The relationship between metabolic associated fatty liver disease (MAFLD) and thyroid nodule (TN) is unknown, despite the overweight obese individuals showed a greater risk of nonalcoholic fatty liver disease(NAFLD) and thyroid cancer compared to the normal Body mass index(BMI) individuals. This is a cross-sectional study examining the association between TN and MAFLD in healthy Chinese population undergoing simultaneous abdominal and thyroid ultrasonography. A total of 78,077 healthy individuals with complete biochemical, thyroid and liver ultrasonography data from the Quality Control Center of Health Examination in Chongqing, China were included in the study. TNs were classified into malignancy risk levels of 5 different categories in accordance with Thyroid Imaging Reporting and Data System(TI-RADS). We investigated the association between MAFLD and TNs by binomial logistic regression analyses, and multinomial logistic regression analyses were performed to test the independence of associations between TNs or different TI-RADS categories of TNs and MAFLD.This study was designed and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to ensure transparency and completeness in reporting observational research. The prevalence of TN, MAFLD and combined TN with MAFLD were 30.4

OBJECTIVE:To investigate the safety and effectiveness of contiguous dorsal gullwing flaps for a single-stage interdigital web spaces reconstruction in patients with multiple-digit postburn syndactyly. METHODS:A respective analysis was performed for 16 patients with multiple-digit postburn syndactyly who underwent surgery in a single-stage separation in our hospital from January 2016 to May 2023. The contiguous dorsal gullwing flaps were designed for interdigital web space reconstruction, at the same time using a zigzag incision to address scar contracture. Remaining skin defects would be covered with full-thickness skin grafts from the groin or wrist. A comprehensive review was conducted on various data points, including patient demographics, the scar pliability score per the Vancouver Scar Scale on the dorsal hand, the survival rates of flaps and skin grafts, preoperative and postoperative photographs, hand function assessments, patient satisfaction, and modified Withey scores. RESULTS:The study included 12 boys and 4 girls with an average age of 42.13 ± 23.68 months, encompassing 37 affected web spaces. Among these patients, 11 cases involved three-fingered postburn syndactyly, meanwhile 5 cases were four-fingered postburn syndactyly. The follow-up time ranged from 6 months to 2 years. All flaps and skin grafts successfully survived without complications or web creep development. In the patient satisfaction survey, there were 10 cases of "very satisfied" and 6 cases of "satisfied". Based on the modified Withey score rule, the median value of digital flexion-extension deformity in the postoperative period was 0.63 ± 0.25, which was significantly lower than that of 1.88 ± 0.50 in the preoperative period (P < 0.001). The median value of web creep decreased from 3.38 ± 0.50 in the preoperative period to 0 in the postoperative period (P < 0.001). Besides, the median value of total Withey scores in the postoperative period was as low as 1.06 ± 0.25, compared with 6.69 ± 0.95 in the preoperative period (P < 0.001). Hand appearance and joint mobility were significantly improved post-operation. CONCLUSION:Contiguous dorsal gullwing flaps enable an effective single-stage separation of multiple digits postburn syndactyly cases in which sufficient pliable dorsal skin is available. This approach not only prevents web space contracture but also reduces the need for subsequent surgical interventions, achieving both satisfactory aesthetic outcomes and functional digital reconstruction without complications.

Cohort studies have suggested that breast-conserving therapy (BCT) offers better survival outcomes compared to mastectomy in patients with early breast cancer (BC). However, survival comparisons between BCT and mastectomy with breast reconstruction (Mastectomy + BR) are lacking. To investigate this, we conducted a cohort study using data from the SEER database. Patients with first-diagnosed locoregional BC between 2010 and 2016 were included and categorized into BCT and Mastectomy + BR groups. Propensity score matching (PSM) was performed to reduce selection bias. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the groups. After PSM, 56,420 patients were matched (1:1) into the BCT and Mastectomy + BR groups. No significant differences in BCSS or OS were observed between the two matched groups overall. However, subgroup analyses based on tumor size and nodal status showed that, among patients with node-negative and tumors ≤ 5 cm, Mastectomy + BR was associated with decreased BCSS compared to BCT (HR 1.23, 95% CI 1.02-1.49, P = 0.03). Inferior BCSS for Mastectomy + BR was also observed in tumors located in the upper-outer quadrant (HR  1.54, 95% CI 1.07-2.20, P = 0.02), nipple & central area (HR 4.98, 95% CI 1.44-17.21, P = 0.01), and in triple-negative BC (HR  1.45, 95% CI 1.07-1.98, P = 0.02). Additionally, in triple-negative BC, Mastectomy + BR was associated with worse OS (HR  1.33, 95% CI 1.00-1.76, P = 0.048). For patients with node-positive or tumors > 5 cm, no significant differences in BCSS or OS were found between the BCT and Mastectomy + BR groups, except in the HER2-enriched subtype, where Mastectomy + BR was associated with improved BCSS (HR 0.43, 95% CI 0.22-0.85, P = 0.015) and a marginal better OS (HR 0.54, 95% CI 0.29-1.01, P = 0.055). This study suggests that, except for the HER2-enriched subtype, BCT remains an equivalent or, in specific clinical scenarios, a superior alternative to Mastectomy + BR for the treatment of breast cancer.

Venous thromboembolism (VTE) is a common and preventable complication in orthopedic surgery, yet adherence to prophylaxis guidelines remains suboptimal. A pharmacist-led anticoagulation care model based on the Pharmacist Early Active Consultation (PEAC) framework may enhance the quality and safety of VTE prevention in surgical patients. This study aimed to evaluate the impact of a pharmacist-led Venous Thromboembolism Clinical Pharmaceutical Care (VTE-CPC) model, derived from the PEAC framework, on VTE prevention and anticoagulation quality in orthopedic surgery patients. A retrospective cohort study was conducted at a tertiary hospital in China. Patients admitted between December 2023 and May 2024 received routine care (no VTE-CPC group), while those admitted between June and November 2024 received additional pharmacist-led interventions (VTE-CPC group). Multivariate logistic regression was used to identify independent risk factors for VTE. Propensity score matching (PSM) was performed to control baseline differences, resulting in a balanced cohort of 812 patients. Outcomes included VTE incidence, pharmacological prophylaxis practices, and safety endpoints. A total of 959 patients were included (no VTE-CPC: n = 531; VTE-CPC: n = 428). The incidence of VTE was significantly lower in the VTE-CPC group (3.74

We report our experience with correction of radially deviated Wassel type III thumb polydactyly. After comprehensive assessments from preoperative radiographs, physical examinations and intraoperative reports, we corrected the metacarpophalangeal joint in 34 cases of radially deviated Wassel type III thumb polydactyly. Opening-wedge osteotomies combining bone graft and soft tissue reconstruction were used in 28 cases and soft tissue reconstruction only in six cases. Absorbable sutures were used instead of traditional Kirschner (K)-wires to fix the bone grafts. Patients were followed up for 12-78 months (mean 47 months). According to the Tada scoring system, 25 patients achieved good results, seven fair results and two poor results. Our modified technique for correcting radially deviated Wassel type III thumb polydactyly yielded satisfactory results. Continued follow-up and further studies will contribute to a better understanding of the long-term efficacy and potential refinements of this technique.Level of evidence: IV

Background Circular RNAs are involved in autoimmune disease pathogenesis. Our previous study indicated that circPTPN22 is involved in autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, but the underlying mechanisms remain unclear. Methods First, the expression of circPTPN22 was detected by real-time PCR and western blotting. After overexpression or knockdown of circPTPN22, the proliferation of Jurkat cells was detected by the CCK-8 assay, and the apoptosis of Jurkat cells was detected by flow cytometry. In addition, the relationship between circPTPN22-miR-4689-S1PR1 was confirmed by bioinformatic analyses, fluorescence in situ hybridization assays, RNA-binding protein immunoprecipitation, and dual luciferase reporter assays. Results We found that circPTPN22 expression was downregulated in the PBMCs of SLE patients compared to those of healthy controls. Overexpression of circPTPN22 increased proliferation and inhibited apoptosis of Jurkat T cells, whereas knockdown of circPTPN22 exerted the opposite effects. CircPTPN22 acts as a miR-4689 sponge, and S1PR1 is a direct target of miR-4689. Importantly, the circPTPN22/miR-4689/S1PR1 axis inhibited the secretion of TNF-α and IL-6 in Jurkat T cells. Conclusions CircPTPN22 acts as a miR-4689 sponge to regulate T-cell activation by targeting S1PR1 , providing a novel mechanism for the pathogenesis of SLE.

ObjectivesDihydroartemisinin (DHA), an artemisinin derivative extracted from the traditional Chinese medicinal herb Artemisia annua, has the potential to suppress head and neck squamous cell carcinoma (HNSCC) progression. However, the mechanisms underlying these effects remain unclear. Therefore, we aimed to examine the mechanisms underlying the effects of DHA on tumor invasion and migration.MethodsHuman HNSCC cell lines CAL-27 and FaDu were exposed to varying DHA concentrations (0, 5, 20, and 80 μM) for 24 h. Cell proliferation, invasion, and migration were assessed using CCK8, transwell, and wound-healing assays, respectively. Quantitative real-time PCR, western blotting, and immunofluorescence were used to assess the expression levels of the target genes and proteins.ResultsDHA suppressed the invasion and migration of CAL-27 and FaDu cells. Additionally, miR-195-5p suppressed the invasion and migration of HNSCC cells. This study revealed significant differences in the expression of miR-195-5p and TENM2 between clinical samples and multiple public databases. DHA treatment and miR-195-5p overexpression significantly reduced TENM2 expression in HNSCC cells, which suggested that miR-195-5p overexpression enhanced the inhibitory effect of DHA on TENM2.ConclusionsThis study provides the first evidence that DHA inhibits cell invasion and migration by regulating the miR-195-5p/TENM2 axis in HNSCC cells, suggesting it as a potentially effective treatment strategy for HNSCC.

Abstract Background Breast cancer is the most common malignancy in women and also shares similar risk factors with fatty liver, especially metabolic associated fatty liver disease (MAFLD). Chemotherapy can lead to hepatic impairment and hepatic steatosis (HS), which seriously affects the treatment and quality of life of breast cancer women (BCW). Therefore, this study aims to investigate the incidences of HS and MAFLD based on liver ultrasound elastography (USE), liver function abnormalities, and metabolic syndrome in Chinese BCW in the initially diagnosed, during chemotherapy and follow-up stages. Methods A total of 767 BCW treated at Chongqing Breast Cancer Centre were finally enrolled and classified into initially diagnosed group, chemotherapy group, and the follow-up group. The related conditions of HS and MAFLD as well as liver function abnormalities and metabolic syndrome were assessed by liver conventional ultrasound (US) or USE in all groups. Results Compare to US-diagnosed HS (21.7%, 36.7%, 38%), higher incidence of HS (60.4%, 78.6%, 68.0%) were detected by USE in the initially diagnosed, chemotherapy and follow-up groups. 50–70% of US-negative patients were detected by USE as having a fatty liver, which was predominantly mild to moderate. Based on the USE diagnosis, there was a higher prevalence of MAFLD in the initially diagnosed group (49.8%), which increased to 68.1% in the chemotherapy group and decreased in the follow-up group (59.1%), with a predominantly decrease of mild-to-moderate cases. BMI and age subgroups showed a higher incidence of MAFLD in patients with BMI ≥ 23 kg/m2 or age ≥ 60 years old. In addition, BCW combined with MAFLD had a higher incidence of liver function abnormalities and metabolic syndrome. Conclusion Patients treated with chemotherapy for breast cancer have a higher incidence of HS and MAFLD, especially overweight or obese and menopausal patients. Breast cancer patients with combined MAFLD have higher rates of liver function abnormalities and metabolic syndrome. USE has a higher sensitivity than US and can detect more patients with mild to moderate fatty liver disease, enabling early intervention.

Objective:To investigate the effectiveness of autologous nano-fat mixed granule fat transplantation in the treatment of facial soft tissue dysplasia in children with mild hemifacial microsomia (HFM). Methods:A total of 24 children with Pruzansky-Kaban type Ⅰ HFM were admitted between July 2016 and December 2020. Among them, 12 children were treated with autologous nano-fat mixed granule fat (1∶1) transplantation as study group and 12 with autologous granule fat transplantation as control group. There was no significant difference in gender, age, and affected side between groups ( P>0.05). The child's face was divided into region Ⅰ(mental point-mandibular angle-oral angle), region Ⅱ (mandibular angle-earlobe-lateral border of the nasal alar-oral angle), region Ⅲ (earlobe-lateral border of the nasal alar-inner canthus-foot of ear wheel). Based on the preoperative maxillofacial CT scan+three-dimensional reconstruction data, the differences of soft tissue volume between the healthy and affected sides in the 3 regions were calculated by Mimics software to determine the amount of autologous fat extraction or grafting. The distances between mandibular angle and oral angle (mandibular angle-oral angle), between mandibular angle and outer canthus (mandibular angle-outer canthus), and between earlobe and lateral border of the nasal alar (earlobe-lateral border of the nasal alar), and the soft tissue volumes in regions Ⅰ, Ⅱ, and Ⅲ of healthy and affected sides were measured at 1 day before operation and 1 year after operation. The differences between healthy and affected sides of the above indicators were calculated as the evaluation indexes for statistical analysis. At 1 year after operation, the parents, the surgeons, and the nurses in the operation group made a self-assessment of satisfaction according to the frontal photos of the children before and after operation. Results:The study group and the control group were injected with (28.61±8.59) and (29.33±8.08) mL of fat respectively, with no significant difference ( t=0.204, P=0.840). After injection, 1 child in the control group had a little subcutaneous induration, and no related complications occurred in the others. All children in both groups were followed up 1 year to 1 year and 6 months, with an average of 1 year and 4 months in the study group and 1 year and 3 months in the control group. At 1 year after operation, the asymmetry of the healthy and affected sides improved in both groups; the satisfactions of parents, surgeons, and nurses in the study group were all 100% (12/12), while those of the control group were 100% (12/12), 83% (10/12), and 92% (11/12), respectively. The differences between healthy and affected sides in mandibular angle-oral angle, mandibular angle-outer canthus, earlobe-lateral border of the nasal alar, and the soft tissue volume in 3 regions of the two groups after operation were significantly smaller than those before operation ( P<0.05). There was no significant difference in the above indexes between the two groups before operation ( P>0.05). After operation, all indexes were significantly lower in study group than in control group ( P<0.05). Conclusion:Autologous nano-fat mixed granule fat transplantation and autologous granule fat transplantation can both improve the facial soft tissue dysplasia in children with mild HFM, and the former is better than the latter.

CONTEXT:Thyroid function variation within the thyroxine reference range has negative metabolic effects. Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed definition. OBJECTIVE:We aim to explore the effects of thyroid function status on prevalence and mortality of MAFLD. METHODS:Data of 10 666 participants from the Third National Health and Nutrition Examination Survey (NHANES III) were used. MAFLD was diagnosed based on the new definition. Thyroid function variation within the thyroxine reference range was defined based on thyroid-stimulating hormone (TSH) levels: subclinical hyperthyroidism, <0.39 mIU/L; strict-normal thyroid function, 0.39-2.5 mIU/L; and low thyroid function, >2.5 mIU/L, which comprised low-normal thyroid function (2.5-4.5 mIU/L) and subclinical hypothyroidism (> 4.5 mIU/L). Logistic and Cox regression were used in multivariate analysis. RESULTS:Low thyroid function is independently associated with MAFLD (odds ratio: 1.27). Compared with strict-normal thyroid function, subclinical hypothyroidism was significantly associated with increased risk for all-cause and cardiovascular mortality in the total population (hazard ratio [HR] for all-cause: 1.23; cardiovascular: 1.65) and MAFLD population (HR for all-cause: 1.32; cardiovascular: 1.99); meanwhile, in the low-normal thyroid function group, an increasing trend in mortality risk was observed. Furthermore, low thyroid function also showed significant negative impact on mortality in the total and MAFLD population. Among thyroid function spectrum, mild subclinical hypothyroidism showed the highest HRs on mortality. CONCLUSIONS:Low thyroid function is independent risk factor of MAFLD and is associated with increased risk for all-cause and cardiovascular mortality in the MAFLD population. Reevaluation of TSH reference range should be considered.

Background and aimsAn international expert consensus statement was released on 2020 that non-alcoholic fatty liver disease (NAFLD) should be replaced by metabolic associated fatty liver disease (MAFLD) and hepatic steatosis (HS) is fundamental for the diagnosis of MAFLD in the new set of criteria. While female breast cancer has surpassed lung cancer as the most commonly diagnosed malignant tumor and shares the same risk factors with HS and MAFLD, but their prevalence in breast cancer survivors (BCS) is unknown. Herein, we employed the liver ultrasound elastography (USE), a more sensitive detector for HS diagnosis, to explore the more accurate prevalence of HS and MAFLD among BCS.MethodA total of 263 BCS with conventional liver ultrasonography (US) and USE tests, followed up in the clinic of the Breast Cancer Center of Chongqing, as well as age and sex matching controls (1:10) with US test, from 135,436 healthcare population in the Quality Control Center of Health Examination of Chongqing of the First Affiliated Hospital of Chongqing Medical University, were enrolled. Both US and USE were implemented to diagnose HS. Afterwards the anthropology information and relative laboratory test results were collected to estimate the prevalence of MAFLD based on USE and US according to the 2020 international consensus.ResultsThe prevalence of HS detected by US in BCS was significantly higher than that in healthcare population (41.8% vs. 22.4%, P<0.001), and it rose to 69.6% when the BCS were screened by USE. Accordingly, the prevalence of MAFLD based on US in BCS was also significantly higher than that in healthcare population (39.5% vs. 21.2%, P<0.001) and it rose to 63.5% when the BCS were screened by USE. The prevalence of HS and MAFLD based on US in elderly BCS (≥60 yr) were obviously higher than those in healthcare population (56.7% & 56.7 % vs. 31.3% & 30.7%, P<0.001), respectively, and they rose to 80.0% and 73.3%, respectively when the BCS were screened by USE.ConclusionHS and MAFLD prevail in breast cancer survivors, especially in most of the elderly breast cancer survivors (≥60 yr). Their prevalence are much higher than in the general population. Early prevention, diagnosis and treatment of HS and MAFLD in breast cancer survivors should be implemented.

Background Fatty liver index (FLI) is the most recognized blood biomarker for diagnosis of hepatic steatosis (HS), but lacks the reliable specific cut-off points (COPs). Therefore, we aim to investigate the population-specific COPs of FLI based on the results of liver ultrasound transient elastography (LUTE) and conventional ultrasonography in the National Health and Nutrition Examination Survey (NHANES). Methods 5948 participants who underwent LUTE from the NHANES 2017–2018 and 14,797 participants who underwent conventional ultrasonography from the Third NHANES (NHANES III) were recruited. FLI was calculated by using body mass index (BMI), waist circumference (WC), triglyceride, and gamma-glutamyl transferase, and its optimal COPs in a specific population (stratified by sex, BMI, and WC) were obtained from receiver operator characteristics (ROC) curve with ultrasonic-diagnosed HS as the reference standard. Results Based on LUTE in NHANES 2017–2018, the prevalence of HS and metabolic dysfunction-associated fatty liver disease (MAFLD) were 58.7% and 56.2%, respectively, and the optimal COP of FLI for HS diagnosis in the overall population was 45.60, with an area under ROC curve (AUROC) of 0.833 (0.822–0.844). Based on conventional ultrasonography in NHANES III, the prevalence of HS and MAFLD were 34.4% and 27. 9%, respectively, and the optimal COP of FLI for HS was 59.5, with an AUROC of 0.681 (0.671–0.691). With the increase of BMI and WC, the COPs increased gradually with significant differences between different groups. Compared with conventional ultrasonography, the COPs of FLI based on LUTE were much more precise, with higher diagnostic ability. The population-specific COPs of FLI stratified by gender, WC, and BMI were tabulated. Conclusion In the United States, the incidences of HS and MAFLD were high, especially when assessed by LUTE. The FLI based on LUTE is well capable of predicting HS when stratified by gender, WC, and BMI.

BACKGROUND AND AIMS:Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace the concept of non-alcoholic fatty liver disease (NAFLD). The relationship between MAFLD and breast lesions has not been reported. Therefore, we aimed to explore their prevalence and relationship among general population.METHODS:This cross-sectional study was conducted in the First Affiliated Hospital of Chongqing Medical University. After considering the exclusion criteria, 46,547 consecutive women who synchronously accepted breast and abdominal ultrasonography during one physical check-up between January 2015 and September 2018 were enrolled in this study. Prevalence of breast masses (BM), BI-RADS categories breast lesions and MAFLD in general population were revealed and the association between MAFLD and breast mass, BI-RADS categories breast lesions was analyzed by conducting logistic regression models.RESULTS:Of 46,547 participants, 8,020 (17.23%) had BM, 6,345 (13.63%) had MAFLD. Women with MAFLD had a lower BM prevalence than those without MAFLD (11.87% vs.18.08%; p<0.001). Overall, women with MAFLD had a lower risk of BM compared to those without MAFLD (adjusted OR=0.849, 95%CI: 0.775-0.930, p<0.001). Analysis based on BI-RADS categories breast lesions demonstrated that MAFLD is negatively related to BI-RADS 2/3 categories breast lesions (BI-RADS 2 category adjusted OR=0.980, 95%CI: 0.906-1.061, p=0.626; BI-RADS 3 category adjusted OR=0.736, 95%CI: 0.641-0.845, p=0.001), while associated with higher risk of BI-RADS ≥4 categories breast lesions (adjusted OR=1.220, 95%CI: 1.005-1.480, p=0.044). Subgroup analysis across age (18-44, 45-54 and≥55 years old) and body mass index (<25 and ≥25kg/m2) demonstrated that MAFLD was negatively associated with BI-RADS 2/3 categories breast lesions in premenopausal and perimenopausal women, and positively associated with BI-RADS ≥4 categories breast lesions in postmenopausal women, whether in obese or not.CONCLUSIONS:MAFLD was inversely associated with BM and BI-RADS 2/3 categories breast lesions in premenopausal and perimenopausal women, irrespective of obesity presence; MAFLD increased the risk of BM and BI-RADS ≥4 categories breast lesions in postmenopausal women.

Background Plasmacytoid dendritic cells (pDCs) are the main producers of type I interferon (IFN-I), and the excessive production of IFN-I is a hallmark of systemic lupus erythematosus (SLE). Both SLC15A4 and miR-31-5p are SLE susceptibility-related genes, and SLC15A4 has been implicated an important role in endolysosomal toll-like receptor (TLR) activation in pDCs. However, whether miR-31-5p exerts a regulating effect on SLC15A4 expression in pDCs is unclear. Methods The expression of SLC15A4 and miR-31-5p in peripheral blood mononuclear cells (PBMCs) of SLE patients was measured by RT-qPCR analyses. The quantitative analysis of IFN-α secretion in the patients’ serum was performed by ELISA assay. Luciferase-reporter assay was applied to confirm the interaction between miR-31-5p and SLC15A4. The expression of miR-31-5p, SLC15A4 and IFN-stimulated genes (ISGs, such as MX1, OAS1 and IFIT3) was detected by Western blot and RT-qPCR assays and further IRF5 phosphorylation was evaluated by immunofluorescence after transfected with miR-31-5p mimics or inhibitor in THP-1 and CAL-1 cells. Results The expression of miR-31-5p was downregulated and negatively correlated with the overexpression of SLC15A4 in PBMCs of SLE patients. In addition to this, the secretion of IFN-α was overexpressed in sera of SLE and positively correlated with SLC15A4 level. We found that miR-31-5p directly targeted SLC15A4 and negatively regulated the expression of SLC15A4 in THP-1 and CAL-1 cells. In vitro inhibition of miR-31-5p increased the phosphorylation of IRF5 and the induction of ISGs stimulated by R848, overexpression of miR-31-5p get the reverse results. Conclusion miR-31-5p might involve in SLE pathogenesis through regulating IFN-I expression by negatively regulating SLC15A4 to increase the levels of IFN-α and ISGs in pDCs.

Pulmonary arterial hypertension (PAH) is a progressive and rare disease without obvious clinical symptoms that shares characteristics with pulmonary vascular remodeling. Right heart failure in the terminal phase of PAH seriously threatens the lives of patients. This review attempts to comprehensively outline the current state of knowledge on PAH its pathology, pathogenesis, natural medicines therapy, mechanisms and clinical studies to provide potential treatment strategies. Although PAH and pulmonary hypertension have similar pathological features, PAH exhibits significantly elevated pulmonary vascular resistance caused by vascular stenosis and occlusion. Currently, the pathogenesis of PAH is thought to involve multiple factors, primarily including genetic/epigenetic factors, vascular cellular dysregulation, metabolic dysfunction, even inflammation and immunization. Yet many issues regarding PAH need to be clarified, such as the “oestrogen paradox”. About 25 kinds monomers derived from natural medicine have been verified to protect against to PAH via modulating BMPR2/Smad, HIF-1α, PI3K/Akt/mTOR and eNOS/NO/cGMP signalling pathways. Yet limited and single PAH animal models may not corroborate the efficacy of natural medicines, and those natural compounds how to regulate crucial genes, proteins and even microRNA and lncRNA still need to put great attention. Additionally, pharmacokinetic studies and safety evaluation of natural medicines for the treatment of PAH should be undertaken in future studies. Meanwhile, methods for validating the efficacy of natural drugs in multiple PAH animal models and precise clinical design are also urgently needed to promote advances in PAH.

Background Congenital melanocytic nevi (CMN), benign pigmented birthmarks caused by the mutation of melanocytic cells during embryofetal development, can cause aesthetic problem when it is located on the face. Surgical managements of facial CMN are required by both pediatric patients and their parents. Surgical management, including excision or staged excision, skin grafting, dermabrasion, tissue expansion or multiple re-expansion combined with flaps transplantation, have been reported previously. However, a systematical report about facial CMN management is still scarce. Objective Herein, we have reviewed our serious of patients with facial CMN, noting their size, location, and histological examination, summarizing the surgical relation behind reconstructive and cosmetic treatment, and proposing a newly classification for facial CMN among pediatric patients, hoping to share a useful surgical algorithm for these lesions on this specific part. Conclusion Proper surgical strategy should be made based on the size and location of the nevi and the adjacent relationship between the location and relaxed skin tension lines and aesthetic units. Postoperative ant-scar treatment improves aesthetic outcomes. With our experience and surgical algorithm about facial CMN surgery, a favorable outcome can be achieved.

OBJECTIVE:To identify one case of rare Hb Lepore-BW associated with IVS-II-654 heterozygous mutation in Sichuan area.METHODS:The blood routine examination and hemoglobin electrophoresis methods were used to analyze the blood routine parameters, HbA2 and HbF in the samples of peripheral blood in proband and his parents, as well as the cord blood of pregnant woman. The detection of thalassemia gene and Sanger sequencing methods were used to detect the hemoglobin mutations.RESULTS:The result showed that the Hb Lepore-BW heterozygous mutation was detected in the father of the proband, while a rare Hb Lepore-BW with IVS-II-654 heterozygous mutation was detected in the proband, as well as his mother and cord blood were both detected as IVS-II-654 heterozygous mutation.CONCLUSION:The study identified a rare Hb Lepore-BW with IVS-II-654 heterozygous mutation, which was characterized by intermediate β-thalassemia. It is necessary to hemoglobin electrophoresis combined with routine blood testing in prenatal screening.

Background The present study aimed to comprehensively investigate the occurrence and risk factors of adverse events (AEs) or adverse drug reactions (ADRs) (especially for thrombocytopenia and bleeding) in Chinese female patients receiving bivalirudin during percutaneous coronary intervention (PCI). Methods A total of 918 female patients from 27 Chinese medical centers took bivalirudin as anticoagulant for PCI were enrolled in this prospective, multi-center, intensive monitoring study. Safety data (AEs, ADRs, thrombocytopenia and bleeding) were collected from admission to 72 h post bivalirudin administration; then, patients were followed up at the 30 th day with the safety data collected as well. Results One hundred and twenty (13.1%) patients occurred AEs, among which 7 (0.8%) cases experienced severe AEs, and 2 (0.2%) cases died. Besides, 40 (4.4%) patients occurred bivalirudin-related ADRs, in which 3 (0.3%) cases experienced severe ADRs, but 0 (0.0%) cases died. It was of note that 27 (2.9%) and 13 (1.4%) patients experienced thrombocytopenia and bleeding, respectively. Subsequent multivariate analyses observed that: clinical presentation of spontaneous coronary artery dissection (SCAD) (odds ratio (OR) = 3.191, P = 0.004), CRUSADE high risk (OR = 2.075, P = 0.031), multiple culprit vessel (OR = 2.328, P = 0.019) independently correlated with higher risk of bivalirudin-related ADRs; clinical presentation of SCAD (OR = 4.388, P = 0.002) and multiple culprit vessel (OR = 2.974, P = 0.010) independently linked with raised thrombocytopenia risk; history of diabetes mellitus (OR = 5.227, P = 0.007) and CRUSADE high risk (OR = 4.475, P = 0.016) were independent factor related to elevated bleeding risk. Conclusion Bivalirudin is well tolerated with low ADRs, thrombocytopenia and bleeding incidences in Chinese female patients undergoing PCI.