Zhonghua yi xue za zhi最新文献

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.

Objective: To investigate the striatal dopamine transporter (DAT) distribution pattern and its relationship with iron deposition in the substantia nigra pars compacta (SNc) in patients with Parkinson's disease (PD) using integrated ¹⁸F-N-(3-fluoropropyl)-2β-carbomethoxy-3β- Methods: A case-control study. PD patients and sex-and age-matched control group who visited the Department of Nuclear Medicine/PET Center, Huashan Hospital, Fudan University from January 2023 to April 2024 were retrospectively enrolled. Differences in striatal (caudate, putamen) DAT specific binding ratio (SBR) and SNc iron deposition between the two groups were compared using ¹⁸F-FP-CIT PET-MRI. Pearson correlation analysis was used to assess the correlations of striatal DAT-SBR and SNc iron deposition with age, disease duration, Unified Parkinson's Disease Rating Scale Part Ⅲ (UPDRS-Ⅲ) scores, and Mini-Mental State Examination (MMSE) scores were analyzed in the PD group. A non-linear mixed model was used to study the spatiotemporal distribution pattern of striatal DAT-SBR in PD patients and to explore the correlation between striatal DAT-SBR and SNc iron deposition. Results: The PD group consisted of 53 patients (34 males, 19 females) aged (64.5±9.4) years. The control group consisted of 10 subjects (7 males, 3 females) aged (60.2±10.4) years. DAT-SBR in the bilateral caudate (left: 4.50±1.89 vs 7.17±2.29; right: 4.22±1.72 vs 7.03±2.31) and bilateral putamen (left: 4.01±1.80 vs 8.48±2.09; right: 3.60±1.49 vs 8.17±2.12) were significantly lower in the PD group than those in the control group (all P<0.001). SNc iron deposition was significantly higher in the PD group than that in the control group [(96.93±29.94) vs (72.42±8.73)×10^-9, P<0.05]. In the PD group, DAT-SBR in the bilateral caudate and putamen was negatively correlated with age and disease duration (r=-0.535--0.350, all P<0.05), while SNc iron deposition showed no significant correlation with age or disease duration (all P>0.05). After adjusting for age and disease duration, DAT-SBR in the putamen was negatively correlated with UPDRS-Ⅲ scores (r=-0.380, P<0.05), but showed no significant correlation with MMSE scores (P>0.05). The non-linear mixed model results indicated that the decline in DAT-SBR in the caudate and putamen occurs 11.8-17.5 years before clinical onset. After further adjusting for age, disease duration, and UPDRS-Ⅲ scores, DAT-SBR in the bilateral caudate and the posterior part of the right putamen showed negative correlations with SNc iron deposition in the PD group (r=-0.548--0.422, all P<0.05). Conclusion: At the time of clinical diagnosis, striatal DAT is already impaired and shows a negative correlation with SNc iron deposition, revealing a correlation between nigrostriatal pathway damage and DAT impairment in PD patients.

Objective: To compare the clinical outcomes of emergency surgery and conservative treatment in patients with acute type A aortic intramural hematoma (IMH). Methods: Patients with acute type A aortic IMH who were diagnosed atthe Department of Cardiovascular Surgery of Guangdong Provincial People's Hospital between November 2011 and February 2023 were retrospectively enrolled. According to international guideline criteria, patients were divided into theemergencysurgery group (surgery group) and theconservative treatment group (conservative group). Baseline characteristics, in-hospital mortality, and 5-year survival after discharge were compared between the two groups. Results: A total of 224 patients with acute type A aortic IMH were included. There were 138 (61.6%) and 86 (38.4%)patients underwent emergent surgery andconservative treatment, respectively. There were no significant differences between the two groups in age, sex, height, weight, diabetes mellitus, dyslipidemia, renal insufficiency, history of cardiovascular disease, moderate to severe aortic regurgitation, or moderate to large pericardial effusion (all P>0.05). The proportions of hypertension [81.9% (113/138) vs 66.3% (57/86)] and coronary artery disease [37.0% (51/138) vs 18.6% (16/86)] were higher in the surgery group than those in the conservative group, whereas the proportions of chronic obstructive pulmonary disease [14.5% (20/138) vs 29.1% (25/86)], smoking history [18.1% (25/138) vs 40.7% (35/86)], Marfan syndrome [1.4% (2/138) vs 8.1% (7/86)], and bicuspid aortic valve [2.2% (3/138) vs 9.3% (8/86)] were lower in the surgery group than those in the conservative group (all P<0.05). Regarding imaging features, the prevalence of ulcer-like projection (ULP) was higher in the surgery group than that in the conservative group [44.9% (62/138) vs 29.1% (25/86), P=0.024]. In addition, ascending aortic length [12.1 (11.6, 13.4) cm vs 9.4 (8.7, 11.7) cm], maximal aortic diameter [44.8 (40.4, 50.0) mm vs 41.7 (37.5, 46.0) mm], and hematoma thickness [13.7 (11.0, 17.6) mm vs 8.0 (6.0, 9.6) mm] were all greater in the surgery group than those in the conservative group (all P<0.001). In-hospital mortality [14.0% (12/86) vs 15.9% (22/138)] and 5-year survival rate [90.1% (95%CI: 83.7%-96.9%) vs 83.5% (95%CI: 77.4%-90.1%)] did not differ significantly between the two groups (both P>0.05). Conclusions: The study indicates that patients in the emergency surgery group had more high-risk imaging features compared with the conservative treatment group. This suggests that for patients with acute type A aortic IMH who are clinically and radiographically stable and strictly selected, conservative treatment can achieve survival outcomes similar to surgery in the mid-term follow-up.​​.

Individualized precision diagnosis and treatment of neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, etc.) faces challenges due to overlapping early symptoms and clinical/pathological heterogeneity. PET-MRI multimodal imaging, integrating in vivo molecular pathological information from PET with brain structural/functional information revealed by MRI, has become a crucial cornerstone for precision diagnosis and treatment of neurodegenerative diseases. However, its clinical translation is limited by practical bottlenecks, such as complexities in data integration, and uneven distribution of resources. AI, with its unique strengths in multimodal data fusion, automated quantitative analysis, and cross-modal image synthesis, is gradually reshaping the paradigm of diagnostic and therapeutic landscape of neurodegenerative diseases. This article systematically explores the pivotal role of AI in PET-MRI, covering its contributions to improving diagnostic objectivity, deciphering disease heterogeneity, enabling stratified care pathways. It also critically addresses the multiple challenges hindering the clinical implementation of AI and proposes that future efforts should focus on the development of interpretable AI models, the construction of embedded clinical systems, and the exploitation of inclusive technological solutions to promote the deep integration of AI and PET-MRI, ultimately driving the transformation of neurodegenerative diseases towards a precision medicine paradigm of early prevention, early diagnosis, and early treatment.

Objective: To investigate the perioperative outcomes of transcarotid artery revascularization (TCAR) in patients with carotid artery stenosis and analyze the related factors of intraprocedural plaque debris capture. Methods: Clinical data from 56 patients who underwent TCAR for carotid artery stenosis at Zhongshan Hospital, Fudan University was retrospectively collected between September 2024 and August 2025. Follow-up were conducted for the patients on the day of surgery, 3 days, 1 week, 2 weeks, and 1 month after surgery through outpatient or inpatient settings. The analysis focused on technical success rates and perioperative complication incidence. Firth's penalized maximum likelihood estimation for multivariable logistic regression analyses were used to screen the risk factors related to plaque debris capture in the reverse-flow device during TCAR procedures. Results: Among the 56 patients aged (70±7) years, 50 were male and 6 were female. The surgical technique achieved a 100% (56/56) success rate with a perioperative complication rate of 1.8% (1/56). All patients [M(Q₁, Q₃)] had the procedure duration of 95 (80, 141) minutes and the positive arterial blood flow occlusion time of 8 (7, 10) minutes. A total of 40 patients registered the situation of plaque debris capture. Reverse-flow device capture of plaque debris was confirmed in 50% (20/40) of patients following TCAR procedures. Multivariate logistic regression analysis demonstrated that symptomatic patients (OR=15.89, 95%CI: 1.96-257.81) and residual lumen diameter at the narrowest-point (OR=0.20, 95%CI: 0.04-0.63) were the related risk factors for plaque debris capture during TCAR procedures. Conclusions: In patients with carotid artery stenosis, TCAR achieved a high technical success rate with few perioperative complications. Symptomatic patients and residual lumen diameter at the narrowest-point were the related factors for plaque debris capture.

Objective: To compare the clinical features of different treatment strategies between patients with type Ⅰ and type Ⅱ spontaneous extracranial carotid artery dissection (sECD). To investigate the efficacy of different treatment methods. Methods: A retrospective analysis was conducted on 181 sECD patients admitted to the First Affiliated Hospital of Zhengzhou University between June 2018 and February 2025, of whom 23 had bilateral involvement, resulting in a total of 204 dissected vessels. Based on the Borgess classification, 204 dissected vessels were categorized into 2 groups: type Ⅰ (intact intima, 71 vessels) and type Ⅱ (with an intimal tear, 133 vessels). Patients were followed up at 3, 6, and 12 months, and every 12 months thereafter via outpatient visits or readmission. Demographic data, clinical manifestations, imaging features, treatment regimens, and follow-up data were collected to analyze and compare the incidence of cerebral ischemic events, cerebral hemorrhage, and mortality during hospitalization and follow-up between the 2 groups. To observe the efficacy between surgical and conservative treatments as well. Results: A total of 181 patients aged (50±11) years were included, comprising 139 males and 42 females. Compared with type Ⅱ sECD, type Ⅰ were younger [48 (40, 56) vs 51 (44, 57) years, P=0.043] and had higher National Institute of Health Stroke Scale scores at admission and discharge [2 (0, 5) vs 0 (0, 3) points, P=0.029; and 0 (0, 2) vs 0 (0, 1) points, P=0.026, respectively]. The incidence of ischemic stroke was significantly higher in type Ⅰ sECD [60.6% (43/71) vs 43.6% (58/133), P=0.021]. Type Ⅰ sECD also exhibited a higher proportion of true lumen stenosis >70% [78.9% (56/71) vs 36.8%(49/133), P<0.001]. A total of 67 patients (71 vessels) underwent surgical treatment with a 100.0% (71/71) success rate and no perioperative complications. Among 114 patients (133 vessels) receiving conservative treatment, the cerebral ischemia recurrence rate was 3.7% (2/53) for type Ⅰ and 6.3% (5/80) for type Ⅱ, with no statistically significant difference (P>0.05). However, the complete and partial healing rates were higher in type I sECD than in type Ⅱ [88.7% (47/53) vs 30.0% (24/80), P<0.001]. Conclusions: Type Ⅰ sECD is more common in younger patients and is associated with a higher risk of severe ischemic stroke, yet it exhibits better healing rates with antithrombotic therapy. Surgical treatment intervention is safe and effective for both types.

Ischemic stroke caused by carotid stenosis has become a significant societal burden. The treatment of carotid artery stenosis serves as an effective strategy for stroke prevention, for which carotid endarterectomy (CEA) is considered the gold standard. However, in clinical practice, certain limitations were observed in traditional carotid endarterectomy (CEA) regarding the reduction of perioperative complication risks and the assurance of mid-to long-term efficacy. Therefore, exploration of modifications to the CEA technique held substantial practical significance. Our center proposed the quality of life-modified eversion carotid endarterectomy (QCEA). The key technical modifications included: making an oblique arteriotomy at approximately a 60° angle relative to the bifurcation plane, shaping the arterial anastomosis through longitudinal trimming and remodeling it into a trumpet-shaped orifice, and employing a minimally invasive cosmetic transverse incision along the natural skin lines.