Objective:To investigate the efficacy and safety of different endovascular interventional treatments for extracranial carotid artery pseudoaneurysms.Method:The clinical data of 48 patients with extracranial carotid artery pseudoaneurysms treated with multiple endovascular procedures were retrospectively analyzed in the First Affiliated Hospital of Zhengzhou University from February 2012 to February 2024. The patients presented with a total of 48 extracranial carotid pseudoaneurysms, ranging in diameter from 2.5 to 34.2 mm [mean (12.0±9.6) mm]. The lesions were distributed as follows: 25 in the internal carotid artery, 16 in the external carotid artery and 7 in the common carotid artery. The selection of endovascular interventional techniques was tailored to individual cases according to the pseudoaneurysm size, anatomical location, morphological configuration, and specific features of the parent artery. Perioperative adverse events were monitored, and the efficacy of individualized endovascular interventional therapy was evaluated based on immediate postoperative and 6-month follow-up digital subtraction angiography (DSA) findings, including aneurysm occlusion and in-stent patency.Result:The treatment modalities included parent artery coiling occlusion ( n=16), overlapping braided carotid stent implantation ( n=3), covered stent placement ( n=23), combined implantation of covered stent and braided carotid stent implantation ( n=4) and flow-diverting stent implantation ( n=2) based on the characteristics of the pseudoaneurysms. Endovascular interventional procedures were successfully completed in 47 patients (technical success rate: 97.9%). Immediate postoperative DSA revealed residual pseudoaneurysm at the distal end of the stent in 1 case. Among the remaining cases, complete aneurysm obliteration or faint opacification was observed, with stent lumen patency confirmed in 31 cases and complete parent artery occlusion achieved in 16 cases. In one case involving a patient who underwent flow-diverting stent implantation, a pulsatile vascular murmur reappeared in the neck one week postoperatively. Follow-up DSA revealed stent migration into the aneurysm sac. After retrieval and removal of the displaced stent, combined implantation of a covered stent and a braided carotid artery stent was performed. Postoperative angiography confirmed complete aneurysm occlusion and patent parent artery blood flow. No severe perioperative adverse events (e.g., aneurysm rupture) were observed. During a postoperative follow-up period of 6.2-24.2 months, DSA at 6 months revealed mild in-stent or distal segment stenosis in 2 patients who underwent covered stent implantation. The remaining 46 patients exhibited complete aneurysm occlusion with no significant stenosis observed within the stent lumen. At the final follow-up, all patients demonstrated resolution or significant alleviation of clinical symptoms. Conclusion:Individualized endovascular interventional therapy demonstrates favorable safety and efficacy profiles in managing extracranial carotid artery pseudoaneurysms.

Biliary atresia is often complicated with portal hypertension, which induces a series of hemodynamic changes leading to splenomegaly. Splenomegaly is a common in patients with biliary atresia, which indicates the status of portal hypertension, esophageal varices, and the progression of hepatic fibrosis. Furthermore, it can help monitor the native liver survival status after Kasai procedure and the need for liver transplantation. For patients with biliary atresia presenting splenomegaly and/or hypersplenism, the treatment strategy, involving the pharmacological or surgical options, should be individually selected based on specific clinical condition. This article reviews the value of splenomegaly in the diagnosis and management of biliary atresia, aiming to provide references for clinical practice.

Objective To observe the ultrasonic manifestations of local recurrence(LR)of breast cancer after surgery.Methods Totally 82 female breast cancer patients with local hypoechoic in surgical area who underwent ultrasound follow-up were enrolled and divided into LR group(n=18)and non LR group(n=64)according to the local hypoechoic was LR or not.Clinical data and ultrasonic manifestations of primary lesion before operation and postoperative local hypoechoic were observed and compared between groups.Results Significant differences of surgical resection type,molecular subtype,status of smooth muscle actin,Calponin status,Ki-67 status,clinical staging,the maximum diameter and posterior echo of the primary lesion,as well as of involved tissue layer,location,long axis parallel to the skin or not,edge,internal echo,posterior echo,skin change and Adler blood flow grading of local hypoechoic in resection area were found between groups(all P＜0.05).Conclusion Ultrasonic manifestations of LR of breast cancer after surgery had certain characteristics.

Objective To investigate the effects of different timing of initiation of rivaroxaban anti-coagulation therapy on the efficacy and bleeding risk of atrial fibrillation patients after stroke.Methods A total of 336 patients with atrial fibrillation and stroke admitted in our hospital be-tween January 2021 and December 2023 were consecutively enrolled,and randomly divided into an experimental group(165 cases)and a control group(171 cases).The experimental group received rivaroxaban treatment within 48 h of symptom onset,whereas the control group initiated oral ri-varoxaban treatment on the 3rd,6th,and 12th day post-stroke onset,respectively,depending on stroke severity(mild,moderate,and severe).Their baseline clinical data were collected,and all of them were followed up till 90 d after stroke.The incidences of recurrent ischemic stroke,symp-tomatic intracranial hemorrhage and extracranial hemorrhage,mortality,and proportion of pa-tients with mRS score≤ 2 and distribution of the score were observed and analyzed in the two groups.Results During a 90-day follow-up period,the patients with moderate stroke from the ex-perimental group of patients exhibited a significantly lower rate of recurrent ischemic stroke than those in the control group(5.4％vs 15.9％,P=0.037).However,for patients with mild and se-vere stroke,no obvious difference was observed in the primary endpoint of recurrent ischemic stroke between the experimental and control groups(3.0％vs 3.2％,12.5％vs 14.8％,P＞0.05).Though no statistical differences were observed,lower rates of symptomatic intracranial hemor-rhage(1.5％vs 3.2％,5.4％vs 9.8％),reduced incidence of extracranial hemorrhage(9.0％vs 14.5％,12.2％vs 15.9％),and lower mRS score[1(0,2)vs 1(1,2),3(1,4)vs 3(2,4)]were seen in the patients with mild and moderate stroke from the experimental group when compared with the control group(P＞0.05).Similarly,there were no statistically differences for the severe stroke patients between the experimental and control groups(P＞0.05)in the incidence of extracranial hemorrhage(20.8％vs 22.2％),rate of symptomatic intracranial hemorrhage(20.8％vs 7.4％),mortality(8.3％vs 3.7％),and mRS score[4(3,4)vs 3(3,4)].Two patients from the experimen-tal group died,with one case due to secondary pulmonary infection and the other due to brainstem hemorrhage.In the control group,only one death occurred due to brainstem hemorrhage.Conclu-sion For atrial fibrillation patients,anticoagulation with rivaroxaban within 48 h after stroke has no significant increase in the risk of bleeding,reduces the proportion of recurrent ischemic stroke in patients with moderate stroke,and may improve the prognosis of patients.

Objective To investigate the clinical efficacy and safety of intravenous thrombolysis with tenecteplase in the treatment of CWS.Methods A prospective study was conducted on 136 CWS patients consecutively admitted in Department of Neurology of Zhengzhou People's Hospital from March 2019 to March 2024.They were randomly divided into a tenecteplase group(67 cases)and a control group(69 cases).NIHSS was used to evaluate the recovery of neurological function after treatment.mRS was employed to assess long-term prognosis.Results Significantly larger proportion of white matter lesions and higher baseline SBP level were observed in the tenecteplase group than the control group(P＜0.05).The tenecteplase group obtained obviously greater ratio of overall recovery than the control group,with notably lower NIHSS score,incidence of new CWS attacks and proportion of new acute cerebral infarction at 24 and 72 h and 7 d after treat-ment(P＜0.05,P＜0.01).Moreover,the proportion of mRS score of 0-2 was notably greater,while that of the score of 3-6 was lower in the tenecteplase group than the Control group(P＜0.05).Intravenous thrombolysis with tenecteplase was an influencing factors for 90-day mRS score of 0-2 and of 3-6 in the CWS patients(OR=0.264,95％CI:0.089-0.813;OR=4.144,95％CI:1.184-14.506,P＜0.05).Conclusion Intravenous thrombolysis with tenecteplase for CWS significantly improves the proportion of patients with good prognosis.

BACKGROUND:Paraspinal muscle degeneration is one of the main causative factors of low back pain,and the changes in the paraspinal muscles are closely related to its occurrence and development.At present,clinical practitioners focus on the changes of paraspinal muscles in degenerative lumbar diseases to prevent and treat lumbar diseases,but ignore the connection and related mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles.OBJECTIVE:To comprehensively summarize the interaction between paraspinal muscles and lumbar intervertebral discs,and to review the relationship and mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles,in order to provide a reference for clinical prevention and treatment.METHODS:Chinese keywords"lumbar intervertebral disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,magnetic resonance imaging"were used to search the relevant literature in Chinese databases such as CNKI,VIP,and WanFang.English keywords"lumbar disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,MRI"were used to search the relevant literature in databases such as Medline,PubMed,and Web of Science.After preliminary screening of titles and abstracts,68 articles were finally selected for result analysis according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Researchers have used various methods to evaluate the degree of paraspinal muscle degeneration,and at the same time evaluated the degree of lumbar intervertebral disc degeneration according to the Pfirrmann grading system.It is found that clinical diagnosis and treatment should pay attention to gender differences,and the influence of factors such as obesity on the degeneration of intervertebral discs and muscles,in order to develop more individualized treatment plans.(2)There is a certain correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration,but the research results are controversial.Most studies have found that fat infiltration of the paraspinal muscles(especially the multifidus muscle)is positively correlated with the degree of lumbar intervertebral disc degeneration.(3)It is currently believed that the three mechanisms of disuse atrophy,denervation,and inflammatory factors may interact with each other to jointly lead to structural and functional changes in the paraspinal muscles,which are closely related to the occurrence of lumbar intervertebral disc degeneration and low back pain.(4)Clinically,attention should be paid to the changes of the muscles at the level below the affected nerve root segment,which is helpful for the diagnosis and localization of lumbar radiculopathy.At the same time,inhibition of inflammatory factors may become a potential target for treatment.(5)Clinically,the first step is to correct nerve root compression through appropriate medication or surgery to control inflammatory reactions and nerve root pain,and then carry out targeted muscle rehabilitation training.If necessary,consider using new treatment methods such as interferential current electrical stimulation to improve the patient's symptoms and prognosis.

Objective To investigate the changes of inflammatory factors in bronchoalveolar lavage fluid(BALF),lung tissue,and serum of a rat pneumonia model induced by inhalation of lipopolysaccharides(LPS).Methods Three days after modeling by LPS 4 mg/mL inhalation,15 min/d,was conducted while monitoring the particle size distribution and aerosol concentration of LPS,the degree of inflammation in lung tissues of rats in each group was observed via HE staining,and neutrophils in BALF were counted by microscope.The contents of interferon gamma(IFN-γ),interleukin-1 beta(IL-1 β),IL-4,IL-5,IL-6,IL-10,IL-13,tumor necrosis factor alpha(TNF-α),and KC/GRO in lung tissue,serum,and BALF were detected by Meso Scale Discovery.Results The lung histopathology of model rats displayed focal and diffuse alveolar epithelial necrosis with shedding and the aggregation and infiltration of inflammatory cells.The particle size distribution of atomized LPS was as follows,Dv(10)=0.6974μm,Dv(50)=3.387 μm,Dv(90)=8.836 μm.The aerosol concentration of LPS was 4.08 g/m3,and the calculated inhalation dose for rats was 47.10 mg/kg.The neutrophil count(P＜0.01)and contents of IL-1β,IL-6,and TNF-α(P＜0.05,P＜0.001,P＜0.001)in the BALF,and the contents of IL-1β,IL-6,and KC/GRO in lung tissue(P＜0.01,P＜0.05,P＜0.01),of model rats were significantly increased.No biologically significant changes were observed in inflammatory factor levels in the serum.Conclusions In the acute pneumonia model induced by inhalation of LPS,significant changes in inflammatory factors such as IL-1β,IL-6,KC/GRO,and TNF-α were observed in both lung tissue and bronchoalveolar lavage fluid(BALF),while no notable changes in these inflammatory factors were detected in serum.This indicates that the inflammation responses are primarily localized in the lungs.

Objective To investigate the value of afterload-related cardiac performance(ACP)in evaluating cardiac dysfunction and prognosis in patients with septic shock.Methods This prospective observational study included 45 patients with septic shock.The patients were divided into the death(n=21)or survival(n=24)group according to whether they died within 28 days.Baseline and labora-tory data were collected within 24 h.Cardiac function indices were collected and monitored at 0,6,12,18,and 24 h using the pulse index continuous cardiac output.Variables affecting the prognosis were included in the multivariate Cox proportional hazard model.Prognosis was predicted using a receiver operating characteristic(ROC)curve.Results The ACP in the death group was significantly lower than that in the survival group at 0,6,12,18,and 24 h(all P＜0.05).Logistic regression analysis showed that decreased ACP,increased acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,increased sequential organ failure assessment(SOFA)score,increased fluid balance at 24 h,increased vasoactive-inotropic score,increased central venous pressure,and decreased mean arterial pressure were risk factors for poor prognosis.The Cox proportional hazard model showed that ACP,APACHE Ⅱ score,and SOFA score were independent risk factors influencing prognosis.ROC analysis showed that the area under the curve of ACP was the largest at 24 h,which was the best time point for predicting 28-day mortality.The corresponding sensitivity,specificity,and best cutoff values were 76.20％,91.70％,and 75.16％,respectively.Conclusion ACP could be used as a valuable index to evaluate cardiac dysfunction and as an independent risk factor for poor prognosis in patients with septic shock.

Objective To investigate the therapeutic efficacy of inspiratory muscle training(IMT)combined with external diaphragm pacing(EDP)in elderly patients with chronic heart failure(CHF).Methods 147 patients with CHF admitted to the Department of Cardiology of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2024 to October 2024 were selected,of which 38 patients were in the conventional drug therapy group(standard care group),52 patients were in the conventional drug therapy+EDP therapy(dual therapy group),and 57 patients were in the conventional drug therapy+EDP therapy+IMT therapy(triple therapy group).Com-parative analyses were performed for maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),handgrip strength,6-minute walk distance(6MWD),modified Medical Research Council(mMRC)scores,resting heart rate,and blood pressure before treatment and 4 weeks post-intervention.Results After treatment,The dual therapy group demonstrated higher MIP,6MWD,and lower mMRC scores than the standard care group(P<0.05).The triple therapy group exhibited superior improvements in MIP,MEP,handgrip strength,6MWD,and lower mMRC scores compared to both standard care and dual therapy groups(P<0.05),with additional benefits including lower resting systolic blood pressure versus dual therapy group(P<0.05)and reduced resting heart rate compared to standard care group(P<0.05).Conclusion The combined IMT and EDP significantly enhances respiratory and upper limb muscle strength in CHF patients,effectively improves cardiopulmonary function,alleviates dys-pnea,and reduces resting heart rate and blood pressure,thus improving the quality of life.It is worthy of clinical promotion and application.

Objective:To investigate the epidemiological status of knee joint tuberculous arthritis in 52 patients and to identify risk factors for recurrence after treatment.Methods:A retrospective analysis was conducted involving 52 patients with knee joint tuberculous arthritis who received treatment at Shaanxi Provincial Tuberculosis Prevention and Control Hospital from January 2018 to June 2023. Patients concurrently diagnosed with knee joint tuberculous arthritis were identified from the hospital's records, and their clinical data were collected. Logistic regression analysis was performed to determine the risk factors associated with recurrence of knee joint tuberculous arthritis.Results:The incidence of knee joint tuberculous arthritis is higher in males than in females, with the most affected age group being 40-60 years old. The most common form of the disease is total knee joint tuberculosis. The positive rate of Mycobacterium tuberculosis culture is 100%, indicating high diagnostic value. Logistic regression analysis results show that the following are independent risk factors for recurrence of knee joint tuberculous arthritis: age > 45 years ( OR = 3.080, 95% CI: 1.445-6.564, P = 0.004), body mass index < 18.5 kg/m2 ( OR = 6.062, 95% CI: 1.621-22.671, P = 0.007), smoking ( OR = 2.649, 95% CI: 1.032-6.799, P = 0.043), diabetes ( OR = 3.629, 95% CI: 1.799-7.321, P = 0.007), duration of tuberculosis symptoms > 6 months ( OR = 5.507, 95% CI: 1.210-25.055, P = 0.027), non-compliance with anti-tuberculosis medication ( OR = 3.152, 95% CI: 1.149-8.649, P = 0.026), elevated erythrocyte sedimentation rate ( OR = 3.297, 95% CI: 1.223-8.889, P = 0.018), and elevated C-reactive protein ( OR = 2.519, 95% CI: 1.025-6.194, P = 0.044). Conclusions:Knee joint tuberculous arthritis is more prevalent in males, with the most affected age group being 40-60 years old. Clinically, a comprehensive diagnosis that includes clinical evaluation, imaging, and bacterial culture is necessary. Lesion excision surgery can result in a good prognosis. Independent risk factors for the recurrence of knee joint tuberculous arthritis include age > 45 years, body mass index < 18.5 kg/m2, smoking, diabetes, duration of tuberculosis symptoms > 6 months, non-compliance with anti-tuberculosis medication, elevated serum erythrocyte sedimentation rate, and elevated C-reactive protein.