Zhonghua yi xue za zhi最新文献

Robot-assisted deep brain stimulation (DBS) surgical systems in neurosurgery have demonstrated significant advantages in enhancing operative precision, reducing complications, and improving clinical outcomes. With advancements in robot-assisted surgical systems and surgical techniques, coupled with their wider adoption in DBS procedures, there is a growing need to further standardize and improve surgical workflows, technical details,etc. This consensus focuses on neurosurgery robot-assisted DBS surgery. Through proposing recommendation questions, summarizing and evaluating evidence, formulating recommendations, expert discussions and clinical practice, eight recommendations were developed covering aspects such as indications, preoperative preparation, surgical planning, registration, anesthesia, key operative steps, and postoperative assessment. The aim is to enhance surgical precision and safety, improve patient prognosis, comprehensively present the latest research progress in robot-assisted DBS surgery, and the collective expertise and opinions of experts in the field, thereby providing guidance for the clinical practice of DBS surgery.

Objective: To evaluate the therapeutic efficacy of interventional radiology (IR) combined with delayed aortic repair in patients with acute type A aortic dissection (ATAAD) with concurrent mesenteric malperfusion syndrome (MeMPS), and explore the risk factors for visceral organ failure and death after IR. Methods: A total of 693 patients with ATAAD admitted to Xijing Hospital from January 2018 to March 2022 were retrospectively analyzed. The therapeutic outcomes of IR combined with delayed aortic repair in patients with MeMPS were observed. Logistic regression was used to analyze the risk factors for mortality due to visceral organ failure after IR. Results: Among the 693 patients, 656 patients (507 males and 149 females) aged [M(Q₁, Q₃)] 52 (44, 58) years did not have any organ malperfusion syndrome, while all 37 (31 males and six females) aged 50 (46, 55) years with MeMPS underwent IR followed by delayed aortic repair after clinical improvement. The median symptom onset time in MeMPS patients was 0.3 (0.2, 0.4) d, and the overall in-hospital mortality was 43.2% (16/37). Some patients also had multiple organ malperfusion syndrome (kidney: 10 cases; lower extremity: two cases). Among the 24 MeMPS patients (64.9%) whose condition improved after IR and who subsequently underwent aortic repair, the in-hospital mortality rate showed no significant difference compared to patients without MeMPS [12.5% (3/24) vs 8.2% (54/656), P=0.714]. Similarly, there were no significant differences in the 1-, 3-, and 5-year survival rates between the two groups (79.2%, 54.4%, 54.4% vs 81.2%, 78.9%, 77.7%, respectively; P=0.300). After IR, death due to organ failure was the main reason preventing aortic repair in MeMPS patients (organ failure: 10 cases; aortic rupture: three cases). Compared with survivors after IR, patients who died of organ failure had higher age, creatinine, D-dimer, and fibrinogen degradation products (FDP), and a smaller true lumen diameter of the abdominal aorta at the diaphragm level (all P<0.05). Multivariate logistic regression analysis identified that the true lumen diameter of the abdominal aorta at the diaphragm level (OR=0.72, 95%CI: 0.52-0.99), FDP (OR=1.03, 95%CI: 1.01-1.06), and D-dimer (OR=1.07, 95%CI: 1.01-1.13) were risk factors for death due to visceral organ failure. Conclusions: For ATAAD patients with concurrent MeMPS, salvage IR can serve as a bridging therapy prior to aortic repair. The true lumen diameter of the abdominal aorta at the diaphragm level, D-dimer, and FDP are risk factors for death due to visceral organ failure.

Acute type A aortic dissection (ATAAD) involves complex pathology in aortic root, and appropriate surgical strategies are crucial to clinical outcomes. Recently, with significant improvements in the safety and short-term efficacy of ATAAD surgical strategies, maximizing the elimination of aortic root dissection and preserving well-functioning aortic valves during emergency surgery is directly related to the long-term survival quality of patients. David procedure is an effective aortic valve repair technique which has shown satisfactory long-term outcome in patients with aortic root aneurysm and aortic regurgitation. Due to its ability to eliminate aortic root dissection, preserve the aortic valve, and facilitate hemostasis, David procedure plays a significant role in the management of ATAAD aortic root pathology and has great potential for broader application. This article elaborates on the characteristics of ATAAD, treatment strategies, the technical features of David procedure, and progress in clinical practices, aiming to provide a reference for the rational application of David procedure in ATAAD and further improve the long-term efficacy and quality of life for patients with ATAAD.

Objective: To evaluate the diagnostic value for temporal lobe epilepsy focus localization based on the asymmetry index (AI) derived from images reconstructed using the ordered subsets expectation maximization (OSEM) and the Bayesian penalized likelihood (BPL) methods on ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET-MRI. Methods: This is a cross-sectional study. We collected and analyzed ¹⁸F-FDG PET-MRI brain images from 18 patients diagnosed with temporal lobe epilepsy at the PET Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2020 and June 2023. The acquired PET list-mode data for each patient were reconstructed using three methods respectively: OSEM, BPL (β=150), and BPL (β=350). Quantitative analysis was performed on 9 pairs of bilateral brain regions: cerebellar cortex, hippocampus, parahippocampal gyrus, superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus, entorhinal cortex, transverse temporal gyrus, and temporal pole. The mean standardized uptake value (SUV_mean) for each region was extracted, and the AI for each region was calculated. The cerebellar cortex was considered the reference region, and other brain regions were classified into the epileptogenic zone (AI≥20%) and epileptic propagation zone (5%mean and AI among the three reconstruction methods were analyzed using one-way ANOVA or the Friedman test. Results: A total of 18 patients with temporal lobe epilepsy were included [6 males, 12 females, mean age (29.5±14.7) years]. In both the right and left cerebellar cortex, the SUV_mean values in the BPL (β=150) and BPL (β=350) were higher than those in the OSEM (left: 6.88±1.86 vs 6.80±1.83 vs 6.57±1.76; right: 6.84±1.81 vs 6.76±1.79 vs 6.49±1.69; all P<0.001). There were no significant differences in AI among the three reconstruction methods for the cerebellar cortex and the epileptic propagation zone (all P>0.05). In the epileptogenic zone, the AI in the BPL (β=350) was lower than that in the OSEM (24.68±4.13 vs 25.42±3.64, P=0.048), while there was no significant difference in AI between the BPL (β=150) and OSEM (P>0.05). Conclusion: Compared with the OSEM method, AI in images reconstructed with the BPL method demonstrates no significant difference for localizing epileptogenic foci in temporal lobe epilepsy on ¹⁸F-FDG PET-MRI.

Type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) are closely related to each other, and their bidirectional pathophysiological interactions significantly increase the risks of liver-related and extrahepatic adverse outcomes. Multidisciplinary management is essential to improve long-term outcomes and the overall quality of integrated care in individuals with T2DM and MASLD. The expert consensus "Chinese expert consensus on multidisciplinary management of type 2 diabetes mellitus complicated with metabolic-dysfunction associated steatotic liver disease (2026 edition)" was developed by multidisciplinary experts from Chinese Society of Health Management, Liver and Gallbladder Diseases Branch of China Association of Chinese Medicine and Liver Health Consortium in China (CHESS). By integrating expertise across specialties, a systematic and continuous care model can be established encompassing early screening, precision diagnosis, risk stratification, individualized interventions, and long-term management. Such an approach can optimize coordinated management strategies for T2DM and MASLD and improve quality of life and long-term survival.

Aortic dissection (AD) is a cardiovascular emergency with an extremely high mortality rate. This review delineates its molecular pathogenesis from four pivotal dimensions: structural and functional abnormalities of the vascular wall, inflammatory and immune dysregulation, hemodynamic disturbances, and epigenetic dysregulation, while critically assessing the translational prospects and challenges of novel therapeutic strategies targeting these mechanisms. Despite continuous advancements in surgical and interventional techniques, the long-term prognosis of AD remains suboptimal. Future research should focus on targeting key molecular pathways, facilitating individualized precision therapy, developing novel diagnostic tools, and innovating drug delivery systems, with the aim of overcoming current diagnostic and therapeutic bottlenecks in AD.​.

Objective: To investigate dynamic positron emission tomography/magnetic resonance (dPET-MRI) using ¹⁸F-deoxyglucose (FDG) in distinguishing tumor progression (TP) from post treatment related change (PTRC) in patients with glioma. Methods: This study is a cross-sectional study. From July 2022 to September 2024, a total of 15 suspected recurrent/progressing post-treatment glioma patients were recruited at the Cancer Prevention and Treatment Center of Sun Yat sen University. They underwent ¹⁸F-FDG PET-MRI examination after postoperative radiotherapy in terms of static parameters, the SUV_max, SUV_mean of all lesions and SUV_mean of normal brain (gray matter and white matter) were measured. Additionally, target-to-background ratios (TBR_gm and TBR_wm) and SUV corrected for blood glucose (SUV_{gluc max} and SUV_{gluc mean})were calculated. The two-tissue compartment model (2TCM) and Patlak plot were used to derive kinetic metrics, including K₁, k₂, k₃, 2TCM-K_i, 2TCM-MR_FDG, Patlak-K_i and Patlak-MR_FDG. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance for differentiating TP from PTRC. Results: Fifteen patients, aged 48 (41, 54) years, including 5 males (33.3%), were detected on enhanced MRI images with a total of 18 lesions detected. Ultimately, 13 lesions were confirmed to have progressed. The 2TCM-K_i [0.018 (0.015, 0.022) vs 0.013 (0.012, 0.014), P=0.016], 2TCM-MR_FDG [8.334 (7.041, 9.836) vs 6.281 (5.713, 7.469), P=0.046], Patlak-K_i [0.017 (0.014, 0.020) vs 0.010 (0.007, 0.011), P=0.004] and Patlak-MR_FDG [7.742 (6.904, 9.084) vs 4.892 (3.833, 5.640), P=0.003] were significantly higher in TP than in PTRC. The Patlak-K_i values exhibited the high distinguishing performance with the area under the curve (AUC) of 0.954 (95%CI: 0.856-1.000), and the sensitivity and specificity was 92.3% and 100.0%, respectively. Conclusion: Kinetic metabolic parameters of ¹⁸F-FDG dPET-MRI, as a non-invasive biomarker, is hopeful as a non-invasive biomarker to distinguish TP from PTRC.

Objective: To analyze the metabolic characteristics of the healthy scalp microenvironment using spatial metabolomics and to compare them with those of psoriasis lesions. Methods: Healthy skin tissue samples from various body sites were prospectively collected from patients undergoing skin biopsy in the Department of Dermatologic Surgery, Shanghai Dermatology Hospital between March 2024 and March 2025. Spatial metabolomics was performed to analyze metabolite differences between scalp skin and skin from other body regions (control group). Metabolic pathway analysis was conducted using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Additionally, dataset GSE13355 (containing psoriatic lesional skin and healthy skin from healthy individuals) was downloaded from the Gene Expression Omnibus (GEO) database. Differential gene expression analysis was performed between psoriatic lesions and healthy control skin followed by KEGG enrichment analysis of the differentially expressed genes. Results: A total of 40 healthy skin tissue samples (2 cm×3 cm) were collected from 12 different body sites, including 4 scalp samples and 36 control samples. Spatial metabolomics identified 375 differential metabolites, of which 274 were upregulated in the scalp. The scalp exhibited enrichment of lipid and acidic metabolites, including fatty acyls, glycerides, glycerophospholipids, sphingolipids, organic acids and derivatives, and amino acids and metabolites (all P<0.05). KEGG pathway analysis revealed that scalp differential metabolites were primarily enriched in lipid metabolism and skin function-related pathways, particularly bile secretion, glycerophospholipid metabolism, and sphingolipid metabolism. KEGG enrichment analysis based on the GSE13355 dataset from the GEO showed significant enrichment of pathways related to unsaturated fatty acid biosynthesis, fatty acid metabolism, and cholesterol metabolism in psoriatic lesions (all P<0.05). These metabolic characteristics were similar to those observed in normal scalp tissue. Conclusions: The healthy scalp region exhibits distinct lipid and acidic metabolic characteristics, while psoriasis lesions show disturbances in both lipid and acidic metabolism. Both share similar metabolic characteristic profiles.

Objective: To investigate the efficacy of selective sinus replacement (SSR) in the treatment of acute Stanford type A aortic dissection. Methods: A retrospective analysis was conducted on patients who underwent selective aortic sinus replacement or aortic root replacement for aortic sinus involvement. These patients were among 310 emergency cases of Stanford type A aortic dissection admitted to the Division of Cardiovascular Surgery of the University of Hong Kong-Shenzhen Hospital between July 1, 2020, and December 31, 2024. Based on the surgical procedure performed on the aortic root, the patients were divided into three groups: the David group, the SSR group, and the bioprosthetic Bentall (Bio-Bentall) group. The operative time, intraoperative blood loss, cardiopulmonary bypass time, aortic cross-clamp time, postoperative hospital stay, complications, and follow-up outcomes including aortic valve function and changes in aortic root diameter were compared among the different surgical groups. Results: A total of 42 patients (34 males and 8 females) aged (48±21) years were included, with 11, 20 and 11 cases in the David group, the SSR group and the Bio-Bentall group, respectively. All surgeries were successfully completed without perioperative mortality or major cardiovascular events. The SSR group demonstrated shorter aortic cross-clamp time [(138±29) min vs (166±19) min], cardiopulmonary bypass time [(201±43) min vs (219±23) min], and operative time [(423±60) min vs (448±58) min] compared with the David group (both P<0.05). No statistically significant differences were observed in 30-day postoperative complications or long-term follow-up outcomes among the SSR, David, and Bio-Bentall groups (all P>0.05). During follow-up, all patients exhibited well aortic valve function, with no moderate or severe aortic regurgitation. In the SSR group, the aortic sinus diameter significantly decreased at 6 months postoperatively compared with the preoperative measurement [(36±3) mm vs (40±5) mm, P=0.032]. No statistically significant difference was observed between the measurements at 6 months and 1 year postoperatively [(36±3) mm vs (35±3) mm, P=0.522]. Conclusion: SSR represents a safe and effective surgical strategy for acute Stanford type A aortic dissection in carefully selected patients.