BackgroundCrohn’s disease (CD) is characterized by persistent intestinal inflammation, immune dysregulation, and intestinal barrier dysfunction. Inflammasome-mediated pyroptosis is an innate immune mechanism increasingly implicated in inflammatory bowel disease (IBD); however, the upstream molecular signals associated with NLRP3–Caspase-1–GSDMD activation in CD remain insufficiently defined. Here, we explored whether the angiopoietin-1 (ANGPT1)–gamma-aminobutyric acid receptor-associated protein (GABARAP) axis is associated with CD-related pyroptotic signaling.MethodsProtein quantitative trait locus (pQTL)-based two-sample Mendelian randomization (MR) was performed to prioritize pyroptosis-related proteins genetically associated with CD risk. Putative upstream regulators of GABARAP were then examined by two-step MR and mediation analysis. Functional validation was performed using a dextran sulfate sodium (DSS)-induced murine colitis model and LPS plus nigericin-induced cell models of NLRP3 inflammasome activation. ANGPT1–GABARAP signaling and the NLRP3–Caspase-1–GSDMD pathway were evaluated following GABARAP or ANGPT1 knockdown and exogenous recombinant human ANGPT1 (rhANGPT1) supplementation, by qRT-PCR, western blotting, ELISA, and LDH release assays.ResultsMR analysis prioritized GABARAP as a suggestive protective candidate for CD, with genetically predicted higher GABARAP levels associated with a decreased disease risk (OR = 0.563, 95% CI 0.327–0.968, P = 0.038). Two-step MR further suggested a putative genetic association between ANGPT1 and GABARAP, and mediation analysis indicated that GABARAP may partially mediate the genetically predicted ANGPT1–CD association, with an estimated mediation proportion of 22.97%. DSS-induced colitis was associated with reduced ANGPT1 and GABARAP expression, along with increased NLRP3 expression, Caspase-1 processing, GSDMD-N accumulation, and elevated IL-1β, IL-18, and LDH levels. In vitro, silencing either GABARAP or ANGPT1 enhanced NLRP3 inflammasome-associated pyroptotic signaling under LPS plus nigericin stimulation, whereas rhANGPT1 treatment partially attenuated these responses in association with restored GABARAP expression.ConclusionThese findings support a potential role for the ANGPT1–GABARAP axis in NLRP3 inflammasome-mediated pyroptosis associated with intestinal inflammation. Together, these results provide a genetically informed framework for understanding pyroptosis-related inflammatory signaling in CD and support further investigation of the potential therapeutic relevance of this axis.

Background:F-box protein 28 (FBXO28) plays a role in several malignancies; however, its association with gastric cancer (GC) remains uncertain. This study aimed to investigate the effects of FBXO28 on GC by bioinformatics analysis and molecular biology. Methods:The expression of FBXO28 in GC was discovered. The probable roles of FBXO28 in the proliferation, migration, invasion, and apoptosis of GC cells were explored. To further study the possible mechanism, western blotting was conducted to evaluate whether FBXO28 was involved in the epithelial-mesenchymal transition (EMT) and the mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathway. The GSE62254 dataset and 213 clinical samples were used to explore the connection between FBXO28 and the clinicopathological features of GC. Results:Based on bioinformatics analysis, FBXO28 messenger RNA (mRNA) was found to be highly expressed in GC. However, compared with normal tissues, GC tissues had lower levels of FBXO28 expression. The cell experiments showed that FBXO28 played an anti-tumor role in GC cells. The pathway analysis results illustrated that FBXO28 could affect the EMT and the MAPK/ERK pathway. Furthermore, there was a correlation between FBXO28 and GC's clinicopathological features, and FBXO28 serves as an independent predictor of the prognosis. Conclusions:FBXO28 played a tumor-suppressive role in GC cells and was related to the EMT process. Patients with GC with a better prognosis expressed higher levels of FBXO28.

Abstract Tryptophan (Trp) is catabolized by gut microorganisms, resulting in a wide range of metabolites implicated in both beneficial and adverse host effects. Inulin, a fermentable fiber, has the potential to reshape the gut microbial environment. However, whether inulin interacts with dietary Trp levels to direct microbial Trp metabolism toward beneficial rather than potential harmful metabolites remains unclear. In this study, combined Trp and inulin supplementation was associated with a distinct microbial Trp metabolic profile characterized by increased indole-3-propionic acid and reduced indole levels. This shift was accompanied by concurrent changes in short-chain fatty acids and positive associations with markers related to intestinal barrier integrity. Inulin intake was also linked to an increased abundance of Faecalibaculum rodentium , a taxon associated with Trp metabolism. In addition, the altered metabolic profile was associated with activation of the aryl hydrocarbon receptor and pregnane X receptor, together with higher interleukin-22 levels. These findings suggest that inulin may help redirect microbial Trp metabolism toward beneficial derivatives under increased Trp availability, supporting a potential prebiotic–amino acid synergy in maintaining gut epithelial homeostasis.

The relationship between maternal thyroid function and intellectual development of offspring is controversial. Iodine may be an important confounding factor. This study investigated whether maternal iodine status could affect the efficacy of levothyroxine (LT4) treatment during early pregnancy on the intellectual growth of progeny.This prospective study divided participants into two groups; the normal iodine group included 53 mother–child pairs and the low iodine group included 60 mother–child pairs (urinary iodine concentration (UIC) ≥ 150 µg/L and UIC < 150 µg/L). Each iodine status group was further subdivided according to specific maternal thyroid disorders. The two groups were categorized as follows: Control(N), hypothyroxinemia (IH) + LT4, subclinical hypothyroidism (SCH) + LT4, positive thyroid peroxidase antibodies (TPOAbs) + LT4. Finally, the study included eight groups. The Bayley Scales of Infant Development-II were employed to evaluate the neurodevelopment of children (age: 12 -30 months). The main results were age-adjusted scores from the Mental Development Index (MDI) and Psychomotor Development Index (PDI).We found that: 1) Under the similar conditions of thyroid function and treatment, iodine deficiency during early pregnancy reduced the MDI value of the offspring (P < 0.001), while, the PDI value was not affected (P = 0.276). Linear regression demonstrated a substantial positive correlation between maternal UIC and MDI of offspring (B = 0.09 [CI 0.06–0.13]; P = 0.01). In the case of iodine deficiency during pregnancy, LT4 treatment on SCH and IH could not improve offspring MDI scores (P < 0.001, P = 0.037, respectively) in contrast to the normal group. However, under normal iodine status during pregnancy, LT4 treatment on SCH and IH could improve offspring MDI scores (P = 0.525, P = 0.650, respectively) compared with the normal group. Concurrently, the PDI of the aforementioned categories did not differ significantly (P > 0.05). 3) In comparison to the normal group, LT4 treatment on TPOAbs during pregnancy could not improve the MDI of the offspring, regardless of whether the iodine nutritional status was normal or not (P < 0.001, P = 0.047, respectively). These findings suggest that concurrent assessment and optimization of both thyroid function and iodine status during early pregnancy may be essential for maximizing offspring intellectual development.

Fetal head circumference (HC) is a key biometric indicator in prenatal ultrasound, essential for gestational age estimation and fetal growth assessment. However, conventional Convolutional Neural Networks (CNN)-based segmentation models often struggle to capture long-range dependencies, which hinders segmentation accuracy. To address this, we introduce Swin-DAG-VNet, a hybrid segmentation model which builds upon the Deeply Supervised Attention-Gated V-Net (DAG V-Net) as the baseline and integrates Swin Transformer to enhance global context modeling while preserving fine-grained structural details. Additionally, we incorporate Swin-Net-Add, a Transformer-enhanced feature fusion module, to improve multi-scale feature aggregation and boundary delineation. Furthermore, we employ an elliptical parameter regression method to predict key biometric parameters from the segmented contour, combines with an adaptive contour sampling strategy to refine segmentation, reducing noise and improving robustness. A physical calibration module ensures accurate real-world HC measurements. Experiments on the HC18 dataset demonstrate that Swin-DAG-VNet achieves an absolute difference (AD) of 1.78 mm, reducing absolute measurement bias by 5.3

Objective Dysthyroid optic neuropathy (DON) is a severe complication of thyroid eye disease (TED) with limited early detection methods. This study aimed to investigate the clinical characteristics of patients with TED who developed DON and to establish a predictive model for early identification of high-risk cases. Methods Herein, 257 TED patients were prospectively included, of whom 68 (26.5%) developed DON. All patients were divided into derivation and validation cohorts, and Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression analyses were applied to identify clinical factors and construct a prediction model. Results In the derivation cohort (185 TED patients), 49 (26.5%) developed DON. DON patients showed significantly higher prevalence of pretibial myxedema (PTM) (22.4 vs 5.9%, P = 0.001), diabetes mellitus (18.4 vs 7.4%, P = 0.029), older age (58.04 ± 11.30 years vs 47.99 ± 10.65 years, P < 0.001), higher CAS (5 vs 4, P < 0.001), elevated triglyceride (TG) levels (1.44 mmol/L vs 1.15 mmol/L, P = 0.042), and lower visual functioning (VF) (43.75 vs 62.50, P < 0.001). LASSO regression analysis identified age, PTM, TG, VF, and CAS as independent predictors of DON. The developed nomogram presented AUCs of 0.853 (95% CI: 0.792–0.914) and 0.856 (95% CI: 0.762–0.950) in the derivation and validation cohorts, respectively. Conclusions Altogether, the findings of this study identify advanced age, elevated CAS, increased TG, lower VF, and PTM as significant predictors of DON in patients with TED. The proposed nomogram offers a practical clinical tool for risk stratification, providing clinicians with an approach for individualized risk assessment and timely therapeutic intervention.

Accurate measurement of fetal head circumference (HC) in ultrasound images remains essential yet challenging for obstetric assessment, primarily due to anatomical variations across gestational stages and inherent imaging artifacts. In response to these limitations, we introduce YOSAM, a novel framework for fetal HC measurement that synergistically combines YOLOv11-based detection with our enhanced MedSAM-AD model. The MedSAM-AD integrates an Adapter layer for domain-specific feature adaptation and a Dimensional Reciprocal Attention Mixing Transformer (D-RAMiT) block for a joint spatial-channel attention mechanism into the MedSAM architecture. Within our cascaded framework, YOLOv11 first generates bounding boxes to localize the fetal head, serving as spatial prompts for MedSAM-AD to perform precise segmentation. The segmented fetal head is then processed with Canny edge detection and elliptical fitting to compute HC. Experimental results show that our approach achieves outstanding performance among standard biometric metrics of the HC18 dataset, attaining a Dice Similarity Coefficient (DSC) of 98.06 ± 1.06

OBJECTIVE:The aim of this study is to evaluate the global burden trends of atrial fibrillation/flutter with attributable risk factors among adolescents and young adults from 1990 to 2021, particularly in the context of the increasing prevalence of cardiovascular diseases in younger populations. MATERIALS AND METHODS:Disease burden data for atrial fibrillation/atrial flutter were sourced from the 2021 Global Burden of Disease Study. The primary metrics were incidence, disability-adjusted life years, and mortality. Population attributable fractions were used to calculate the percentage contribution of the major underlying risk factors to the disease burden. RESULTS:From 1990 to 2021, the global burden of atrial fibrillation/atrial flutter among the studied population increased by 57.26% in incidence, 71.32% in mortality, and 62.34% in disability-adjusted life years. The rate increases were 15.87%, 26.22%, and 19.61%, respectively. The burden of atrial fibrillation/atrial flutter in 2021 and its temporal trends varied significantly according to sex, sociodemographic index quintiles, and geographic location. In 2021, the burden was the highest in the middle-sociodemographic-index regions. Sex differences were found in all potential risk factors of atrial fibrillation/atrial flutter-related mortality and disability-adjusted life year rates. The top three potential risk factors in men were high systolic blood pressure, tobacco exposure, and high alcohol use, and in women, high systolic blood pressure, high body mass index, and tobacco exposure. CONCLUSION:An imbalance in disease burden across different regions exists. The rapidly increasing disease burden warrants attention, and prevention and treatment strategies should be adjusted to prevent further increase.

Essential hypertension involves complex gene–environment interactions. Identifying high-risk subgroups for targeted intervention remains a challenge in hypertension prevention. We hypothesized that integrating the GPX3 rs3828599 polymorphism with environmental risk factors could stratify individuals to warrant precision antioxidant-based prevention. In a rural Han Chinese case‒control investigation involving 400 hypertensive patients and 400 normotensive controls, we conducted genotyping of the GPX3 promoter variant rs3828599, measured the serum levels of GPx-3, and evaluated the interactions between GPx-3 and metabolic and lifestyle factors. Multivariable logistic regression was employed to assess the risk of hypertension under genetic models, while gene‒environment interactions were analysed using MDR. The rs3828599 C allele was found to significantly increase the risk of hypertension. In the codominant model, when the CC genotype was compared with the TT genotype, the odds ratio (OR) was 2.12 (95

BACKGROUND:Uric acid, the final product of purine metabolism, is primarily excreted through the kidneys and intestines. Dysregulation in uric acid production or excretion can result in hyperuricemia and gout. Several proteins play important roles in uric acid metabolism. Among them, GLUT9, a key protein for uric acid excretion, has garnered significant attention, particularly for two SNPs (rs3733591 and rs1014290) on its encoding gene SLC2A9. However, their relationship with gout and hyperuricemia in the Han Chinese population has not been researched. METHODS:This study investigated 498 individuals, including 300 patients with hyperuricemia or gout and 198 healthy controls. Serum uric acid levels were measured, and the genotypes of rs3733591 and rs1014290 were determined using the multicolor melting curve analysis (MMCA) method. These results were subjected to statistical analysis. RESULTS:This detection result highlights the value of MMCA as a rapid and accurate method for genotyping rs3733591 and rs1014290. Statistical analysis revealed that the proportion of the wild-type (C) allele at rs3733591 and the mutant (A) allele at rs1014290 were significantly higher in patients with hyperuricemia and gout compared to healthy controls. Additionally, individuals with the homozygous mutant genotype at rs3733591 had significantly lower uric acid levels compared to those with the wild-type and heterozygous genotypes, whereas homozygous mutants of rs1014290 exhibited higher uric acid levels. Among the various models based on clinical and laboratory data from 433 participants, the logistic regression model based on eight factors - gender, age, eGFR, WBC, HDL, MCHC, rs3733591, and rs1014290 - demonstrated the best diagnostic performance for gout and hyperuricemia, achieving an AUC of 0.8737. CONCLUSION:In conclusion, this study demonstrated a close association between SLC2A9 gene polymorphisms and gout as well as hyperuricemia in the Han Chinese population. Furthermore, the SLC2A9 gene polymorphisms could serve as key parameters for diagnosing these conditions.

Objective: The management of thyroid eye disease (TED) has undergone significant changes for decades. The study sought to investigate current clinical practice on the management of TED in China. Methods: An online questionnaire survey was conducted from April to May 2023. The questionnaire involved diagnostic criteria for TED, multidisciplinary treatment (MDT) collaboration, and treatment preference for mild, moderate, and severe TED. Results: A total of 289 questionnaires were collected, with 165 from endocrinologists and 124 from ophthalmologists. Only 36.7% of participants claimed there was an MDT clinical pattern for TED in their institutions. The coverage of biological agents was around 10% or lower. These were distinctly lower than in Western countries. About 62.6% of participants believed the incidence of TED has increased in recent years. Imaging techniques were used widely to assist in the diagnosis of TED. However, there was still controversy regarding the definition of proptosis in the Chinese population. Most doctors managed risk factors and provided orbital supportive treatments of artificial tears and glasses. For mild active TED, endocrinologists (39.4%) were inclined to recommend therapy for hyperthyroidism alone, while ophthalmologists (43.6%) preferred orbital corticosteroid injections. Currently, the most widely used treatment for moderate to severe active TED was high-dose intravenous corticosteroid (94.8%), while orbital radiotherapy combined with immunosuppressive agents was the most recognized second-line therapy (43.6%). Conclusion: The study documented the consistency and differences between current clinical practices in the management of TED in China and the recently updated guidelines. There was a remarkable difference between ophthalmology and endocrinology departments, warranting management optimization.

BACKGROUND:Hypertension is a major risk factor for cardiovascular disease (CVD), with a high prevalence in rural northeastern China. This study assesses the cardiovascular risk associated with different blood pressure patterns: systolic dominant, diastolic dominant, and parallel elevation. METHODS:We analyzed data from the Northeast Rural Cardiovascular Health Study (NCRCHS), which included 8,189 participants aged 35 and above. Baseline surveys from 2012 to 2013 and follow-ups in 2015 and 2018 provided a median follow-up of 4.66 years. Participants were categorized into ten subgroups based on systolic and diastolic blood pressure elevations. Kaplan-Meier curves and Cox regression models were used to examine CVD incidence and cardiovascular risk across these groups. RESULTS:The incidence of CVD varied significantly among hypertension categories. Patients with grade 1 hypertension had no significant increase in cardiovascular risk at nearly 5 years. Notably, parallel elevations in systolic and diastolic pressures posed the highest cardiovascular risk, while a predominant rise in diastolic pressure alone did not significantly increase risk. This highlights the importance of analyzing blood pressure comprehensively for cardiovascular risk stratification and suggests rethinking treatment strategies for diastolic dominant hypertension. CONCLUSIONS:Our findings call for a nuanced approach to cardiovascular risk assessment in hypertension, taking into account distinct patterns of systolic and diastolic blood pressure. The study supports personalized treatment interventions and reinforces current hypertension treatment guidelines. We advocate for prioritizing non-pharmacological management in grade 1 hypertension and further clinical evaluation of treatment thresholds for diastolic dominant hypertension.

Objective: Gestational transient thyrotoxicosis (GTT) and Graves' disease (GD) are the most common causes of hyperthyroidism during pregnancy. However, few studies have compared pregnancy outcomes of patients who had GTT with those who had GD in the first trimester of pregnancy.Methods: We conducted a prospective multicenter cohort study in China. Participants received questionnaires, physical examinations, and underwent measurements of thyrotropin (TSH), free thyroxine (fT4), thyroid peroxidase antibody (TPOAb), TSH receptor antibody (TRAb), and urinary iodine in the first trimester. The patients diagnosed with either GTT or GD and normal thyroid function (NTF) group were followed until delivery. The thyroid function and pregnancy outcomes were reported.Results: A total of 125 pregnant women with thyrotoxicosis and 246 age-matched pregnant women with NTF were included. (1) The thyroid function of the GTT group returned to normal range in the third trimester, but was consistently abnormal in the GD group. (2) The incidence of gestational diabetes mellitus (GDM) in the GTT group (11.5%, 9/78) was significantly higher than that in NTF group (4.9%, 12/246) (p = 0.037). The incidence of premature delivery in the GD untreated (30.8%, 8/26, p = 0.002) and treated groups (28.6%, 6/21, p = 0.008) was both, respectively, higher than that in the NTF group (7.7%, 19/246). Miscarriage (15.4%, 4/26 vs. 3.7%, 9/246, p = 0.026) and gestational hypertension (19.2%, 5/26 vs. 3.3%, 8/246, p = 0.004) were more prevalent in the GD untreated group than in the NTF group. (3) The presence of positive TRAb and positive TPOAb in the first trimester were independent risk factors for miscarriage (odds ratio [OR] = 5.23, confidence interval [CI] = 1.11-24.78, p = 0.037) and low birth weight infants (OR = 7.76, CI = 1.23-48.86, p = 0.029), respectively.Conclusion: In conclusion, pregnancy outcomes appear variable, according to the etiology of first trimester thyrotoxicosis. GTT appears to be associated with GDM. GD appears to be associated with an increased risk of premature delivery, gestational hypertension, and miscarriage. The diagnosis of GTT and GD patients during early pregnancy and appropriate treatment of GD patients may be associated with improved pregnancy outcomes.

Background: Gastric cancer (GC) is a common malignancy. A mounting body of evidence has demonstrated the correlation between GC prognosis and epithelial-mesenchymal transition (EMT)-related biomarkers. This research constructed an available model using EMT-related long noncoding RNA (lncRNA) pairs to predict the survival for GC patients. Methods: The transcriptome data along with clinical information on GC samples were derived from The Cancer Genome Atlas (TCGA). Differentially expressed EMT-related lncRNAs were acquired and paired. Univariate and least absolute shrinkage and selection operator (LASSO) Cox regression analyses were applied to filter lncRNA pairs, and the risk model was built to investigate its effect on the prognosis of GC patients. Then, the areas under the receiver operating characteristic curves (AUCs) were calculated and the cutoff point for distinguishing low- or high-risk GC patients was identified. And the predictive ability of this model was tested in the GSE62254. Furthermore, the model was evaluated from the perspectives of survival time, clinicopathological parameters, infiltration of immunocytes, and functional enrichment analysis. Results: The risk model was built by using the identified twenty EMT-related lncRNA pairs, and it was not necessary to know the specific expression level of each lncRNA. Survival analysis pointed out that GC patients with high risk had poorer outcomes. Additionally, this model could be an independent prognostic variable for GC patients. The accuracy of the model was also verified in the testing set. Conclusions: The new predictive model constructed here is composed of EMT-related lncRNA pairs, with reliable prognostic values, and can be utilized to predict the survival of GC.

RATIONAL:Wilson disease (WD), also known as hepatolenticular degeneration, is an autosomal-recessive hereditary disease with abnormal copper metabolism. Crohn disease (CD) is a chronic inflammatory gastrointestinal disease, which belongs to inflammatory bowel disease, all segments of the gastrointestinal tract can be affected, especially the terminal ileum and colon, accompanied by extraintestinal manifestations and related immune disorders. WD complicated by ulcerative colitis has been reported before, but WD complicated by CD has not been reported so far.PATIENT CONCERNS AND DIAGNOSIS:We presented the first report of a young patient with WD complicated by CD, who was admitted to the hospital because of repeated low fever, elevated C-reactive protein for 3 years, and anal fistula for 6 months.INTERVENTIONS AND OUTCOMES:In this complicated disease, Ustekinumab is safe and effective.LESSONS:We conclude that copper metabolism and oxidative stress play important roles in WD and CD.

Objective:We aimed to establish and validate a user-friendly and clinically practical nomogram for estimating the probability of echocardiographic left ventricular hypertrophy (echo-LVH) indexed to BSA among hypertensive patients from northern China.Methods:A total of 4954 hypertensive patients were recruited from a population-based cohort study from January 2012 to August 2013. The dataset was randomly split into two sets: training (n = 3303) and validation (n = 1651). Three nomograms were initially constructed. That is the Cornell product nomogram, the non-ECG nomogram, and the integrated nomogram which integrated non-ECG risk factors and Cornell-voltage duration product. The least absolute shrinkage and selection operator strategies were employed to screen for non-ECG features. The performance of the nomograms was evaluated using discrimination, calibration, and decision curve analysis (DCA). The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were also calculated.Results:The AUCs, NRIs, IDIs, and DCA curves of the nomograms demonstrated that the integrated nomogram performed best among all three nomograms. The integrated nomogram incorporated age, sex, educational level, hypertension duration, SBP, DBP, eGFR, sleep duration, tea consumption, and the Cornell-voltage duration product. The AUC was 0.758 and had a good calibration (Hosmer-Lemeshow test, P = 0.73). Internal validation showed an acceptable AUC of 0.735 and good calibration was preserved (Hosmer-Lemeshow test, P = 0.19). The integrated nomogram was clinically beneficial across a range of thresholds of 10-50%.Conclusion:The integrated nomogram is a convenient and reliable tool that enables early identification of hypertensive patients at high odds of LVH and can assist clinicians in their decision-making.

Gastroesophageal cancers (GECs) comprise malignancies in the stomach, esophagus, and gastroesophageal junction. Despite ongoing improvements in chemoradiotherapy, the clinical outcomes of GEC have not significantly improved over the years, and treatment remains challenging. Immune checkpoint inhibitors (ICIs) have been the subject of clinical trials worldwide for several years. Encouraging results have been reported in different countries, but further research is required to apply ICIs in the clinical care of patients with GEC. This review summarizes completed and ongoing clinical trials with programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) pathway blockers in GEC and current biomarkers used for predicting PD-1/PD-L1 blockade efficacy. This review captures the main findings of PD-1/PD-L1 antibodies combined with chemotherapy as an effective first-line treatment and a monotherapy in second-line or more treatment and in maintenance therapy. This review aims to provide insight that will help guide future research and clinical trials, thereby improving the outcomes of patients with GEC.

Immune checkpoint inhibitors (ICIs) have opened up a new way for tumor therapy but simultaneously led to the occurrence of immune-related adverse events. We report a case of successful treatment of PD-1 inhibitor-associated colitis with fecal microbiota transplantation (FMT). The patient was a palatal malignant melanoma who developed diarrhea and hematochezia accompanied by fever, gastrointestinal bleeding, and infection after the third treatment with PD-1 (Toripalimab). The patient received general treatment unsuccessful, corticosteroid therapy after initial success but rapid loss of response, and finally successful treatment after fecal microbiota transplantation.

Background and Objectives:A novel wide-band dielectric mapping system, named as KODEX-EPD (EPD Solutions, Philips, Best, the Netherlands), was effectively used in the EA mapping for atrial fibrillation (AF) ablation. To date, only a few studies have concentrated on the application of the KODEX-EPD system for ablating supraventricular tachycardia or ventricular premature beats (VPBs) in human models. This study aims to assess the applicability and efficiency of a novel three-dimensional electro-anatomic (EA) mapping system to improve the success rate of ablation. Methods:This study included 11 consecutive patients who underwent ablation after EA mapping with the KODEX-EPD system. Results:All surgeries were successfully performed using the KODEX-EPD system, including 6 cases who underwent ablation of paroxysmal supraventricular tachycardia (PSVT), 2 cases who received ablation of VPBs from right ventricular outflow tract (RVOT), and 3 cases who underwent cryoablation of AF. For ablation of PSVT or VPBs, the operation time was 31.4 (range, 24.0-38.0) min, in which a median operation time of 2.9 min was used to create anatomic images, and the median fluoroscopic dose was 7.4 mGy. For ablation of AF, the operation time was 56.0 (range, 49.0-62.0) min, in which a median of 4.3 (range, 3.4-5.2) min was used for constructing left atrium map, and the median fluoroscopic dose was 15.0 mGy. The operation time and the fluoroscopic dose were greatly shortened for all surgeries. Conclusion:The KODEX-EPD system is an effective and safe tool to guide the EA mapping, leading to improvement in the success rate of ablation. It can promote the ablation process with the reduced fluoroscopic dose, and it is also a promising tool for complex surgeries.

Objective: The use of antithyroid drugs (ATDs) carries potential risk for teratogenic effects. For women with well-controlled hyperthyroidism on a low dose of ATDs, drug withdrawal upon pregnancy is recommended by international medical guidelines. Therefore, it is necessary to determine the characteristics of patients suitable for ATD withdrawal, subsequent changes in thyroid function after ATD discontinuation, and its impact on pregnancy and offspring outcomes.Methods: This prospective study recruited 63 pregnant women with well-controlled Graves' hyperthyroidism who had stopped ATDs during early pregnancy. Patients were followed up until the end of pregnancy and data on pregnancy outcomes were collected.Results: Overall, 20 patients (31.7%) had rebound of hyperthyroidism. Patients with either subnormal thyrotropin (TSH) levels (TSH <0.35 mIU/L, odds ratio [OR] = 5.12, confidence interval [CI = 1.29-20.34], p = 0.03) or positive thyrotropin receptor antibody (TRAb) (TRAb >1.75 IU/L, OR = 3.79, [CI = 1.17-12.30], p = 0.02) at the time of ATDs withdrawal presented a higher risk of rebound than those with either normal TSH levels or negative TRAb. Patients with both subnormal TSH and positive TRAb at the time of ATD withdrawal were more likely to experience rebound (83.3%, 5/6) than those with both normal TSH and negative TRAb (13%, 3/23, OR = 33.33, [CI = 2.83-392.60], p = 0.003). The prevalence of adverse pregnancy outcomes was significantly higher in patients who experienced rebound compared with those who did not (55.0% vs. 9.3%, OR = 11.92, [CI = 3.08-46.18], p = 0.0002).Conclusions: Subnormal TSH levels and TRAb positivity at the time of ATD withdrawal in early pregnancy may be associated with rebound of Graves' hyperthyroidism. Rebound of hyperthyroidism during pregnancy may increase the risk of adverse pregnancy outcomes. Larger prospective studies are needed to confirm these findings.