(all P<0.05).After PSM,there were no significant differences in baseline characteristics between the groups(all P>0.05).After matching,the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups(both P<0.05),while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups(both P>0.05).Subgroup analysis showed that in TNM stage I patients,DFS in the NAT+AT group was significantly better than in the non-NAT/AT group(P<0.05),but OS was not significantly different(P>0.05).In TNM stage Ⅱ and Ⅲ patients,both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group(both P<0.05),and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients(P<0.05).Conclusion:NAT combined with AT provides better survival benefits for patients with locally advanced ICC,but its benefit for early-stage ICC patients is limited.However,the retrospective design and sample size limitations of this study may affect the stability of the results,and future large-sample,multicenter,prospective studies are needed for further validation.

Purpose To evaluate the predictive value of left atrial appendage(LAA)morphological assessment by preoperative left atrial CT imaging in the risk of peri-device leak(PDL)after left atrial appendage occlusion(LAAO)in atrial fibrillation.Materials and Methods Seventy-one patients with atrial fibrillation who successfully underwent LAAO in Nanchong Central Hospital from January 2020 to February 2024 were retrospectively analyzed.According to the results of left atrial CT imaging after LAAO,all patients were divided into the PDL group(n=26)and the non-PDL group(n=45).The long diameter,short diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area,and LAA length and LAA depth were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to explore the risk factors leading to the differences between the two groups.Results The long diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area in the PDL group were statistically higher than those in the non-PDL group(t/Z=4.952,-5.570,-2.912,3.191,6.757,-6.462,-3.318,3.733,all P<0.05).The LAA orifice short diameter,LAA length,LAA depth and the short diameter of landing area in the PDL group were higher than those in the non-PDL group,but there were no statistically significant differences between the two groups(t/Z=-1.773,1.765,1.509,-1.415,all P>0.05).Univariate Logistic regression analysis showed that the long diameter,long diameter/short diameter ratio,area and perimeter of LAA orifice and landing area before operation were correlated with postoperative PDL(P<0.05).Multivariate Logistic regression analysis showed that,the long diameter/short diameter ratio of LAA landing area was an independent risk factor for postoperative PDL.Conclusion Preoperative evaluation of the morphology of LAA orifice and landing zone by left atrial CT imaging can predict the occurrence of PDL after LAAO in atrial fibrillation in advance.When the long/short diameter of the landing area is large,it is necessary to be highly alert to the occurrence of PDL,which provides a basis for selecting and customizing the occluder before LAAO in patients with atrial fibrillation.

Purpose To explore the feasibility of coronary CT angiography to predict major adverse cardiovascular events(MACE)in patients with grey zone of CT-derived fractional flow reserve(CT-FFR).Materials and Methods The imaging and clinical features of patients with suspected coronary heart disease who underwent coronary CT angiography examination and had a CT-FFR within 0.76-0.80 in Beijing Anzhen Hospital Affiliated to Capital Medical University from March 2017 to October 2018 were retrospectively collected.The incidence of MACE after coronary CT angiography was assessed by telephone at follow-up.The Cox regression model was used for feature selection,and the area under the receiver operating characteristic curve(AUC)was plotted to evaluate the predictive performance.Results The study included a total of 105 subjects,with an observed incidence rate of MACE at 31.4%(33/105).Multivariate Cox regression,adjusted for relevant parameters,indicated that △CT-FFR(HR=1.217,P=0.008),pericoronary fat attenuation index(HR=1.052,P=0.029)and plaque length(HR=1.068,P=0.047)were independent risk factors of MACE,and AUC were 0.705,0.656 and 0.701,respectively.The AUC of the combined model was 0.793,its predictive ability was higher than △CT-FFR(Z=-2.001,P=0.048),pericoronary fat attenuation index(Z=-2.402,P=0.016)and plaque length(Z=-2.004,P=0.045),respectively.Conclusion △CT-FFR,pericoronary fat attenuation index and plaque length are independent risk factors for predicting MACE in patients with grey zone of CT-FFR,and the combined model has best predictive efficacy.

Purpose To evaluate the predictive value of left atrial appendage(LAA)morphological assessment by preoperative left atrial CT imaging in the risk of peri-device leak(PDL)after left atrial appendage occlusion(LAAO)in atrial fibrillation.Materials and Methods Seventy-one patients with atrial fibrillation who successfully underwent LAAO in Nanchong Central Hospital from January 2020 to February 2024 were retrospectively analyzed.According to the results of left atrial CT imaging after LAAO,all patients were divided into the PDL group(n=26)and the non-PDL group(n=45).The long diameter,short diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area,and LAA length and LAA depth were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to explore the risk factors leading to the differences between the two groups.Results The long diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area in the PDL group were statistically higher than those in the non-PDL group(t/Z=4.952,-5.570,-2.912,3.191,6.757,-6.462,-3.318,3.733,all P<0.05).The LAA orifice short diameter,LAA length,LAA depth and the short diameter of landing area in the PDL group were higher than those in the non-PDL group,but there were no statistically significant differences between the two groups(t/Z=-1.773,1.765,1.509,-1.415,all P>0.05).Univariate Logistic regression analysis showed that the long diameter,long diameter/short diameter ratio,area and perimeter of LAA orifice and landing area before operation were correlated with postoperative PDL(P<0.05).Multivariate Logistic regression analysis showed that,the long diameter/short diameter ratio of LAA landing area was an independent risk factor for postoperative PDL.Conclusion Preoperative evaluation of the morphology of LAA orifice and landing zone by left atrial CT imaging can predict the occurrence of PDL after LAAO in atrial fibrillation in advance.When the long/short diameter of the landing area is large,it is necessary to be highly alert to the occurrence of PDL,which provides a basis for selecting and customizing the occluder before LAAO in patients with atrial fibrillation.

Purpose To explore the feasibility of coronary CT angiography to predict major adverse cardiovascular events(MACE)in patients with grey zone of CT-derived fractional flow reserve(CT-FFR).Materials and Methods The imaging and clinical features of patients with suspected coronary heart disease who underwent coronary CT angiography examination and had a CT-FFR within 0.76-0.80 in Beijing Anzhen Hospital Affiliated to Capital Medical University from March 2017 to October 2018 were retrospectively collected.The incidence of MACE after coronary CT angiography was assessed by telephone at follow-up.The Cox regression model was used for feature selection,and the area under the receiver operating characteristic curve(AUC)was plotted to evaluate the predictive performance.Results The study included a total of 105 subjects,with an observed incidence rate of MACE at 31.4%(33/105).Multivariate Cox regression,adjusted for relevant parameters,indicated that △CT-FFR(HR=1.217,P=0.008),pericoronary fat attenuation index(HR=1.052,P=0.029)and plaque length(HR=1.068,P=0.047)were independent risk factors of MACE,and AUC were 0.705,0.656 and 0.701,respectively.The AUC of the combined model was 0.793,its predictive ability was higher than △CT-FFR(Z=-2.001,P=0.048),pericoronary fat attenuation index(Z=-2.402,P=0.016)and plaque length(Z=-2.004,P=0.045),respectively.Conclusion △CT-FFR,pericoronary fat attenuation index and plaque length are independent risk factors for predicting MACE in patients with grey zone of CT-FFR,and the combined model has best predictive efficacy.

Objective:To explore the feasibility and effect of applying spherical fitting technology in CT three-dimensional reconstruction in preoperative planning of the resection range of Cam-type femoral acetabular impingement (FAI).Methods:46 Cam-type FAI patients who underwent arthroscopic femoroplasty in the Department of Sports Medicine in the Third Affiliated Hospital of Southern Medical University from July 2020 to June 2022 were enrolled in the spherical fitting group, including 26 females and 20 males, with an average age of 38.4±15.2 years (range of 24-53 years). The preoperative planning was performed using spherical fitting technology in CT three-dimensional reconstruction. Another 42 Cam-type FAI patients who underwent arthroscopic femoroplasty from July 2018 to June 2020 were enrolled in the observation group, including 25 females and 17 males, with an average age of 43.6±18.4 years (range 24-61 years). The preoperative planning was performed using CT three-dimensional reconstruction observation method. This study evaluated the impact of femoroplasty planned by spherical fitting technique on patients' prognosis though comparing the differences of postoperative α angle, femoral head-neck offset ratio, modified Harris hip score (mHHS), and visual analog score (VAS) at 3, 6, 9, and 12 months between two groups.Results:The average follow-up time was 11.8±0.6 months in spherical fitting group and 11.3±0.8 months in observation group. There was no significant difference regarding α angle, femoral head-neck offset ratio, mHHS, and VAS between two groups preoperatively ( P>0.05). The mHHS in two groups increased gradually, while VAS decreased sequentially at 3, 6, 9, and 12 months postoperatively. The postoperative mHHS and VAS were significantly better than those before surgery ( P<0.05). The mHHS was 83.2±14.8 vs. 70.5±11.2 in spherical fitting group and observation group at the followup of 9 months with significant difference ( t=4.471, P=0.007). It was 85.7±13.3 vs. 73.2±12.5 at the followup of 12 months with significant difference ( t=4.596, P=0.008). No significant difference was found in α angle, femoral head-neck offset ratio or mHHS at 3 and 6 months postoperatively ( P>0.05), and no significant difference was found in VAS at 3, 6, 9, and 12 months postoperatively between two groups. Conclusion:The spherical fitting technology in CT three-dimensional reconstruction could assist surgeons with planning of the resection range of Cam deformity preoperatively, and achieve a smooth progress of arthroscopic femoroplasty intraoperatively; after short term follow-up, we found that patients who underwent femoroplasty using this technology achieved satisfactory outcomes.

Objective To establish and validate a Nomogram model for predicting the overall survival(OS)of the patients with intrahepatic cholangiocarcinoma(ICC)based on domestic multicenter data,and screen the beneficiaries of adjuvant chemotherapy based on the prediction model.Methods From December 2011 to December 2017,the data of 278 patients with postoperative pathological diagnosis of ICC from 4 medical centers in our country were collected retrospectively COX regression model was used to screen the independent risk factors of OS and constructed a Nomogram model.This model was used to stratify the risk of OS for all patients and to screen the beneficiaries of adjuvant chemotherapy.Results A total of 278 patients were enrolled,and 23 cases(8.3%)received adjuvant chemotherapy.COX multivariate analysis showed that drinking history,ECOG score,method of hepatectomy,lymph node status,number of tumors,and tumor differentiation were independent risk factors for postoperative OS.The Nomogram model had a C-index of 0.690(95%CI:0.646-0.734)in the training cohort and 0.740(95%CI:0.863-0.617)in the validation cohort.According to risk stratification by Nomogram model,in the high-risk group there was a statistically significant difference in survival between adjuvant chemotherapy and non-adjuvant chemotherapy(P=0.033),whereas in the low-risk group,there was no significant difference in survival(P=0.59).Conclusions Nomogram model based on independent risk factors of OS demonstrated excellent predictive capability for survival and could be used to screen,and identify the patients with ICC who benefit from adjuvant chemotherapy.

High glucose level, bacterial infection, and persistent inflammation within the microenvironment are key factors contributing to the delay of diabetic ulcers healing, while traditional therapeutic methods generally fail to address these issues simultaneously. Here, we present a spatiotemporally responsive cascade bilayer microneedle (MN) patch for accelerating diabetic wound healing via local glucose depletion and sustained nitric oxide (NO) release for long-term antibacterial and anti-inflammatory effects. The MN patch (G/AZ-MNs) possesses a degradable tip layer loading glucose oxidase (GOx), as well as a dissolvable base layer encapsulating l-arginine (Arg)-loaded nanoparticles (NPs). After wound administration, the base part rapidly dissolved, resulting in prompt separation of the MN tip within the wound tissue, which subsequently responded to the overexpressed matrix metalloproteinase-9 (MMP-9) in diabetic lesions, leading to the responsive release of GOx. The released enzyme catalyzed glucose into gluconic acid and hydrogen peroxide (H₂O₂), which not only reduced glucose level within the diabetic wound, but also initiated the cascade reaction between H₂O₂ with the Arg that was released from NPs, thereby achieving continuous production of NO for 7 days. Our findings demonstrate that a single administration of the MN patch could effectively heal non-infected or biofilm-infected diabetic wounds with the multifunctional properties.

Objective:To evaluate the diagnostic performance of non-contrast-enhanced Dixon water-fat separation Compressed SENSE (CS-SENSE) whole-heart coronary magnetic resonance angiography (CMRA) at 3.0 T on patients with suspected coronary artery disease (CAD).Method:The study complied with the Declaration of Helsinki. Local ethics committee approved this study and written informed consent was obtained from each patient. In this prospective study, from March 2021 to September 2021, 53 consecutive participants with suspected CAD who were scheduled for X-ray coronary angiography (CAG) were prospectively recruited in Zhongshan Hospital. CMRA was performed with a 3.0 T scanner without contrast agent enhancement during free breathing with Dixon water-fat separation and CS-SENSE methods. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using CAG as the reference method.Results:Acquisition of whole-heart CMRA images was successfully performed in 46 (86.8%) of 53 patients with an average imaging time of (7.8±1.8) min. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of CMRA according to a patient-based analysis were 95.8%(95%CI 78.9%-99.9%), 81.8%(95%CI 59.7%-94.8%), 85.2%(95%CI 66.3%-95.8%), 94.7%(95%CI 74.0%-99.9%), 89.1%(95%CI 76.4%-96.4%), respectively. The areas under the receiver-operator characteristic curve (AUC) from CMRA images according to patient-, vessel-and segment-based analyses were 0.876(95%CI 0.745-0.955), 0.880(95%CI 0.814-0.929), 0.903(95%CI 0.877-0.926), respectively.Conclusion:3.0 T non-contrast-enhanced Dixon water-fat separation CS-SENSE whole-heart CMRA is a promising technique to detect clinically significant coronary stenosis on patients with suspected CAD.