Objective:To investigate the effect of long-term oral aspirin on the changes in the aneurysm sac and persistent type Ⅱ endoleak after endovascular aortic repair (EVAR) of infrarenal abdominal aortic aneurysms based on propensity score-matched analysis.Methods:A retrospective cohort study was used to analyze the clinical data of 133 patients with infrarenal abdominal aortic aneurysms treated with EVAR from January 2019 to December 2021 in the Department of Vascular Surgery, Nanjing Drum Tower Hospital. There were 113 males and 20 females, aged (74.8±7.2) years (range: 59 to 95 years). Patients were divided into the group receiving aspirin ( n=80) and the group not taking aspirin ( n=53) based on whether they took aspirin regularly for a long time after surgery. The two groups were matched in a 1∶1 ratio using propensity score matching and the caliper value was 0.05. Cumulative probability curve was plotted using the Kaplan-Meier method and the Log-rank test was used to compare the differences in primary endpoint events (enlargement of the aneurysm sac, occurrence of persistent type Ⅱ endoleak) and secondary endpoint events (adverse cardiovascular events and clinically relevant bleeding events) between the two groups. Results:The follow-up time was (38.4±11.8) months (range: 30 to 58 months). Among the 133 patients, a total of 25 cases (18.8%) suffered enlargement of the aneurysm sac, including 20 cases in the group receiving aspirin and 5 cases in the group not taking aspirin; 35 cases (26.3%) suffered persistent type Ⅱ endoleak, including 26 cases in the group receiving aspirin and 9 cases in the group not taking aspirin. Adverse cardiovascular events occurred in 11 cases (8.3%) and clinically relevant bleeding events were reported in 5 cases (3.8%). A matched cohort was established after propensity score matching, resulting in 32 cases per group. The survival analysis found that the rate of aneurysm sac enlargement was significantly higher in the group receiving aspirin than that in the group not taking aspirin (Log-rank test: P=0.010), and the incidence of persistent type Ⅱ endoleak was significantly higher than that in the group not taking aspirin (Log-rank test: P=0.019). The incidence of adverse cardiovascular events and clinically relevant bleeding events were not significantly different in two groups (Log-rank test: P=0.061, P=0.286). Conclusions:The risk of aneurysm sac expansion and persistent type Ⅱ endoleak were significantly higher in patients taking long-term aspirin after EVAR than in the group not taking asprin. Therefore, high-risk abdominal aortic aneurysm patients who are prone to aneurysm sac expansion should be evaluated in advance so that the risks and benefits of surgery can be comprehensively evaluated and treatment strategies can be optimized.

Objective:To investigate the effect of long-term oral aspirin on the changes in the aneurysm sac and persistent type Ⅱ endoleak after endovascular aortic repair (EVAR) of infrarenal abdominal aortic aneurysms based on propensity score-matched analysis.Methods:A retrospective cohort study was used to analyze the clinical data of 133 patients with infrarenal abdominal aortic aneurysms treated with EVAR from January 2019 to December 2021 in the Department of Vascular Surgery, Nanjing Drum Tower Hospital. There were 113 males and 20 females, aged (74.8±7.2) years (range: 59 to 95 years). Patients were divided into the group receiving aspirin ( n=80) and the group not taking aspirin ( n=53) based on whether they took aspirin regularly for a long time after surgery. The two groups were matched in a 1∶1 ratio using propensity score matching and the caliper value was 0.05. Cumulative probability curve was plotted using the Kaplan-Meier method and the Log-rank test was used to compare the differences in primary endpoint events (enlargement of the aneurysm sac, occurrence of persistent type Ⅱ endoleak) and secondary endpoint events (adverse cardiovascular events and clinically relevant bleeding events) between the two groups. Results:The follow-up time was (38.4±11.8) months (range: 30 to 58 months). Among the 133 patients, a total of 25 cases (18.8%) suffered enlargement of the aneurysm sac, including 20 cases in the group receiving aspirin and 5 cases in the group not taking aspirin; 35 cases (26.3%) suffered persistent type Ⅱ endoleak, including 26 cases in the group receiving aspirin and 9 cases in the group not taking aspirin. Adverse cardiovascular events occurred in 11 cases (8.3%) and clinically relevant bleeding events were reported in 5 cases (3.8%). A matched cohort was established after propensity score matching, resulting in 32 cases per group. The survival analysis found that the rate of aneurysm sac enlargement was significantly higher in the group receiving aspirin than that in the group not taking aspirin (Log-rank test: P=0.010), and the incidence of persistent type Ⅱ endoleak was significantly higher than that in the group not taking aspirin (Log-rank test: P=0.019). The incidence of adverse cardiovascular events and clinically relevant bleeding events were not significantly different in two groups (Log-rank test: P=0.061, P=0.286). Conclusions:The risk of aneurysm sac expansion and persistent type Ⅱ endoleak were significantly higher in patients taking long-term aspirin after EVAR than in the group not taking asprin. Therefore, high-risk abdominal aortic aneurysm patients who are prone to aneurysm sac expansion should be evaluated in advance so that the risks and benefits of surgery can be comprehensively evaluated and treatment strategies can be optimized.

General anesthesia plays a significant role in modern medicine. However, the precise mechanism of general anesthesia remains unclear, posing a key scientific challenge in anesthesiology. Advances in neuroscience techniques have enabled targeted manipulation of specific neural circuits and the capture of brain-wide neural activity at high resolution. These advances hold promise for elucidating the intricate mechanisms of action of general anesthetics. This review aims to summarize our current understanding of the role of cortical and subcortical nuclei in modulating general anesthesia, providing new evidence of cortico-cortical and thalamocortical networks in relation to anesthesia and consciousness. These insights contribute to a comprehensive understanding of the neural network mechanisms underlying general anesthesia.
Humans ; Anesthesia, General ; Animals ; Nerve Net/physiology* ; Cerebral Cortex/drug effects* ; Neural Pathways/drug effects* ; Thalamus/drug effects* ; Consciousness/drug effects*

Objective:To explore the surgical treatment strategy of stent graft infection after interventional treatment of major iliac artery related diseases.Methods:Retrospective analysis was performed on the clinical data of 6 patients with secondary stent graft infection after interventional treatment for major iliac artery related diseases admitted to the Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University from November 2021 to August 2022.There were 5 males and 1 female,with a mean age of 64 years (range:49 to 79 years).The infection time was 53 days to 3 165 days.All the 6 patients received surgical treatment,including 3 patients who underwent anatomic bypass grafting (axillary arterial-femoral artery bypass,femoral arterial-femoral artery bypass) using artificial vessels,and 3 patients who underwent in situ abdominal aorta reconstruction using bovine pericardium.The perioperative situation,postoperative infection and the occurrence of serious adverse events were recorded,and the safety of different treatment methods and materials was evaluated.Results:All patients successfully completed the operation and no death occurred during hospitalization.Intraoperative blood loss was 2 000 to 5 000 ml,and intraoperative blood transfusion was 1 600 to 5 350 ml.All the patients were followed up for 81 to 395 days after surgery,and the incision healed well,and no reinfection occurred.Postoperative gastrointestinal bleeding occurred in 1 patient,secondary surgery (retroperitoneal hematoma removal) was performed in 1 patient due to postoperative bleeding at the vascular anastomosis,both lower limb amputations were performed in 1 patient due to postoperative lower limb ischemia,and intermittent claudication occurred in 2 patients.All patients were alive at the last follow-up.Conclusion:For patients with aortic stent graft infection,when the infection is not serious and there is enough space to block the proximal and distal aorta,in situ aortic reconstruction is an effective treatment,and different materials can achieve satisfactory results in a short period of time.

Objective:To investigate the study of the correlation between C-reactive protein to albumin ratio (CAR) and restenosis after stenting in patients with lower extremity atherosclerotic occlusive disease(LEASO).Methods:The clinical data of 95 patients with LEASO admitted to the Department of Vascular Surgery of Nanjing Drum Tower Hospital from June 2020 to December 2022 were retrospectively analyzed. There were 67 males and 28 females,aged (73.1±9.4) years (range:51 to 92 years). The patients were classified into the restenosis group ( n=61) and the patency group ( n=34) according to the CT angiography results. Independent sample t test,Mann-Whitney U test and χ2 test were used to compare the data between two groups. Risk factors for restenosis after femoropopliteal artery stenting in patients with LEASO were analyzed using multivariate Cox regression. The relationship between preoperative CAR level and restenosis after stent placement was analyzed. Subject operating characteristic(ROC) curves of CAR were plotted to assess the predictive value of CAR for restenosis after stenting,and the results were expressed as area under the curve (AUC). Results:The aortoiliac calcification grade,number of stents,length of stents,C-reactive protein and CAR levels in restenosis group were higher than those in the patency group,and the serum albumin level was lower than that in the patency group(all P<0.05). And the results of multifactorial Cox regression analysis showed that higher pre-procedure CAR level and lower ABI value was an independent risk factor for in-stent restenosis. The AUC of the ROC curve for restenosis was 0.737(95% CI:0.617 to 0.856),the AUC of the ROC curve for 12-month restenosis was 0.709(95% CI:0.602 to 0.815), and the AUC of the ROC curve for 24-month restenosis was 0.702(95% CI:0.594 to 0.811). Conclusion:Higher pre-procedural CAR levels in patients with LEASO is risk factor for in-stent restenosis,and CAR has a predictive value for restenosis after lower extremity arterial stent dilatation and angioplasty.

Objective:To explore the surgical treatment strategy of stent graft infection after interventional treatment of major iliac artery related diseases.Methods:Retrospective analysis was performed on the clinical data of 6 patients with secondary stent graft infection after interventional treatment for major iliac artery related diseases admitted to the Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University from November 2021 to August 2022.There were 5 males and 1 female,with a mean age of 64 years (range:49 to 79 years).The infection time was 53 days to 3 165 days.All the 6 patients received surgical treatment,including 3 patients who underwent anatomic bypass grafting (axillary arterial-femoral artery bypass,femoral arterial-femoral artery bypass) using artificial vessels,and 3 patients who underwent in situ abdominal aorta reconstruction using bovine pericardium.The perioperative situation,postoperative infection and the occurrence of serious adverse events were recorded,and the safety of different treatment methods and materials was evaluated.Results:All patients successfully completed the operation and no death occurred during hospitalization.Intraoperative blood loss was 2 000 to 5 000 ml,and intraoperative blood transfusion was 1 600 to 5 350 ml.All the patients were followed up for 81 to 395 days after surgery,and the incision healed well,and no reinfection occurred.Postoperative gastrointestinal bleeding occurred in 1 patient,secondary surgery (retroperitoneal hematoma removal) was performed in 1 patient due to postoperative bleeding at the vascular anastomosis,both lower limb amputations were performed in 1 patient due to postoperative lower limb ischemia,and intermittent claudication occurred in 2 patients.All patients were alive at the last follow-up.Conclusion:For patients with aortic stent graft infection,when the infection is not serious and there is enough space to block the proximal and distal aorta,in situ aortic reconstruction is an effective treatment,and different materials can achieve satisfactory results in a short period of time.

Objective:To investigate the study of the correlation between C-reactive protein to albumin ratio (CAR) and restenosis after stenting in patients with lower extremity atherosclerotic occlusive disease(LEASO).Methods:The clinical data of 95 patients with LEASO admitted to the Department of Vascular Surgery of Nanjing Drum Tower Hospital from June 2020 to December 2022 were retrospectively analyzed. There were 67 males and 28 females,aged (73.1±9.4) years (range:51 to 92 years). The patients were classified into the restenosis group ( n=61) and the patency group ( n=34) according to the CT angiography results. Independent sample t test,Mann-Whitney U test and χ2 test were used to compare the data between two groups. Risk factors for restenosis after femoropopliteal artery stenting in patients with LEASO were analyzed using multivariate Cox regression. The relationship between preoperative CAR level and restenosis after stent placement was analyzed. Subject operating characteristic(ROC) curves of CAR were plotted to assess the predictive value of CAR for restenosis after stenting,and the results were expressed as area under the curve (AUC). Results:The aortoiliac calcification grade,number of stents,length of stents,C-reactive protein and CAR levels in restenosis group were higher than those in the patency group,and the serum albumin level was lower than that in the patency group(all P<0.05). And the results of multifactorial Cox regression analysis showed that higher pre-procedure CAR level and lower ABI value was an independent risk factor for in-stent restenosis. The AUC of the ROC curve for restenosis was 0.737(95% CI:0.617 to 0.856),the AUC of the ROC curve for 12-month restenosis was 0.709(95% CI:0.602 to 0.815), and the AUC of the ROC curve for 24-month restenosis was 0.702(95% CI:0.594 to 0.811). Conclusion:Higher pre-procedural CAR levels in patients with LEASO is risk factor for in-stent restenosis,and CAR has a predictive value for restenosis after lower extremity arterial stent dilatation and angioplasty.

Objective:To investigate the effect of ultra-low dose (ULD) computed tomography (CT) scanning on the diagnosis of ankle fractures and the quality of a three-dimensional printing (3DP) model.Methods:This study was a prospective study. A total of 61 patients with clinical ankle fractures treated conservatively in Zhuhai Hospital of Guangdong Hospital of Traditional Chinese Medicine from November 2019 to January 2022 were included in this study. Patients underwent standard dose (SD) CT scan and ultra-low dose (ULD) CT scan, respectively. The tube voltage/tube current of SD and ULD were 120 kV/100 mAs and 80 kV/10 mAs, respectively. Two senior radiologists evaluated the presence of ankle fractures. The effective radiation dose ( E), noise, signal-to-noise ratio (SNR), contrast signal-to-noise ratio (CNR), and CT value of bone cortex minus CT value of peripheral fat (CTc) were compared. The radiologists also evaluated the discoverability, diagnosability, and overall image quality of the fracture line according to Likert′s 5-point scoring method. Two senior orthopedists subjectively evaluated the quality of each 3DP model (model clarity and operation guidance). A score ≥ 3 indicated that the quality of the CT diagnostic image and 3DP model were acceptable. Results:The interval between the two CT scans was (9.23 ± 1.92) d. A total of 94 fracture sites were found. There were no missed diagnosis or misdiagnosis based on the SD and ULD scans.Noise, SNR, and CNR were better on the SD CT scanning ( F=5.92, 9.70, 8.32, P=0.00), however, CTc was higher on the ULD scans ( F=27.55, P<0.01). The image scores of the SD and ULD scans were (4.97 ± 0.18) and (4.21 ± 0.71), and the quality scores of the 3DP model (4.99 ± 0.01) and (4.87 ± 0.34), respectively. The SD scans were better than the ULD scans with respect to CT image quality and 3DP model quality ( Z=-6.88, -2.91, P<0.01), but both were considered suitable to meet clinical needs (all ≥ 3 points). The E associated with SD and ULD scannings were (34.68 ± 4.96) μSV and (1.04 ± 0.10) μSV, respectively. The latter was thus significantly better than the former ( F=38.77, P =0.00). Conclusions:The E value of ULD scanning is about 3.00% of SD scanning E, which can meet the needs of clinical diagnosis of ankle fracture and 3DP model printing diagnosis.

MicroRNA(miRNA) affect various biological processes such as cell differentiation, proliferation, and apoptosis by inhibiting the translation of target genes after transcription and are widely involved in the regulation of immune and inflammatory responses in organisms. Autoimmune liver diseases are a group of chronic inflammatory diseases of the hepatobiliary system mediated by abnormal immunity, and abnormal immune inflammatory response of liver tissue with the involvement of miRNA is closely associated with the development and progression of autoimmune liver diseases. This article reviews the current research advances in miRNA in autoimmune liver diseases.

Objective To evaluate the clinical effects of intra-articular injection of autologous adipose derived stem cells (ADSCs) or ADSCs combined with hyaluronate acid (HA) for knee osteoarthritis.Methods From May 2013 to May 2015,a total of 108 patients with knee osteoarthritis (Kellgren-Lawrence grades:1-3) were recruited in the present study.The patients were randomly divided into three groups:ADSCs,HA and ADSCs+HA.All patients (36 cases in each group) were injected with the drug in the joint cavity once a week for three weeks.The methods used for evaluating the clinical manifestations and joint damage on MRI included visual analogue scale (VAS),Western Ontario and McMaster University (WOMAC) osteoarthritis index and whole-organ magnetic resonance imaging score (WORMS).Evaluations were conducted before injection and at 3,6,12,24 and 36 months after injection.Results All patients were followed up for 36 months without any dissociation.No adverse reaction was observed during the treatment and at the follow-up duration.The VAS score and WOMAC total score of the ADSCs group and the ADSCs+HA group were better than those in the HA group at each time point after injection (P＜0.05).The average VAS of the ADSCs group decreased from 4.14±1.42 at pre-injection to 2.39±1.74 at 36 months after injection.The WOMAC total score decreased from 42.86± 31.24 to 27.17±27.99.The average VAS in the ADSCs+HA group decreased from 4.25±1.13 to 2.31±1.74,and the WOMAC total score decreased from 34.92±22.62 to 21.33±21.38.However,the average VAS and WOMAC total score of the HA group at 36 months after injection were higher than those before the injection.In terms of the VAS at 3 months after injection,the ADSCs+HA group scored better than that of the ADSCs group (P＜0.05).There was no significant difference in WOMAC scores between the ADSCs and ADSCs+HA groups at each time point after injection (P＞0.05).The WORMS cartilage injury score improved in 10 patients with ADSCs after injection (P＜0.05).The subchondral bone wear score improved as well (P＜0.05).The difference of WORMS cartilage injury scores before and after injection was correlated with the difference of the WOMAC total score (r=0.790,P=0.007) and that of VAS score difference (r=0.800,P=0.005).Conclusion Autologous ADSCs and ADSCs combined with HA intra-articular injections can effectively relieve pain and improve function of patients with knee osteoarthritis for 36 months.In addition,ADSCs combined with HA injections can relieve pain more effectively within a short duration.Cartilage repair is associated with joint function improvement.