BackgroundHybrid coronary revascularization (HCR) has been demonstrated as a safe and effective revascularization strategy in selected patients with multivessel coronary artery disease; however, the inclusion criteria are too strict.ObjectivesThis study was conducted to compare in-hospital and midterm outcomes after generalized HCR and off-pump coronary artery bypass (OPCABG) in patients with multivessel coronary artery disease.MethodsWe proposed a generalized idea of HCR. First, the PCI for non-LAD vessels suitable for coronary stents was performed. Then, MICS-CABG for LIMA to the LAD and saphenous to other non-LAD vessels that were not suitable for stents or stenting failed. Propensity score matching was used, and 222 patients (n = 111 in both the generalized HCR and OPCABG groups) were enrolled in the study. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and the secondary endpoints were in-hospital outcomes.ResultsNo significant difference was observed in the cumulative rate of MACCE (9.9% vs. 16.2%; HR, 0.567; 95% CL, 0.268–1.201; P = 0.138) between the generalized HCR and OPCABG groups. The residual SYNTAX score was similar between two groups (6.3 ± 5.5 for generalized HCR vs. 6.8 ± 5.3 for OPCABG; P = 0.486). Compared with OPCABG, generalized HCR was associated with a significantly lower intra-aortic balloon pump (IABP) implantation rate (2.7% vs. 9.9%; P = 0.027) and shorter postoperative length of stay (6.3 ± 3.2 vs. 7.7 ± 3.0; P = 0.001).ConclusionsThe generalized HCR procedure appears to be safe and efficacious, with outcomes similar to those of standard off-pump CABG and satisfactory completeness of revascularization.

[This corrects the article DOI: 10.1016/j.heliyon.2024.e38035.].

Recently, the identification of autoantibodies (AT1-AA) targeting the second extracellular loop of angiotensin II type 1 receptor (AT1R-ECII) in patients with coronary heart disease (CHD) offers a novel perspective on the interplay between immunity and cardiovascular disease. However, much remains unknown regarding the functional diversity of AT1-AA. In this study, we measured the levels of AT1-AA in the sera of 306 CHD patients and purified AT1-AA from patient's sera (n = 127). The subclasses of AT1-AA were categorized based on their impact on intracellular calcium ([Ca2+](i)) levels in mouse arterial smooth muscle cells (MASMCs). Our findings revealed 4 distinct [Ca2+](i) response patterns indicating the existence of 4 functional subclasses named H1-, H2-, H3-, and H4-AT1-AA. The correlation analysis demonstrated a positive association between H1-AT1-AA and endogenous coagulation, as well as between H2-AT1-AA and exogenous coagulation; no significant correlation was observed between H3-AT1-AA and the indicators we analyzed. Conversely, H4-AT1-AA exhibited a negative correlation with both leukocyte number and bile acid levels. Logistic regression analysis showed that H2-AT1-AA possessed predictive value for severe CHD. Furthermore, in vitro experiments indicated that both H1- and H2-AT1-AA exerted cytotoxic effects on MASMCs, while H4-AT1-AA increased cell viability. Additionally, an AT1-AA-positive rat model was established by subcutaneously injecting with AT1R-ECII peptide, which produced four similar functional subclasses of rat AT1-AA upon active immunization. This study suggested that classifying different functional subclasses of AT1-AAs can facilitate more accurate evaluation of the condition and prognosis in patients with CHD, thereby providing a novel basis for clinical diagnosis and treatment.

OBJECTIVE:The impact of uric acid on worsening of diastolic function and clinical outcomes in patients with coronary slow flow remains unclear. This study aims to investigate possible associations between serum uric acid, worsening of diastolic function, and major adverse cardiovascular events in coronary slow flow patients.METHODS:Blood samples were obtained prospectively from 537 patients who had been angiographically diagnosed with coronary slow flow. Of those, 425 patients underwent comprehensive cardiac function assessment both before and after maximal treadmill exertion by stress echocardiography. The association between serum uric acid and major adverse cardiovascular events was examined using Cox proportional hazards regression model.RESULTS:Among the 425 patients (mean age: 58 ± 11 years; 52.2% men), worsening of diastolic function occurred in 176 (41.4%) after exercise stress. Patients with worsening of diastolic function had elevated levels of serum uric acid compared to those without (5.7 [4.1, 6.7] vs 4.3 [3.6, 5.3] mg/dL, respectively; P <.001). Higher serum uric acid levels were also significantly associated with neutrophil counts and high-sensitive C-reactive protein in patients with worsening of diastolic function but not in those without. Multivariate regression analysis found serum uric acid to be an independent predictor of worsening of diastolic function (odds ratio = 1.87 [1.17-3.82], P =.023). Moreover, serum uric acid remained associated with major adverse cardiovascular events even after adjusting for echocardiographic and clinical variables (hazard ratio = 1.56 [1.03-2.89], P =.016).CONCLUSION:Serum uric acid is associated with worsening of diastolic function and may be mediated by inflammation. These findings indicate that uric acid is a risk factor for major adverse cardiovascular events in patients with coronary slow flow.

Background Glioblastoma (GBM) is a highly aggressive primary brain tumor with a poor prognosis. This study investigates the therapeutic potential of human Vγ9Vδ2 T cells in GBM treatment. The sensitivity of different glioma specimens to Vγ9Vδ2 T cell-mediated cytotoxicity is assessed using a patient-derived tumor cell clusters (PTCs) model. Methods The study evaluates the anti-tumor effect of Vγ9Vδ2 T cells in 26 glioma cases through the PTCs model. Protein expression of BTN2A1 and BTN3A1, along with gene expression related to lipid metabolism and glioma inflammatory response pathways, is analyzed in matched tumor tissue samples. Additionally, the study explores two strategies to re-sensitize tumors in the weak anti-tumor effect (WAT) group: utilizing a BTN3A1 agonistic antibody or employing bisphosphonates to inhibit farnesyl diphosphate synthase (FPPS). Furthermore, the study investigates the efficacy of genetically engineered Vγ9Vδ2 T cells expressing Car-B7H3 in targeting diverse GBM specimens. Results The results demonstrate that Vγ9Vδ2 T cells display a stronger anti-tumor effect (SAT) in six glioma cases, while showing a weaker effect (WAT) in twenty cases. The SAT group exhibits elevated protein expression of BTN2A1 and BTN3A1, accompanied by differential gene expression related to lipid metabolism and glioma inflammatory response pathways. Importantly, the study reveals that the WAT group GBM can enhance Vγ9Vδ2 T cell-mediated killing sensitivity by incorporating either a BTN3A1 agonistic antibody or bisphosphonates. Both approaches support TCR-BTN mediated tumor recognition, which is distinct from the conventional MHC-peptide recognition by αβ T cells. Furthermore, the study explores an alternative strategy by genetically engineering Vγ9Vδ2 T cells with Car-B7H3, and both non-engineered and Car-B7H3 Vγ9Vδ2 T cells demonstrate promising efficacy in vivo, underscoring the versatile potential of Vγ9Vδ2 T cells for GBM treatment. Conclusions Vγ9Vδ2 T cells demonstrate a robust anti-tumor effect in some glioma cases, while weaker in others. Elevated BTN2A1 and BTN3A1 expression correlates with improved response. WAT group tumors can be sensitized using a BTN3A1 agonistic antibody or bisphosphonates. Genetically engineered Vγ9Vδ2 T cells, i.e., Car-B7H3, show promising efficacy. These results together highlight the versatility of Vγ9Vδ2 T cells for GBM treatment.

Primary intracranial histiocytic sarcomas (PIHSs) are extremely rare with limited reported cases, making their prognostic factors and management uncertain. This study aims to describe the clinical characteristics of PIHSs and propose a treatment protocol for this entity. Clinical data were collected from six patients diagnosed with PIHSs at Beijing Tiantan Hospital between March 2011 and October 2022. Additionally, a comprehensive search of the PubMed database was conducted using the keywords "primary intracranial" or "primary central nervous system" combined with "histiocytic sarcoma" or "histiocytic sarcomas" between 1996 and 2022, identifying 24 cases. A pooled analysis of individual patient data was performed to assess risk factors for overall survival (OS). The six cases included four males and two females, with a mean age of 42.2 ± 13.3 years. In total, 24 cases of PIHSs were identified from previous studies. Multivariate Cox regression analysis revealed that gross total resection (GTR) was the only factor predicting a longer OS (p = 0.027). Kaplan–Meier analysis demonstrated that GTR (p = 0.0013), solitary lesions (p = 0.0048), and radiotherapy (p = 0.0492) were associated with a longer OS. PIHSs are rare brain tumors with poor clinical prognosis. Patients with solitary lesions have a longer OS than those with multifocal lesions. Gross total resection must be the first choice. Radiotherapy may bring benefits for these patients, but chemotherapy may not be useful. Further studies involving larger cohorts are necessary to validate these findings.

ObjectPediatric diffuse intrinsic pontine glioma (DIPG) is a radiologically heterogeneous disease entity, here we aim to establish a multimodal imaging-based radiological classification and evaluate the outcome of different treatment strategies under this classification frame.MethodsThis retrospective study included 103 children diagnosed with DIPGs between January 2015 and August 2018 in Beijing Tiantan Hospital (Beijing, China). Multimodal radiological characteristics, including conventional magnetic resonance imaging (MRI), diffuse tensor imaging/diffuse tensor tractography (DTI/DTT), and positron emission tomography (PET) were reviewed to construct the classification. The outcome of different treatment strategies was compared in each DIPG subgroup using Kaplan-Meier method (log-rank test) to determine the optimal treatment for specific DIPGs.ResultsFour radiological DIPG types were identified: Type A ("homocentric", n=13), Type B ("ventral", n=41), Type C ("eccentric", n=37), and Type D ("dorsal", n=12). Their treatment modalities were grouped as observation (43.7%), cytoreductive surgery (CRS) plus radiotherapy (RT) (24.3%), RT alone (11.7%), and CRS alone (20.4%). CRS+RT mainly fell into type C (29.7%), followed by type B1 (21.9%) and type D (50%). Overall, CRS+RT exhibited a potential survival advantage compared to RT alone, which was more pronounced in specific type, but this did not reach statistical significance, due to limited sample size and unbalanced distribution.ConclusionWe proposed a multimodality imaging-based radiological classification for pediatric DIPG, which was useful for selecting optimal treatment strategies, especially for identifying candidates who may benefit from CRS plus RT. This classification opened a window into image-guided integrated treatment for pediatric DIPG.

Abstract Background Gated 99m Tc-sestamibi myocardial perfusion single-photon emission computed tomography (G-SPECT) is a non-invasive imaging technique that offers accurate evaluation of myocardial perfusion and resting left ventricular diastolic function in patients with coronary slow flow (CSF). However, it’s uses to estimate the diastolic function during stress is still not well determined.Objective To evaluate the left ventricular diastolic function at rest and during stress in CSF patients using G-SPECT and to determine the association between the clinical variables and the rest-stress changes in diastolic function.Methods We identified 18 angiographically proven CSF patients (56 ± 8.9 years, 12 male), from January 2017 through October 2018, who underwent a 2-day 99mTc-t sestamibi adenosine/exercise stress test along with rest protocols. The cardiac diastolic function parameters, including peak filling rate (PFR), time to peak filling (TTPF), and peak filling rate normalized to EDV (end diastolic volume) (PFR/EDV) were obtained using G‑SPECT. Then, the association between the diastolic function parameter changes (Δ stress-rest) and cardiovascular risk factors were analyzed.Results Compared with rest, summed stress scores were significantly higher (P = 0.01). TTPF, PFR, and PFR adjusted by EDV(PFR/EDV) alone showed no significant difference between rest and stress as diastolic dysfunction was present in both states. There was progressive decrease in TTPF, PFR and PFR/EDV with stress. In stepwise regression model, total cholesterol was significantly associated with the difference of summed scores (ΔStress-Rest) (β = 0.518, P = 0.028). In the same model, uric acid was found inversely associated with the difference in TTPF (ΔStress-Rest) and PFR/EDV (ΔStress-Rest) (β= -0.516, P = 0.028 and β= -0.560, P = 0.015, respectively).Conclusion Uric acid is significantly associated with the diastolic function worsening during stress in CSF patients. It may be a potential predictor and possible therapeutic target to attenuate the early diastolic function deterioration in these patients.

PurposeHigh grade pleomorphic xanthoastrocytomas (HGPXAs) are very rare and their management and prognostic outcomes remain unclear. To better understand the disease, we aimed to evaluate the risk factors for progression-free survival (PFS) and overall survival (OS), and propose a treatment protocol based on cases from our institute and cases from the literature.MethodsThe authors reviewed the clinical data of 26 patients with HGPXAs who underwent surgical treatment in Department of Neurosurgery of Beijing Tiantan Hospital between August 2014 and September 2021. We also searched the PubMed database using the keywords “anaplastic” combined with “pleomorphic xanthoastrocytoma(s)” between January 1997 and October 2022. Risk factors for PFS and OS were evaluated in the pooled cases.ResultsThe authors’ cohort included 11 males and 15 females with a mean age of 36.7 ± 20.3 years (range: 5.5-71 years). Gross-total resection (GTR) and non-GTR were achieved in 17 (65.4%) and 9 (34.6%) patients, respectively. Radiotherapy and chemotherapy were administered to 22 and 20 patients, respectively. After a mean follow-up of 20.5 ± 21.2 months (range: 0.5-78.1 months), 7 patients suffered tumor recurrence and 6 patients died with a mean OS time of 19.4 ± 10.8 months (range: 8-36 months). In the literature between January 1997 and October 2022, 56 cases of HGPXAs were identified in 29 males and 27 females with a mean age of 29.6 ± 19.6 years (range; 4-74 years). Among them, 24 (44.4%) patients achieved GTR. Radiotherapy and chemotherapy was administered to 31 (62%) patients and 23 (46%) patients, respectively. After a median follow-up of 31.4 ± 35.3 months (range: 0.75-144 months), the mortality and recurrence rates were 32.5% (13/40) and 70% (28/40), respectively. Multivariate Cox regression model demonstrated that non-GTR (HR 0.380, 95% CI 0.174-0.831, p=0.015), age≥30 (HR 2.620, 95% CI 1.183-5.804, p=0.018), no RT (HR 0.334,95% CI 0.150-0.744, p=0.007) and no CT (HR 0.422, 95% CI 0.184-0.967, p=0.042) were negative prognostic factors for PFS. Non-GTR (HR 0.126, 95% CI 0.037-0.422, p=0.001), secondary HGPXAs (HR 7.567, 95% CI 2.221-25.781, p=0.001), age≥30 (HR 3.568, 95% CI 1.190-10.694, p=0.023) and no RT (HR 0.223,95% CI 0.073-0.681, p=0.008) were risk factors for OS.Conclusion:High grade pleomorphic xanthoastrocytomas are very rare brain tumors. Children and younger adults have better clinical outcome than elderly patients. Secondary HGPXAs had worse OS than primary HGPXAs. Complete surgical excision plus RT and CT is recommended for this entity. The frequency of BRAF mutations in HGPXAs is 47.5% (19/40) in this study, however, we do not find the connections between BRAF mutations and clinical outcomes. Future studies with larger cohorts are necessary to verify our findings.

Abstract Background Gated 99m Tc-sestamibi myocardial perfusion single-photon emission computed tomography (G-SPECT) is a non-invasive imaging technique that offers accurate evaluation of myocardial perfusion and resting left ventricular diastolic function in patients with coronary slow flow (CSF). However, it’s uses to estimate the diastolic function during stress is still not well determined. Objective To evaluate the left ventricular diastolic function at rest and during stress in CSF patients using G-SPECT and to determine the association between the clinical variables and the rest-stress changes in diastolic function. Methods We identified 18 angiographically proven CSF patients (56 ± 8.9 years, 12 male), from January 2017 through October 2018, who underwent a 2-day 99m Tc-t sestamibi adenosine/exercise stress test along with rest protocols. The cardiac diastolic function parameters, including peak filling rate (PFR), time to peak filling (TTPF), and peak filling rate normalized to EDV (end diastolic volume) (PFR/EDV) were obtained using G‑SPECT. Then, the association between the diastolic function parameter changes (Δ stress-rest) and cardiovascular risk factors were analyzed. Results Compared with rest, summed stress scores were significantly higher ( P = 0.01). TTPF, PFR, and PFR adjusted by EDV(PFR/EDV) alone showed no significant difference between rest and stress as diastolic dysfunction was present in both states. There was progressive decrease in TTPF, PFR and PFR/EDV with stress. In stepwise regression model, total cholesterol was significantly associated with the difference of summed scores (ΔStress-Rest) (β = 0.518, P = 0.028). In the same model, uric acid was found inversely associated with the difference in TTPF (ΔStress-Rest) and PFR/EDV (ΔStress-Rest) (β= -0.516, P = 0.028 and β= -0.560, P = 0.015, respectively). Conclusion Uric acid is significantly associated with the diastolic function worsening during stress in CSF patients. It may be a potential predictor and possible therapeutic target to attenuate the early diastolic function deterioration in these patients.

Post-operative hydrocephalus is common among children with medulloblastoma after initial tumor resection. This study aimed to establish a novel model for predicting the development of post-operative hydrocephalus in children with medulloblastoma. Only pediatric patients who received initial medulloblastoma resection at Beijing Tiantan Hospital between January 2018 and May 2021 were included in this study. The potential risk factors associated with post-operative hydrocephalus were identified based on multivariate logistic regression and the nomogram. Receiver operating characteristic (ROC) curve were used to evaluate the performance of the nomogram model based on an independent cohort of medulloblastoma patients who underwent surgery from June 2021 to March 2022. A total of 105 patients were included in the primary cohort. Superior invasion ( P = 0.007), caudal invasion ( P = 0.025), and intraventricular blood ≥ 5 mm ( P = 0.045) were significantly related to the development of post-operative hydrocephalus and thus were assembled into the nomogram model. The model accurately predicted post-operative hydrocephalus based on the calibration curve. The area under the ROC curves for the primary and validation cohorts was 0.849 and 0.855, respectively. In total, the nomogram we developed may aid clinicians in assessing the potential risk of pediatric patients with MB developing post-operative hydrocephalus, especially those who would otherwise not have received a diversionary procedure at presentation.

BACKGROUND:Endoscopic rhizotomy (ER) of the medial branch has been recently developed for the treatment of lumbar facet joint pain (LFJP). However, there are no studies comparing the pain-free duration after ER and radiofrequency (RF).OBJECTIVES:To evaluate the long-term outcomes for pain and physical function in patients who underwent ER versus RF for LFJP and compare their pain-free survival.STUDY DESIGN:Open label, prospective, real-world study that includes patients treated with ER or RF at a single center between November 2017 and February 2020.SETTING:The research took place within a single university-based neuro-spine center.METHODS:Patients with a positive diagnostic medial branch block (>= 80% pain relief) were treated with ER or RF. Numeric rating scale (NRS), Oswestry Disability Index (ODI), and Global Impression of Change (GIoC) were obtained at the baseline, and at 6 months and 12 months postoperatively. The duration of pain-free time was recorded at every follow-up. The final follow-up was conducted in March 2021.RESULTS:Of 55 patients with LFJP, 19 underwent ER, and 36 underwent RF. Both ER and RF groups showed significant decreases in NRS and ODI scores at 6 months and 12 months compared with baseline (P < 0.001). ER had significantly better efficacy than RF in NRS, ODI, and GIoC scores at 6 and 12 months (P < 0.05). The pain-free survival curves showed that the median pain-free duration was 20 months and 10 months in ER and RF, respectively.LIMITATION:Patients were not randomized to different groups, which may have led to bias.CONCLUSIONS:Both ER and RF can improve the pain and physical function in patients with LFJP. ER is associated with a longer operative duration and medical expenses; however, it provides more sustained efficacy than RF. The surgical choice should depend on the patients' specific conditions.

Almost 50% of children with intracranial ependymoma experience disease relapse, and their outcomes are extremely poor. The aim of this study was to investigate optimal salvage treatment for pediatric intracranial ependymoma after the first relapse and to identify prognostic factors affecting survival. We conducted a retrospective analysis of 159 children who underwent initial treatment for intracranial ependymoma at Beijing Tiantan Hospital from 2013 to 2017. Relapse was observed in 73 patients (73/159; 45.9%), with a median age of 7.2 ± 3.5 years old. Molecular subgrouping analysis identified H3K27me3-negative PF-EPNs in 74% of patients, ST-RELA EPNs in 21% of patients, and H3K27me3-positive PF-EPNs in 5% of patients. The 5-year event-free survival (EFS) and overall survival (OS) rates after first relapse were 21.1% (95% CI 16.0–26.2) and 30.5% (95% CI 19.8–30.8), respectively. Patients with GTR at first relapse had higher 5-year EFS and 5-year OS than those with STR (P = 0.031 and P = 0.003) or no surgery (P = 0.007 and P = 0.001). Radiotherapy or re-radiotherapy at first relapse significantly prolonged 5-year EFS and OS (both P < 0.001). Patients with H3K27me3-negative PF-EPN had worse 5-year EFS and OS than those with ST-RELA EPN (P = 0.001 and P = 0.002). Multivariate analysis showed that both tumor resection and radiotherapy at first relapse had independent prognostic significance for survival (all P < 0.05). Children with recurrent intracranial EPN have poor outcomes, and surgery and radiotherapy at first relapse should be encouraged to improve their prognosis.

目的:利用meta分析的方法研究胎停育的危险因素,为胎停育的预防提供依据.方法:通过检索Pubmed、CNKI、万方等数据库,使用"胎停育""胚胎停止发育"与"影响因素""相关因素""危险因素"等主题词组合进行检索,检索时间从建库至2021年6月1日.收集研究胎停育危险因素的病例对照研究,按照确定的纳排标准筛选文献,使用Revman5.3.0进行meta分析.结果:共纳入了 30篇文献,共34 848例,其中胎停育组9850例,对照组24 998例.胎停育的危险因素为孕妇≥35岁(OR=1.65,95％CI 1.25～2.17)、沙眼衣原体感染(OR=4.15,95％CI 1.96～8.77)、解脲支原体感染(OR=8.15,95％CI 3.46～19.19)、吸烟(OR=3.02,95％CI 1.74～5.24)、饮酒(OR=4.97,95％CI 3.92～6.30)、既往流产史(OR=5.59,95％CI 3.19～9.51)、不良心理(OR=3.51,95％CI 2.34,5.28)、不良环境(OR=4.36,95％CI 2.08～9.17)、胎儿染色体异常(OR=5.83,95％CI 4.36～7.78)等.而补充叶酸是胎停育的保护因素(OR=0.30,95％CI 0.21～0.45).结论:胎停育的危险因素较多,早期识别、干预,有利于预防胎停育的发生,实现优生优育.

In December 2019, an unprecedented outbreak of the novel coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began to spread internationally, now impacting more than 293,750,692 patients with 5,454,131 deaths globally as of January 5, 2022. COVID-19 is highly pathogenic and contagious which has caused a large-scale epidemic impacting more deaths than the severe acute respiratory syndrome (SARS) epidemic in 2002-2003 or the Middle East respiratory syndrome (MERS) epidemic in 2012-2013. Although COVID-19 symptoms are mild in most people, in those with pre-existing comorbidities there is an increased risk of progression to severe disease and death. In an attempt to mitigate this pandemic, urgent public health measures including quarantining exposed individuals and social distancing have been implemented in most states, while some states have even started the process of re-opening after considering both the economic and public health consequences of social distancing measures. While prevention is crucial, both novel agents and medications already in use with other indications are being investigated in clinical trials for patients with COVID-19. The collaboration between healthcare providers, health systems, patients, private sectors, and local and national governments is needed to protect both healthcare providers and patients to ultimately overcome this pandemic. The purpose of this review is to summarize the peer-reviewed and preprint literature on the epidemiology, transmission, clinical presentation, and available therapies as well as to propose a preventive strategy to overcome the present global pandemic.

Objective Cerebellar liponeurocytomas (CLPNs) are very rare. Limited studies described this disease and their treatment protocol remain unclear. To better understand the disease, we review the clinical features and outcomes, and propose a treatment protocol based on previously reported cases and cases from our institute. Methods The clinical data were obtained from 7 patients with pathologically confirmed CLPNs, who accepted surgical treatment in our institute between November 2011 and June 2021. We also reviewed the literature and 75 patients with CLPNs were identified between September 1993 and June 2021. Risk factors for Progression-free survival (PFS) were evaluated in the pooled cohort. Results The authors’ cohort included 4 males and 3 females with a mean age of 43.9±14.5 (range: 29-64 years). 3 cases are located in lateral ventricle and 4 cases are located in cerebellum. All 7 cases achieved gross total resection (GTR) and radiotherapy was administered to 2 cases. After a mean follow-up of 44.9±44.4 months, all patients remained well with no recurrence or death. For the reported 75 patients, there are 35 males and 40 females with a mean age of 46.2±13.6 years (range: 6-77 years). Biopsy, gross total resection (GTR) and non-GTR were achieved in 1 (1.3%), 50 (66.7%), and 24 (32%) patients, respectively. Radiotherapy was administered to 16 cases and chemotherapy was administered to only 1 case. After a mean follow-up of 47.5±51.5 months, 3 patients died and tumor recurrence occurred in 17 patients. Multivariate Cox analysis revealed that non-GTR predicted a poor PFS (p=0.030). Kaplan-Meier analysis showed that GTR was significantly associated with better PFS (p=0.0084). PFS rates at 1, 5, 10 years were 92.7%, 78.0%, 23.8% respectively. Conclusions Cerebellar liponeurocytomas (CLPNs) are very rare brain tumors. Although they have favorable clinical prognosis, the recurrence is relatively high. GTR should be the first choice and close follow-up is necessary. Postoperative radiotherapy could not improve PFS in this study. A larger cohort is needed to verify our findings.

OBJECTIVE Data on the impact of metabolic syndrome (MetS) and systemic inflammation on endothelial function remains scarce. In this study, we aimed to investigate the combined effects of MetS and systemic inflammation on endothelial function in postmenopausal women. METHODS We identified 423 postmenopausal women from February 2019 through July 2020. MetS was diagnosed according to the International Diabetes Federation (IDF) criteria, and high sensitivity C-reaction protein (hs-CRP) was measured to assess the degree of underlying inflammation. The measurement of endothelial function was using digital arterial tonometry by assessing reactive hyperemia-induced vasodilation in one arm and adjusting for changes in the contralateral arm (reactive hyperemia index, RHI). RESULTS There were 156 patients with MetS and 267 without MetS. Compared to the group without MetS, patients with MetS had significantly lower natural logarithmic RHI (0.66±0.29 versus 0.91±0.31; p<0.001), but higher levels of hs-CRP (0.98 [0.31, 3.54] versus 0.53 [0.20, 2.14]; p<0.001). In sequential multivariable analysis, the presence of hs-CRP (ΔR2=0.047, p=0.004) had a significant and independent influence on natural logarithmic RHI. Furthermore, the interaction of hs-CRP*MetS was synergistically associated with endothelial dysfunction even in the fully adjusted model (β=-0.107, 95% CI [-0.161~-0.053], p=0.009). CONCLUSION MetS and systemic inflammation are synergistically associated with endothelial dysfunction in postmenopausal women. Postmenopausal women with both these conditions appear to be at a significantly higher risk for adverse cardiovascular events.

目的 研究伊伐布雷定联合沙库巴曲缬沙坦治疗慢性充血性心力衰竭(CHF)的临床疗效.方法 选取2017年4月至2020年4月于北京安贞医院心内科住院及门诊就诊的病情稳定的CHF患者.两组患者均使用沙库巴曲缬沙坦治疗,一组在标准抗心力衰竭(心衰)治疗的基础上,窦性心率仍>70次/min的68例患者,予以伊伐布雷定治疗(伊伐布雷定组),并选取同期就诊的已接受沙库巴曲缬沙坦为基础的标准抗心衰治疗,但因各种原因未使用伊伐布雷定治疗的CHF患者66例(对照组).伊伐布雷定初始剂量为2.5 mg/次,2/d,根据心率调整剂量,最大量7.5 mg/次,2/d.控制患者的静息心率60次/min左右,连续用药6个月,纪录两组用药前后心率(HR)、N末端脑钠肽前体(NT-proBNP)、6 min步行距离(6MWD)、心脏彩超测定左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD),并记录药物的不良反应.结果 加用伊伐布雷定前两组比较,HR、NT-proBNP、6MWD、LVEF、LVEDD、LVESD无统计学差异(P均>0.05),治疗6个月后,伊伐布雷定组与对照组比较,HR、NT-proBNP、LVEDD、LVESD降低(P<0.05),6MWD、LVEF增加(P<0.05).伊伐布雷定组治疗6个月后与治疗前比较,HR显著下降(68.5±10.1 vs.81.2±7.7次/min),NT-proBNP水平也显著下降(455±51 ng/L vs.2510±506 ng/L),LVEDD有显著下降(51±4 mm vs.61±6 mm),LVESD显著下降(33.2±0.9 mm vs.42.1±1.3 mm),6MWD显著增加(198±55 m vs.110±55 m),LVEF显著增加(40.0±6.0％vs.31.0±7.0％).治疗前后比较差异有统计学意义(P<0.05),且药物不良反应少.结论 伊伐布雷定联合沙库巴曲缬沙坦治疗能够降低CHF患者的心率,改善心功能,提高运动耐力,且不增加不良反应发生率,改善CHF患者的生活质量,减少疾病复发,安全、有效.

OBJECTIVE:Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) have the ability to noninvasively visualize changes in white matter tracts, as well as their relationships with lesions and other structures. DTI/DTT has been increasingly used to improve the safety and results of surgical treatment for lesions in eloquent areas, such as brainstem cavernous malformations. This study aimed to investigate the application value of DTI/DTT in brainstem glioma surgery and to validate the spatial accuracy of reconstructed corticospinal tracts (CSTs).METHODS:A retrospective analysis was performed on 54 patients with brainstem gliomas who had undergone surgery from January 2016 to December 2018 at Beijing Tiantan Hospital. All patients underwent preoperative DTI and tumor resection with the assistance of DTT-merged neuronavigation and electrophysiological monitoring. Preoperative conventional MRI and DTI data were collected, and the muscle strength and modified Rankin Scale (mRS) score before and after surgery were measured. The surgical plan was created with the assistance of DTI/DTT findings. The accuracy of DTI/DTT was validated by performing direct subcortical stimulation (DsCS) intraoperatively. Multiple linear regression was used to investigate the relationship between quantitative parameters of DTI/DTT (such as the CST score and tumor-to-CST distance [TCD]) and postoperative muscle strength and mRS scores.RESULTS:Among the 54 patients, 6 had normal bilateral CSTs, 12 patients had unilateral CST impairments, and 36 had bilateral CSTs involved. The most common changes in the CSTs were deformation (n = 29), followed by deviation (n = 28) and interruption (n = 27). The surgical approach was changed in 18 cases (33.3%) after accounting for the DTI/DTT results. Among 55 CSTs on which DsCS was performed, 46 (83.6%) were validated as spatially accurate by DsCS. The CST score and TCD were significantly correlated with postoperative muscle strength (r = -0.395, p < 0.001, and r = 0.275, p = 0.004, respectively) and postoperative mRS score (r = 0.430, p = 0.001, and r = -0.329, p = 0.015, respectively). The CST score was independently linearly associated with postoperative muscle strength (t = -2.461, p = 0.016) and the postoperative mRS score (t = 2.052, p = 0.046).CONCLUSIONS:DTI/DTT is a valuable tool in the surgical management of brainstem gliomas. With good accuracy, it can help optimize surgical planning, guide tumor resection, and predict the postoperative muscle strength and postoperative quality of life of patients.

The impact of reverse left ventricular remodeling (r-LVR) on clinical outcomes after surgical correction of anomalous left coronary artery from the pulmonary artery (ALCAPA) remains unclear. This study aims to examine the prognostic significance of r-LVR in patients with ALCAPA after surgery. We prospectively identified 61 patients undergoing surgical correction for ALCAPA; 54 patients had adequate echocardiographic image quality with quantitative biplane analysis performed both at baseline and at 30-day postoperative follow-up. Postoperative r-LVR was defined as a reduction of ≥ 10% in left ventricular end-diastolic volume index during follow-up. Cox proportional-hazards regression was used to investigate the independent association of r-LVR and all-cause mortality. Among 54 patients (age: 21.2 ± 7 months; 37% females), r-LVR occurred in 35 patients (64.8%) after surgery. Compared to patients with r-LVR, patients without r-LVR had significantly higher level of N-terminal pro B-type natriuretic peptide (NT-proBNP) [2176 (711, 4219) vs 998 (623, 2145) P < 0.001] and lower survival rate (47.3% vs 82.9%, HR = 5.72 [1.96 to 17.20], P < 0.001) at 1-year follow-up. NT-proBNP (OR = 2.27 [1.67 to 18.3], P = 0.02) was an independent predictor of r-LVR in multivariate analysis. Moreover, r-LVR was significantly associated with a lower rate of all-cause mortality (HR = 0.27 [0.08 to 0.98], P = 0.03) in multivariate analysis, even after adjustment for clinical and echocardiographic variables. R-LVR occurred in more than half of patients with ALCAPA undergoing surgical correction and it was associated with better clinical outcomes. NT-proBNP is an independent predictor of r-LVR.