iATC_Deep-mISF: A Multi-Label Classifier for Predicting the Classes of Anatomical Therapeutic Chemicals by Deep Learning

The recent worldwide spreading of pneumonia-causing virus, such as Coronavirus, COVID-19, and H1N1, has been endangering the life of human beings all around the world. To provide useful clues for developing antiviral drugs, information of anatomical therapeutic chemicals is vitally important. In view of this, a CNN based predictor called “iATC_Deep-mISF” has been developed. The predictor is particularly useful in dealing with the multi-label systems in which some chemicals may occur in two or more different classes. To maximize the convenience for most experimental scientists, a user-friendly web-server for the new predictor has been established at http://www.jci-bioinfo.cn/iATC_Deep-mISF/, which will become a very powerful tool for developing effective drugs to fight pandemic coronavirus and save the mankind of this planet.

MDCT angiography to evaluate the therapeutic effect of PTVE for esophageal varices

Abstract AIM:To evaluate the role of multi-detector row computed tomography(MDCT) angiography for assessing the therapeutic effects of percutaneous transhepatic variceal embolization(PTVE) for esophageal varices(EVs).METHODS:The subjects of this prospective study were 156 patients who underwent PTVE with cyanoacrylate for EVs.Patients were divided into three groups according to the filling range of cyanoacrylate in EVs and their feeding vessels:(1) group A,complete obliteration,with at least 3 cm of the lower EVs and peri-/EVs,as well as the adventitial plexus of the gastric cardia and fundus filled with cyanoacrylate;(2) group B,partial obliteration of varices surrounding the gastric cardia and fundus,with their feeding vessels being obliterated with cyanoacrylate,but without reaching lower EVs;and(3) group C,trunk obliteration,with the main branch of the left gastric vein being filled with cyanoacrylate,but without reaching varices surrounding the gastric cardia or fundus.We performed chart reviews and a prospective follow-up using MDCT images,angiography,and gastrointestinal endoscopy.RESULTS:The median follow-up period was 34 mo.The rate of eradication of varices for all patients was 56.4%(88/156) and the rate of relapse was 31.3%(41/131).The rates of variceal eradication at 1,3,and 5 years after PTVE were 90.2%,84.1% and 81.7%,respectively,for the complete group;61.2%,49% and 42.9%,respectively,for the partial group;with no varices disappearing in the trunk group.The relapsefree rates at 1,3 and 5 years after PTVE were 91.5%,86.6% and 81.7%,respectively,for the complete group;71.1%,55.6% and 51.1%,respectively,for the partial group;and all EVs recurred in the trunk group.Kaplan-Meier analysis showed P values of 0.000 and 0.000,and odds ratios of 3.824 and 3.603 for the rates of variceal eradication and relapse free rates,respectively.Cyanoacrylate in EVs disappeared with time,but those in the EVs and other feeding vessels remained permanently in the vessels without a decrease with time,which is important for the continued obliteration of the feeding vessels and prevention of EV relapse.CONCLUSION:MDCT provides excellent visualization of cyanoacrylate obliteration in EV and their feeding veins after PTVE.It confirms that PTVE is effective for treating EVs.

Application of interventional diagnostic and therapeutic technique for coronary artery fine branch fistula

Objective:To explore the value of angiographic diagnosis and interventional therapy of the coronary artery fine branch fistula.Methods:All of the 18 patients with coronary artery fine branch fistula underwent selective coronary arteriography,7 underwent interventional therapy, while 8 underwent prosthesis for coronary artery fistula (CAF) under extracorpored circulation. Results:Among 18 cases of coronary artery fine branch fistula, 7 happened in right coronary artery (38.9%), 11 in left coronary artery (61.1%). Among the 11 cases in left coronary artery,5 happened in descending anterior branch, 5 occurred in left circumflex branch, 1 arised from both left anterior branch and left circumflex branch. Among the 18 cases, there are 10 cases of coronary-to-pulmonary artery fistula (55.6%), 5 cases of fistula draining into right atrium (27.8%), 2 cases of fistula draining into left atrium (11.1%) and 1 draining into right ventricle (5.6%). Interventional treatment was successful in 7 patients. During the 12 months’ follow-up, there was no cardiovascular events. Conclusion:Selective coronary angiography is the first choice for diagnosing the coronary artery fine branch fistula. In respect of therapy, besides of surgical treatment, intervention is still a rather good measure presently.

Emerging chemical engineering of exosomes as“bioscaffolds”in diagnostics and therapeutics

All cells release extracellular vesicles(EVs)as part of their normal physiology.As one of the subtypes,exosomes(EXOs)have an average size range of approximately 40 nm e160 nm in diameter.Benefiting from their inherent immunogenicity and biocompatibility,the utility of autologous EXOs has the potential for both disease diagnosis/treatment.EXOs are generally employed as“bioscaffolds”and the whole diagnostic and therapeutic effects are mainly ascribed to exogenous cargos on the EXOs,such as proteins,nucleic acids,and chemotherapeutic agents and fluorophores delivered into specific cells or tissues.Surface en-gineering of EXOs for cargo loadings is one of the prerequisites for EXO-mediated diagnosis/treatment.After revisiting EXO-mediated diagnosis/treatment,the most popular strategies to directly undertake loadings of exogenous cargos on EXOs include genetic and chemical en-gineering.Generally,genetically-engineered EXOs can be merely produced by living organisms and intrinsically face some drawbacks.However,chemical methodologies for engineered EXOs diversify cargos and extend the functions of EXOs in the diagnosis/treatment.In this review,we would like to elucidate different chemical advances on the molecular level of EXOs along with the critical design required for diagnosis/treatment.Besides,the prospects of chemical engineering on the EXOs were critically addressed.Nevertheless,the superiority of EXO-medi-ated diagnosis/treatment via chemical engineering remains a challenge in clinical translation and trials.Furthermore,more chemical crosslinking on the EXOs is expected to be explored.Despite substantial claims in the literature,there is currently no review to exclusively summa-rize the chemical engineering to EXOs for diagnosis/treatment.We envision chemical engi-neering of EXOs will encourage more scientists to explore more novel technologies for a wider range of biomedical applications and accelerate the successful translation of EXO-based drug“bioscaffolds”from bench to bedside.

Small-molecule chemical probes for the potential therapeutic targets in alcoholic liver diseases

Alcoholic liver disease(ALD)encompasses a range of conditions resulting from prolonged and excessive alcohol consumption,causing liver damage such as alcoholic fatty liver,inflammation,fibrosis,and cirrhosis.Alcohol consumption contributes to millions of deaths each year.So far,the effective treatments for ALD are limited.To date,the most effective treatment for ALD is still prevention by avoiding excessive alcohol consumption,and only few specialized medicines are in the market for the treatment of patients suffering from ALD.Small molecules targeting various pathways implicated in ALD pathogenesis can potentially be used for effective therapeutics development.In this review,we provide a concise overview of the latest research findings on potential therapeutic targets,specifically emphasizing small-molecule interventions for the treatment and prevention of ALD.

Assembling the RNA therapeutics toolbox

From the approval of COVID-19 mRNA vaccines to the 2023 Nobel Prize awarded for nucleoside base modifications,RNA therapeutics have entered the spotlight and are transforming drug development.While the term“RNA therapeutics”has been used in various contexts,this review focuses on treatments that utilize RNA as a component or target RNA for therapeutic effects.We summarize the latest advances in RNA-targeting tools and RNA-based technologies,including but not limited to mRNA,antisense oligos,siRNAs,small molecules and RNA editors.We focus on the mechanisms of current FDA-approved therapeutics but also provide a discussion on the upcoming workforces.The clinical utility of RNA-based therapeutics is enabled not only by the advances in RNA technologies but in conjunction with the significant improvements in chemical modifications and delivery platforms,which are also briefly discussed in the review.We summarize the latest RNA therapeutics based on their mechanisms and therapeutic effects,which include expressing proteins for vaccination and protein replacement therapies,degrading deleterious RNA,modulating transcription and translation efficiency,targeting noncoding RNAs,binding and modulating protein activity and editing RNA sequences and modifications.This review emphasizes the concept of an RNA therapeutic toolbox,pinpointing the readers to all the tools available for their desired research and clinical goals.As the field advances,the catalog of RNA therapeutic tools continues to grow,further allowing researchers to combine appropriate RNA technologies with suitable chemical modifications and delivery platforms to develop therapeutics tailored to their specific clinical challenges.

Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via transvenous approach

Objective To describe the transvenous catheterization technique for the treatment of cavernous sinus dural arteriovenous fistulas (CSdAVFs), including its indications, complications and efficacy.Methods Eight patients with symptomatic CSdAVFs were treated by endovascular embolization with platinum coils, via the inferior petrosal sinus (IPS) in 6 patients, and via the Sylvian vein after surgical exposure in other 2 patients.Results Complete angiographic resolution of the fistula was obtained in six patients immediately after the procedures, and a complete resolution of symptoms and signs was achieved in all patients. The residual fistulas in two patients disappeared completely in the follow-up angiography.Conclusion Transvenous embolization is a useful and safe approach in the management of CSdAVFs.

Comparison of Efficacy of Different Treatments for Pulmonary Embolism

An optimal therapy for pulmonary embolism（PE） was explored by comparing three different methods in order to alleviate the sufferings of PE patients and reduce the mortality. Eighty patients with PE diagnosed by computed tomography angiography（CTA） were treated with thrombolysis, anticoagulation only, or surgery/intervention. The clinical efficacy of different treatments were compared and analyzed. Twenty-four out of the 26 patients（92%） in anticoagulation only group showed improvement in CTA and clinical presentations, which was significantly higher than that in the thrombolysis group（87%, n=39, P〈0.05）. However, there was no significant difference in the rate of mortality between thrombolysis group and anticoagulation only group. In the surgery/interventional group（n=15）, the success rate was 47%, and the mortality rate was 14%. Both of them were significantly different from those in thrombolysis and anticoagulation only groups（both P〈0.05）. Log-rank analysis of the data of 5-year follow-up revealed that the survival time in surgery/intervention group was significantly shorter than in the other two groups（P0.05）. It was suggested that it is of importance to choose the appropriate therapeutic regimen for PE patients. Mortality may be reduced and prognosis may be improved with anticoagulation only and thrombolysis therapy.

Hydroxyethyl starch and its derivatives as nanocarriers for delivery of diagnostic and therapeutic agents towards cancers

Many types of drugs and agents used for cancer diagnosis and therapy often have low bioavailability and insufficient efficacy,as well as causing various side effects due to their nonspecific delivery.Nanocarriers with purposely-designed compositions and structures have shown varying degrees of abilities to deliver these compounds towards cancers in passive or active manners.Despite the availability of a variety of materials for the construction of nanocarriers,natural polymers with good biocompatibility and biodegradability are preferable for such usage because of their high in vivo safety as well as easy removal of degradation products.Among the natural polymers intended for building nanocarriers,hydroxyethyl starch and its derivatives have gained tremendous attention in the field of drug delivery in the form of nanomedicines over the last decade.There is growing optimism that ever more hydroxyethyl starch-based nanomedicines will be a significant addition to the armoury currently used for cancer diagnosis and therapy.

黄芪的化学成分、药理作用及临床应用

黄芪自古以来作为一种重要的中药资源具有很高的药用价值。黄芪的化学成分主要包括黄酮类化合物、多糖类、皂苷类、氨基酸、微量元素等,药理作用和治疗应用主要体现在提高免疫力、保护脑和心脏、降血脂、抗肿瘤、降血糖、神经保护、抗衰老、抗溃疡以及保护肝脏和肾脏等方面。

经导管动脉栓塞治疗股深动脉假性动脉瘤破裂出血

股动脉假性动脉瘤(pseudoaneurysm,PSA)主要表现为患侧腹股沟区、会阴区及下肢肿痛,部分病例可触及搏动性包块和/或闻及股动脉区收缩期“吹风样”杂音[1]。股深动脉(profunda femoris artery,PFA)PSA少见,通常为股骨干骨折或股骨近端骨折内固定术后并发症,为PFA及其穿支动脉损伤所致[2];股骨近端骨折内固定术后血管损伤发生率为0.49%,其中PFA PSA占67.03%[3],未及时治疗可致出血、感染、骨折愈合延迟、骨筋膜室综合征或深静脉血栓形成,甚至大出血和休克[4]。

经鼻内镜联合血管内治疗在复杂颅底肿瘤手术中的应用

目的探讨经鼻内镜联合血管内治疗在复杂颅底肿瘤手术中的应用价值。方法回顾分析天津市环湖医院2017年1月至2022年7月9例内镜下经鼻入路颅底肿瘤切除术联合血管内治疗患者的临床资料,观察肿瘤切除程度;根据世界卫生组织实体瘤测量标准评估术后疗效;随访期采用Glasgow预后分级(GOS)评估术后神经功能预后;同时记录肿瘤复发或进展情况,以及血管内治疗相关并发症如出现假性动脉瘤、自发性脑出血、脑梗死等。结果9例患者中4例术前经DSA确认供体动脉或颈内动脉破裂,其中1例术前进行弹簧圈栓塞,1例术中提前置入颈动脉导管鞘,1例术中行颈内动脉弹簧圈栓塞成功止血,1例术中行覆膜支架植入成功止血;4例术中经DSA确认颈内动脉破裂;1例术后即刻DSA确认颈内动脉破裂者行颈内动脉弹簧圈栓塞成功止血。肿瘤全切除率为8/9。随访时间32.00(25.00,48.50)个月,均未见肿瘤复发或进展。末次随访时GOS评分均为4~5分,均为神经功能预后良好。1例经免疫治疗的复发性鼻咽癌患者颈内动脉岩骨段覆膜支架植入术后3个月支架远端再次出现假性动脉瘤,遂行颈外动脉⁃桡动脉⁃大脑中动脉搭桥术成功止血,且术后无并发症;余8例未出现假性动脉瘤、自发性脑出血等并发症。所有患者术后均未出现脑梗死。结论血管内治疗有助于内镜下经鼻入路颅底肿瘤切除术前评估颅底肿瘤与周围血管之间的关系,可以有效阻断供体动脉,减少术中出血量,有效治疗大血管破裂,也减少严重并发症的发生,疗效和安全性均较高。

Pipeline Flex血流导向装置治疗颅内动脉瘤疗效观察

目的观察使用Pipeline Flex血流导向装置(PED)治疗颅内动脉瘤的疗效及安全性。方法回顾性分析2020年6月至2022年6月中山市人民医院使用PED治疗的25例颅内动脉瘤(共29个动脉瘤)患者的临床资料,25例患者中2例存在2个串联动脉瘤,1例有3个串联动脉瘤。29个动脉瘤分布在颈内动脉26个,大脑中动脉1个,椎基底动脉2个。术后进行临床及影像学随访,评估术后即刻动脉瘤栓塞情况和出院时患者改良Rankin评分量表(mRS),并在术后6个月及12个月时随访进行影像学检查以明确动脉瘤闭塞情况。结果25例患者均成功置入PED,其中15个动脉瘤联合弹簧圈栓塞,14个动脉瘤单独置入PED支架。术中有1例使用球囊扩张,24例经导丝微导管按摩均贴壁良好,术后临床随访中1例(4%)患者有缺血症状。术后6个月随访22个(75.9%)动脉瘤完全闭合,术后12个月随访2个(6.9%)动脉瘤影像学随访中未见闭合,27个(93.1%)动脉瘤完全闭合。结论PED治疗颅内动脉瘤短期随访安全有效,并发症较少,动脉瘤闭塞率较高。

动脉栓塞联合经皮置管引流治疗Ⅲ型腹直肌鞘血肿

目的观察动脉栓塞联合经皮置管引流治疗Ⅲ型腹直肌鞘血肿(RSH)效果及其安全性。方法回顾性分析16例经CT和/或超声证实Ⅲ型RSH并接受动脉栓塞联合经皮置管引流患者资料,分析RSH影像学表现,记录治疗的技术成功率和临床成功率,观察12个月随访期间病变复发状况。结果16例Ⅲ型RSH临床均表现为腹痛,部分伴膀胱刺激症状;其中8例数字减影血管造影显示活动性出血。共栓塞19支出血责任动脉,包括每例1支患侧或血肿较大侧腹壁下动脉及3例外伤侧髂内动脉主干各1支;治疗技术成功率100%,临床成功率87.50%(14/16)。13例接受随访12个月,均未见复发。结论动脉栓塞联合经皮置管引流治疗Ⅲ型RSH效果确切且安全性较高。

血管内治疗小脑后下动脉瘤24例临床经验

目的 探讨血管内治疗小脑后下动脉(PICA)瘤的治疗策略、安全性及临床疗效。方法 回顾性分析安徽医科大学第一附属医院2017年7月至2022年1月行血管内治疗的24例PICA动脉瘤病人的临床资料(其中,PICA近端13例、过渡段1例、远端10例;以蛛网膜下腔出血首诊的21例、未破裂动脉瘤3例),单纯栓塞12例、动脉瘤及载瘤动脉闭塞7例(闭塞材料使用弹簧圈3例、Onyx胶4例)、支架辅助弹簧圈栓塞5例。术后随访3~24个月。结果 24例PICA动脉瘤病人术中动脉瘤均栓塞顺利。23例病人无近期并发症,1例出血病人合并严重脑血管痉挛自动出院(临床预估死亡)。随访结果:19病人远期随访无复发;4例复发,其中2例二期行支架辅助栓塞,后期随访良好、未再复发;1例首次支架辅助栓塞病人再次行穿支架网孔弹簧圈单纯栓塞,后期随访良好、未再复发;1例首次单纯栓塞病人再次行弹簧圈栓塞,后期随访良好、未再复发。结论 血管内治疗PICA动脉瘤安全、可行,疗效可靠。根据动脉瘤血管解剖位置,对于破裂出血的PICA动脉瘤首次治疗倾向单纯栓塞或载瘤动脉闭塞术。首次单栓病例术后复发,可二期行支架辅助栓塞能取得满意效果。对于复发动脉瘤经再次血管内治疗可获得满意效果。

脑动静脉畸形病人栓塞术后发生神经功能障碍的风险预测模型构建与验证

目的脑动静脉畸形病人栓塞术后发生神经功能障碍的风险预测模型构建与验证。方法选取2020年1月至2021年12月梅州市人民医院收治的72例脑动静脉畸形病人为研究对象,均行介入栓塞术。根据是否发生神经功能障碍分为发生神经功能障碍组(19例)及未发生神经功能障碍组(53例)。利用logistic多因素回归分析脑动静脉畸形病人栓塞术后发生神经功能障碍的危险因素。使用R3.5.3软件绘制预测脑动静脉畸形病人栓塞术后发生神经功能障碍的列线图模型。应用受试者操作特征曲线(ROC曲线)下面积对列线图模型预测效能进行检验,利用Bootstrap法检验模型的准确性,并采用决策曲线分析(DCA)评价模型的临床实用性。结果单因素分析显示发生神经功能障碍组术前颅内出血、病灶长径、病灶位置、动脉瘤、Spetzler-Martin分级、深部引流静脉与未发生神经功能障碍组比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,颅内出血、病灶长径、病灶位置、动脉瘤、Spetzler-Martin分级、深部引流静脉均是脑动静脉畸形病人栓塞术后发生神经功能障碍的危险因素(P<0.05)。将logistic多因素分析的结果建立预测脑动静脉畸形病人栓塞术后发生神经功能障碍的风险预警模型,Bootstrap法内部验证结果显示,C-index指数为0.82[95%CI:(0.76,0.88)]。ROC曲线下面积、灵敏度、特异度分别为0.79、81.42%、82.69%。决策曲线可选阈概率为13%~87%,净获益值较高。结论术前颅内出血、病灶长径、病灶位置、动脉瘤、Spetzler-Martin分级、深部引流静脉均是脑动静脉畸形病人栓塞术后发生神经功能障碍的危险因素,基于以上因素构建的列线图风险模型对脑动静脉畸形病人栓塞术后发生神经功能障碍具有较好的预测效能。

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding:A useful predictor of positive angiographic findings

BACKGROUND Gastrointestinal bleeding(GIB)is a severe and potentially life-threatening condition,especially in cases of delayed treatment.Computed tomography angiography(CTA)plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage.AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings.METHODS In this retrospective single-centre study,35 patients(22 men;median age 69 years;range 16-92 years)admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled.Twenty-three(65.7%)patients underwent endoscopy before CTA.Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software.Bleeding rate was obtained from volume change between the two phases and standardised for unit time.Patients were divided into two groups,according to the angiographic signs and their concordance with CTA.RESULTS Upper bleeding accounted for 42.9%and lower GIB for 57.1%.Mean haemoglobin value at the admission was 7.7 g/dL.A concordance between positive CTA and direct angiographic bleeding signs was found in 19(54.3%)cases.Despite no significant differences in terms of bleeding volume in the arterial phase(0.55 mL vs 0.33 mL,P=0.35),a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography(2.06 mL vs 0.9 mL,P=0.02).In the latter patient group,a significant increase in bleeding rate was also detected(2.18 mL/min vs 0.19 mL/min,P=0.02).CONCLUSION In GIB of any origin,extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

经导管动脉栓塞治疗胃十二指肠动脉损伤致腹腔出血

胃十二指肠动脉损伤罕见且病情多急重,常致腹腔出血,威胁患者生命和健康;以传统手术干预创伤较大,且存在并发症风险。经导管动脉栓塞(transcatheter arterial embolization, TAE)的安全性和有效性已获证实。本文报道以TAE治疗5例胃十二指肠动脉损伤致腹腔出血的效果。1资料与方法 1.1研究对象收集2011年1月—2023年1月靖江市人民医院收治的5例胃十二指肠动脉损伤致腹腔出血患者。

经腹股沟结内淋巴管造影用于腹盆腔创伤性淋巴漏

目的观察经腹股沟结内淋巴管造影用于腹盆腔创伤性淋巴漏患者的疗效及其安全性。方法回顾性分析12例经保守治疗无效的腹盆腔创伤性淋巴漏患者,均接受经腹股沟结内淋巴管造影;记录临床表现、疗效及并发症。结果12例共接受21次经腹股沟结内淋巴管造影,其中5例接受单次、6例接受2次、1例接受4次造影;造影技术成功率100%。造影后,12例中,7例(7/12,58.33%)治愈、5例(5/12,41.67%)无效。经腹股沟结内淋巴管造影并发症发生率为14.29%(3/21),包括慢性腹泻2例次、穿刺点疼痛1例次;未见严重并发症。结论经腹股沟结内淋巴管造影对腹盆腔创伤性淋巴漏具有一定治疗效果,且安全性较高。

肝动脉栓塞治疗肝癌介入后假性动脉瘤:2例报告及文献复习

随着肝胆疾病腹腔镜手术和介入治疗的广泛开展,医源性肝动脉假性动脉瘤(hepaticartery pseudoaneurysm,HAP)发病率有所上升。HAP破裂大出血可致严重并发症,而内科治疗HAP效果欠佳,外科手术风险高、创伤大。肝动脉栓塞(hepatic arterialembolization,HAE)治疗HAP具有一定优势[1]。