Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

[Objective] : To improve the accuracy and professionalism of question-answering (QA) model in traditional Chinese medicine (TCM) lung cancer by integrating large language models with structured knowledge graphs using the knowledge graph (KG) to text-enhanced retrieval-augmented generation (KG2TRAG) method. [Methods] : The TCM lung cancer model (TCMLCM) was constructed by fine-tuning ChatGLM2-6B on the specialized datasets Tianchi TCM, HuangDi, and ShenNong-TCM-Dataset, as well as a TCM lung cancer KG. The KG2TRAG method was applied to enhance the knowledge retrieval, which can convert KG triples into natural language text via ChatGPT-aided linearization, leveraging large language models (LLMs) for context-aware reasoning. For a comprehensive comparison, MedicalGPT, HuatuoGPT, and BenTsao were selected as the baseline models. Performance was evaluated using bilingual evaluation understudy (BLEU), recall-oriented understudy for gisting evaluation (ROUGE), accuracy, and the domain-specific TCM-LCEval metrics, with validation from TCM oncology experts assessing answer accuracy, professionalism, and usability. [Results] : The TCMLCM model achieved the optimal performance across all metrics, including a BLEU score of 32.15%, ROUGE-L of 59.08%, and an accuracy rate of 79.68%. Notably, in the TCM-LCEval assessment specific to the field of TCM, its performance was 3% − 12% higher than that of the baseline model. Expert evaluations highlighted superior performance in accuracy and professionalism. [Conclusion] TCMLCM can provide an innovative solution for TCM lung cancer QA, demonstrating the feasibility of integrating structured KGs with LLMs. This work advances intelligent TCM healthcare tools and lays a foundation for future AI-driven applications in traditional medicine.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Objective:To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair (F/B-TEVAR) in patients with complex aortic arch disease.Methods:The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed .Results:There were 46 cases suffering from postoperative complications (22.8%). The risk factors with statistical significance included aortic atherosclerotic plaque [ OR=2.843; 95% CI (1.4-5.6); P<0.01], aortic intramural thrombosis [ OR=2.358; 95% CI (1.2-4.6), P=0.011], the aortic dilatation [ OR=4.219; 95% CI (1.6-11.3), P<0.01], the history of stroke [ OR=2.088; 95% CI (1.1-4.1), P=0.032], smoking history [ OR=2.680; 95% CI: (1.3-5.5); P<0.01], duration of surgery [ OR=1.9; 95% CI: (1.2-2.9); P=0.042].While the application of 3D printing assistive technology [ OR=0.392; 95% CI: (0.2-0.9); P=0.048] was in a negative correlation with postoperative complication. Conclusions:The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque, aortic intramural thrombosis, the aortic dilatation, the history of stroke, smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

Background and Aims:Rupture is the most serious complication of abdominal aortic aneurysm,requiring rapid diagnosis,emergency surgery,and posing significant surgical challenges,with high mortality rates. Currently,there is very limited reporting on ruptured abdominal aortic aneurysm (rAAA) in our country,which presents numerous difficulties for the prevention and treatment of rAAA. This study collected the data of epidemiological characteristics,treatment outcomes,and prognosis of rAAA patients from multiple centers with a large sample size,analyzing the current status and trends of rAAA surgery in China over the past decade,aiming to provide reference for clinical practice.Methods:The clinical and follow-up data of 161 rAAA patients treated at five major vascular surgery centers (50 from Drum Tower Hospital Affiliated to the Medical School,Nanjing University;19 from the First Affiliated Hospital of Anhui Medical University;33 from the Second Affiliated Hospital of Nanchang University;31 from Qilu Hospital,Shandong University;and 28 from the First Affiliated Hospital of the University of Science and Technology of China) were retrospectively analyzed.Results:Among the 161 patients,124 (77.02％) were male and 37 (22.98％) were female,with an average age of 68.27 years. The median age at diagnosis was 70 years for males and 71 years for females. The overall mean aneurysm diameter was 7.11 cm,with males at 7.72 cm and females at 6.82 cm,showing a statistically significant difference (P<0.05). The main comorbidities were hypertension and coronary artery disease. Over 80％ of patients presented with abdominal pain as the initial symptom,while 15％ presented with low back pain,and 8 patients sought medical attention for dizziness or visual disturbances. Among the 161 patients,86 underwent open surgical repair (OSR),and 75 received endovascular aneurysm repair (EVAR). The proportion of EVAR has increased annually,reaching nearly 70％ in the past five years,and up to 90％ in patients aged over 70 years. All OSR procedures were performed under general anesthesia,while 20 EVAR cases used local anesthesia and 55 used general anesthesia. Compared to the OSR group,the EVAR group showed significant differences in operative time (231.77 min vs. 162.49 min),intraoperative blood transfusion volume (1578.56 mL vs. 843.87 mL),length of hospital stay (21.21 d vs. 15.34 d),ICU stay duration (8.28 d vs. 5.49 d),and hospitalization costs (108500 CNY vs. 132800 CNY) (all P<0.05). No significant differences were found between the EVAR and OSR groups in total complications or perioperative mortality rates (both P>0.05). The main causes of perioperative death included respiratory and circulatory failure,acute myocardial infarction,and severe infections. Postoperative follow-up was effectively conducted for 92 patients,with follow-up durations ranging from 10 to 142 months. Survival analysis revealed no significant difference in survival rate between the OSR and EVAR groups (P=0.3182).Conclusion:rAAA is a rare and high-risk disease,with certain clinical differences between male and female patients. The number of EVAR procedures has increased rapidly;however,EVAR has not shown a significant advantage over OSR in improving long-term survival rates.

Background and Aims:Rupture is the most serious complication of abdominal aortic aneurysm,requiring rapid diagnosis,emergency surgery,and posing significant surgical challenges,with high mortality rates. Currently,there is very limited reporting on ruptured abdominal aortic aneurysm (rAAA) in our country,which presents numerous difficulties for the prevention and treatment of rAAA. This study collected the data of epidemiological characteristics,treatment outcomes,and prognosis of rAAA patients from multiple centers with a large sample size,analyzing the current status and trends of rAAA surgery in China over the past decade,aiming to provide reference for clinical practice.Methods:The clinical and follow-up data of 161 rAAA patients treated at five major vascular surgery centers (50 from Drum Tower Hospital Affiliated to the Medical School,Nanjing University;19 from the First Affiliated Hospital of Anhui Medical University;33 from the Second Affiliated Hospital of Nanchang University;31 from Qilu Hospital,Shandong University;and 28 from the First Affiliated Hospital of the University of Science and Technology of China) were retrospectively analyzed.Results:Among the 161 patients,124 (77.02％) were male and 37 (22.98％) were female,with an average age of 68.27 years. The median age at diagnosis was 70 years for males and 71 years for females. The overall mean aneurysm diameter was 7.11 cm,with males at 7.72 cm and females at 6.82 cm,showing a statistically significant difference (P<0.05). The main comorbidities were hypertension and coronary artery disease. Over 80％ of patients presented with abdominal pain as the initial symptom,while 15％ presented with low back pain,and 8 patients sought medical attention for dizziness or visual disturbances. Among the 161 patients,86 underwent open surgical repair (OSR),and 75 received endovascular aneurysm repair (EVAR). The proportion of EVAR has increased annually,reaching nearly 70％ in the past five years,and up to 90％ in patients aged over 70 years. All OSR procedures were performed under general anesthesia,while 20 EVAR cases used local anesthesia and 55 used general anesthesia. Compared to the OSR group,the EVAR group showed significant differences in operative time (231.77 min vs. 162.49 min),intraoperative blood transfusion volume (1578.56 mL vs. 843.87 mL),length of hospital stay (21.21 d vs. 15.34 d),ICU stay duration (8.28 d vs. 5.49 d),and hospitalization costs (108500 CNY vs. 132800 CNY) (all P<0.05). No significant differences were found between the EVAR and OSR groups in total complications or perioperative mortality rates (both P>0.05). The main causes of perioperative death included respiratory and circulatory failure,acute myocardial infarction,and severe infections. Postoperative follow-up was effectively conducted for 92 patients,with follow-up durations ranging from 10 to 142 months. Survival analysis revealed no significant difference in survival rate between the OSR and EVAR groups (P=0.3182).Conclusion:rAAA is a rare and high-risk disease,with certain clinical differences between male and female patients. The number of EVAR procedures has increased rapidly;however,EVAR has not shown a significant advantage over OSR in improving long-term survival rates.

Objective:To evaluate the mid-term results of fenestrated/branched endovascular aortic repair (f/b EVAR) for the treatment of thoracoabdominal aortic aneurysms. M ethods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed. Results:There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%. 100 cases (95.2%) were followed-up, 6 cases (5.7%) received reoperation interventions, and 11 cases (10.5%) died. During the follow-up period, 69 cases had complete imaging data. Based on the recent CT date of the thoracoabdominal aorta, 58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling; there were 31 cases (29.5%) of endoleaks, including 7 cases (6.7%) of type Ⅰb endoleaks, 8 cases (7.6%) of type Ⅱ, 1 case (0.95%) of type Ⅲa, 13 cases (12.4%) of type Ⅲc endoleaks and 2 cases (1.9%) of type Ⅳ. Conclusions:The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR. Internal leakage remains key point for f/b EVAR.

Molecular knowledge of human gastric corpus epithelium remains incomplete. Here, by integrated analyses using single-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and single-cell assay for transposase accessible chromatin sequencing (scATAC-seq) techniques, we uncovered the spatially resolved expression landscape and gene-regulatory network of human gastric corpus epithelium. Specifically, we identified a stem/progenitor cell population in the isthmus of human gastric corpus, where EGF and WNT signaling pathways were activated. Meanwhile, LGR4, but not LGR5, was responsible for the activation of WNT signaling pathway. Importantly, FABP5 and NME1 were identified and validated as crucial for both normal gastric stem/progenitor cells and gastric cancer cells. Finally, we explored the epigenetic regulation of critical genes for gastric corpus epithelium at chromatin state level, and identified several important cell-type-specific transcription factors. In summary, our work provides novel insights to systematically understand the cellular diversity and homeostasis of human gastric corpus epithelium in vivo.
Humans ; Epigenesis, Genetic ; Gastric Mucosa/metabolism* ; Chromatin/metabolism* ; Stem Cells ; Epithelium/metabolism* ; Fatty Acid-Binding Proteins/metabolism*

Objective:To explore the relationship between the subcomponents of executive function and situation awareness.Methods:A total of 73 cadets of our school were selected to complete a flight simulation mission. The situation awareness rating technique (SART) scores, situation awareness global assessment technique (SAGAT) scores and flight performance were recorded as dependent variables. Spatial n-back task, Go/Nogo task, Stroop task and digital shifting task were used to measure the subcomponents of executive functions and perform independent multiple linear regression analysis as predictive variables.Results:Pearson correlation analysis showed that updating score was significantly and positively correlated with response inhibition, SART, SAGAT and flight performance ( r=0.235, 0.285, 0.298, 0.264, P=0.049, 0.016, 0.012, 0.025), response inhibition score was significantly and positively correlated with SAGAT and flight performance ( r=0.349, 0.243, P=0.003, 0.041), interference control score was only negatively correlated with cognitive shifting and flight performance ( r=-0.350, -0.235, P=0.003, 0.045), cognitive shifting score was significantly and positively correlated with SART, SAGAT and flight performance ( r=0.249, 0.275, 0.364, P=0.039, 0.019, 0.002). Further regression analysis indicated that updating score has a significant predictive effect on SART ( t=2.201, P=0.031), updating and response inhibition scores have significant predictive effects on SAGAT ( t=2.270, 2.546, P=0.026, 0.013), and updating and cognitive shifting scores have significant predictive effects on flight performance ( t=2.508, 2.553, P=0.015, 0.013). Conclusions:The subcomponents of executive function are significantly with the level of situation awareness and have predictive significance.

Objective:To explore the relationship between the subcomponents of executive function and situation awareness.Methods:A total of 73 cadets of our school were selected to complete a flight simulation mission. The situation awareness rating technique (SART) scores, situation awareness global assessment technique (SAGAT) scores and flight performance were recorded as dependent variables. Spatial n-back task, Go/Nogo task, Stroop task and digital shifting task were used to measure the subcomponents of executive functions and perform independent multiple linear regression analysis as predictive variables.Results:Pearson correlation analysis showed that updating score was significantly and positively correlated with response inhibition, SART, SAGAT and flight performance ( r=0.235, 0.285, 0.298, 0.264, P=0.049, 0.016, 0.012, 0.025), response inhibition score was significantly and positively correlated with SAGAT and flight performance ( r=0.349, 0.243, P=0.003, 0.041), interference control score was only negatively correlated with cognitive shifting and flight performance ( r=-0.350, -0.235, P=0.003, 0.045), cognitive shifting score was significantly and positively correlated with SART, SAGAT and flight performance ( r=0.249, 0.275, 0.364, P=0.039, 0.019, 0.002). Further regression analysis indicated that updating score has a significant predictive effect on SART ( t=2.201, P=0.031), updating and response inhibition scores have significant predictive effects on SAGAT ( t=2.270, 2.546, P=0.026, 0.013), and updating and cognitive shifting scores have significant predictive effects on flight performance ( t=2.508, 2.553, P=0.015, 0.013). Conclusions:The subcomponents of executive function are significantly with the level of situation awareness and have predictive significance.