Zhonghua yi xue za zhi最新文献

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.

Femoroacetabular impingement syndrome (FAIS) is a prevalent hip disorder, and arthroscopic surgery has emerged as the preferred treatment modality, which has been rapidly adopted in clinical practice across China. Rehabilitation plays a pivotal role in ensuring functional recovery, normal daily activities, and return to sports for orthopedic surgery patients. However, standardized protocols and evidence-based guidelines for perioperative rehabilitation following FAIS arthroscopic surgery remain lacking in China. This expert group organized specialists to develop a rehabilitation consensus for patients with femoroacetabular impingement syndrome (FAIS) requiring arthroscopic surgery, based on systematic literature review, evidence quality assessment, and clinical rehabilitation practice, using the modified Delphi method. The consensus addresses three key aspects: basic principles and common methods, critical issues in rehabilitation intervention, and considerations for special populations. Specifically, it covers fundamental rehabilitation principles, common assessment methods, preoperative rehabilitation, psychological rehabilitation, and postoperative rehabilitation (including phased rehabilitation and progression criteria, pain management, muscle function training, joint range of motion training, weight-bearing training, the clinical value of platelet-rich plasma injections, and return-to-sport criteria). Additionally, it includes rehabilitation considerations for patients of different age groups and those undergoing various surgical approaches, totaling 13 recommendations. This consensus aims to provide evidence-based guidance for clinicians and rehabilitation therapists, facilitating personalized and comprehensive rehabilitation management for FAIS patients undergoing arthroscopic surgery.

Objective: To evaluate the clinical efficacy and safety of carotid endarterectomy (CEA) in the treatment of completely collapsed carotid artery near-occlusion (CANO). Methods: A retrospective analysis was performed on the clinical data of patients with completely collapsed CANO who underwent CEA in the Department of Neurosurgery, Affiliated Hospital of Qingdao University, from January 2020 to December 2024. The changes in the diameter of the collapsed distal internal carotid artery and cerebral blood perfusion on the near-occlusion side before and after surgery were compared, so as to comprehensively assess the clinical efficacy of CEA for completely collapsed CANO. The postoperative follow-up was conducted via outpatient visits or hospitalization at 1, 3, and 6 months after discharge, followed by regular visits every 12 months thereafter. The follow-up content included the occurrence of perioperative complications and long-term clinical outcomes. Results: A total of 30 patients were enrolled with the age of (68±7) years old, including 26 males and 4 females. All patients presented neurological symptoms prior to admission, consisting of 7 cases (23.3%) of transient ischemic attack and 23 cases (76.7%) of cerebral infarction. All patients underwent eversion CEA. The diameter of the collapsed distal internal carotid artery on the near-occlusion side was (3.99±0.80) mm postoperatively, which was larger than the preoperative value of (2.34±0.55) mm. The cerebral blood flow on the near-occlusion side was (63±22) ml·100 g^-1·min^-1 postoperatively, higher than the preoperative level of (34±15) ml·100 g^-1·min^-1 (both P<0.05). Perioperative complications occurred in 5 patients (16.67%), while no severe complications such as intracranial hemorrhage, surgical site hematoma, incision infection, or death were observed in any patient during the entire perioperative period. A postoperative death occurred in 1 patient (3.3%) at 4 months. Conclusion: For patients with completely collapsed CANO, CEA could not only partially restore the diameter of the collapsed distal internal carotid artery but also effectively improve cerebral perfusion, making it a safe and effective therapeutic method.

Objective: To investigate the correlation between periodontitis staging and plaque stability in patients with carotid artery stenosis (CAS). Methods: Clinical data of patients with CAS combined with periodontitis who underwent carotid endarterectomy in the Department of Vascular Surgery, Nanjing Drum Tower Hospital, from January 2020 to December 2024 were retrospectively collected. All patients underwent preoperative carotid computed tomography angiography (CTA), cone-beam computed tomography (CBCT) of the jaw, and laboratory tests of biochemical indices. Periodontitis staging was assessed according to CBCT findings. Based on pathological examination of carotid plaque specimens, patients were divided into a stable plaque group (n=233) and a vulnerable plaque group (n=175). Multivariable logistic regression analysis was used to examine the association between periodontitis staging and plaque stability. Furthermore, receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of periodontitis staging and related indicators in predicting plaque stability. Results: A total of 408 patients were enrolled with the age of (67±8) years, including 286 men and 122 women. The stable plaque group aged (67±9) years consisted of 156 men and 77 women, while the vulnerable plaque group aged (69±9) years included 130 men and 45 women. Multivariate analysis revealed that elevated interleukin-6 (IL-6) levels (OR=1.18,95%CI:1.08-1.30), higher C-reactive protein (CRP) levels (OR=1.10,95%CI: 1.03-1.18) and moderate to severe periodontitis stage (moderate periodontitis: OR=1.58, 95%CI: 1.12-2.23; severe periodontitis: OR=2.26, 95%CI: 1.72-3.45), were risk factors for carotid plaque vulnerability. ROC curve analysis demonstrated that when periodontitis severity was moderate or higher, the area under the curve (AUC) of periodontitis stage for predicting plaque stability was 0.75 (95%CI:0.71-0.79,P<0.001), with a sensitivity of 76% and a specificity of 64%. Conclusions: Periodontitis staging is closely associated with plaque stability in patients with CAS. Patients with moderate to severe periodontitis are more likely to have vulnerable carotid plaques.

To investigate the clinicopathological characteristics of neuroendocrine(NE) cell dysplasia in gastric oxyntic gland mucosa. The clinical data of the patients with gastric mucosal NE cell dysplasia who underwent endoscopic submucosal dissection or endoscopic mucosal resection treatment at Xiangcheng County People's Hospital and the 989th Hospital of the Joint Logistics Support Force from January 2011 to October 2024 were retrospectively included. The clinical and endoscopic manifestations of the patients were analyzed, and their pathological morphological characteristics were observed in combination with immunohistochemical staining. A total of 15 patients were included, aged 54 years (32-69 years), including 6 males and 9 females. There were a total of 25 lesions (4 and 3 patients with 2 and 3 lesions, respectively) lincluding 21 lesions in the gastric body (84.0%) and 4 lesions in the gastric fundus (16.0%). Paris classification: 24 cases (96.0%) were classified as 0-Ⅱa type, 1 case (4.0%) as 0-Ⅱc type, with a median lesion diameter of 11.0 mm (2.0-36.0 mm). Narrowband imaging under endoscopy showed glandular duct disorder and abnormal blood vessels, and the mucosal features were consistent with autoimmune gastritis changes. Histological examination showed intrinsic glandular atrophy accompanied by intestinal metaplasia, and NE cells in mucosal hyperplasia presented as solid micro nodules (≤150 μm), arranged in a beam or glandular pattern. Enlarged micro nodules (>150 μm), fusion, sprout, and micro infiltration foci or single-cell infiltration can be seen, as well as nodules with newly formed stroma. It can be seen that the nodules are located within the mucosal muscle or above the lamina propria. Immunohistochemistry showed positive synaptic and chromaffin in NE cells, with nodules smaller than 0.5 mm in diameter and no submucosal infiltration. Sixteen (64.0%) cases of dysplasia lesions were accompanied by G1 grade neuroendocrine tumors, with continuous cell shape and unclear boundaries between the two. Gastric NE cell dysplasia is a precursor lesion of neuroendocrine tumors, and the key to diagnosis lies in identifying interstitial infiltration.

To explore the feasibility and timeliness of using unmanned aerial vehicle (UAV) to deliver automated external defibrillator (AED) for the emergency rescue of out-of-hospital cardiac arrest (OHCA), a simulation experiment was conducted in the urban area of Jiaxing from November 2023 to November 2024. With the emergency rescue center as the center, 43 simulated OHCA events were randomly set within a radius of 6.5 kilometers. The distance and time indicators among emergency medical services (EMS), UAV-delivered AED, and public AED retrieval were compared. The results showed that the UAV flight distance [2.29 (1.21, 3.58) vs 3.10 (2.10, 5.30) km], flight time [266.0 (193.0, 344.0) vs (555.3±11.6) seconds], and response time [353.0 (272.0, 426.0) vs (597.2±210.0) seconds] were all shorter than those of EMS (all P<0.05). However, the UAV's activation time [(76.4±8.7) vs 40.0 (35.0, 51.0) seconds] was longer than that of EMS (P<0.05). The distance for retrieving public AEDs was shorter than the UAV flight distance [0.76 (0.40, 1.12) vs 2.29 (1.21, 3.58) km], but the retrieval time was longer [550.1 (286.6, 803.5) vs 353.0(272.0, 426.0) seconds] (both P<0.05). This study indicates that UAVs have a significant advantage in emergency rescue timeliness, and the integrated use of EMS, UAV, and AED is a feasible new model for OHCA emergency rescue.

Respiratory syncytial virus (RSV) is the most common viral pathogen causing lower respiratory tract infections in humans, posing a hefty disease burden among infants, young children, and the elderly population, and representing a significant global public health concern. There is an urgent need in China to establish an integrated medical-preventive collaborative system for RSV infection control, encompassing"prevention, diagnosis, treatment and management, " to shift the focus from a "treatment-centered" to a "health-centered" strategy. To better guide and standardize RSV prevention and control measures in China, a multidisciplinary group of Chinese experts was formed to develop the " expert consensus on the collaboration of medical and preventive care for the prevention and treatment of respiratory syncytial virus infection". This consensus integrates existing evidence-based medical data and practical experiences from both domestic and international sources. Based on the strategic needs of RSV infection prevention and control in China, this consensus aims to provides innovative medical and preventive collaboration mechanisms and decision-making recommendations for medical institutions at all levels, disease prevention and control institutions, and relevant primary care professionals, with the aim of comprehensively enhancing the prevention and treatment level of RSV infection in China.

This retrospective study analyzed three GSDME-related deafness pedigrees diagnosed at the Chinese PLA General Hospital between January 2014 and December 2020. Through whole-exome sequencing and Sanger sequencing validation, all three pedigrees were found to carry splice-site variants causing exon 8 skipping. The patients presented with bilateral, symmetrical, and progressive sensorineural hearing loss, with an age of onset ranging from five to 25 years. The hearing loss initially affected high frequencies and gradually progressed to involve all frequencies. Significant phenotypic heterogeneity was observed, even within the same pedigree, with notable variations in the age of onset and progression rate among individuals carrying the same mutation. A review of the literature indicated that 15 GSDME-caused deafness variants have been reported globally, predominantly clustered around exon 8. This study further confirms that GSDME-related deafness has specific pathogenic mechanisms and significant phenotypic heterogeneity.