Nomogram prediction of vessels encapsulating tumor clusters in small hepatocellular carcinoma≤3 cm based on enhanced magnetic resonance imaging

BACKGROUND Vessels encapsulating tumor clusters(VETC)represent a recently discovered vascular pattern associated with novel metastasis mechanisms in hepatocellular carcinoma(HCC).However,it seems that no one have focused on predicting VETC status in small HCC(sHCC).This study aimed to develop a new nomogram for predicting VETC positivity using preoperative clinical data and image features in sHCC(≤3 cm)patients.AIM To construct a nomogram that combines preoperative clinical parameters and image features to predict patterns of VETC and evaluate the prognosis of sHCC patients.METHODS A total of 309 patients with sHCC,who underwent segmental resection and had their VETC status confirmed,were included in the study.These patients were recruited from three different hospitals:Hospital 1 contributed 177 patients for the training set,Hospital 2 provided 78 patients for the test set,and Hospital 3 provided 54 patients for the validation set.Independent predictors of VETC were identified through univariate and multivariate logistic analyses.These independent predictors were then used to construct a VETC prediction model for sHCC.The model’s performance was evaluated using the area under the curve(AUC),calibration curve,and clinical decision curve.Additionally,Kaplan-Meier survival analysis was performed to confirm whether the predicted VETC status by the model is associated with early recurrence,just as it is with the actual VETC status and early recurrence.RESULTS Alpha-fetoprotein_lg10,carbohydrate antigen 199,irregular shape,non-smooth margin,and arterial peritumoral enhancement were identified as independent predictors of VETC.The model incorporating these predictors demonstrated strong predictive performance.The AUC was 0.811 for the training set,0.800 for the test set,and 0.791 for the validation set.The calibration curve indicated that the predicted probability was consistent with the actual VETC status in all three sets.Furthermore,the decision curve analysis demonstrated the clinical benefits of our model for patients with sHCC.Finally,early recurrence was more likely to occur in the VETC-positive group compared to the VETC-negative group,regardless of whether considering the actual or predicted VETC status.CONCLUSION Our novel prediction model demonstrates strong performance in predicting VETC positivity in sHCC(≤3 cm)patients,and it holds potential for predicting early recurrence.This model equips clinicians with valuable information to make informed clinical treatment decisions.

Blood-brain barrier pathology in cerebral small vessel disease

Cerebral small vessel disease is a neurological disease that affects the brain microvasculature and which is commonly observed among the elderly.Although at first it was considered innocuous,small vessel disease is nowadays regarded as one of the major vascular causes of dementia.Radiological signs of small vessel disease include small subcortical infarcts,white matter magnetic resonance imaging hyperintensities,lacunes,enlarged perivascular spaces,cerebral microbleeds,and brain atrophy;however,great heterogeneity in clinical symptoms is observed in small vessel disease patients.The pathophysiology of these lesions has been linked to multiple processes,such as hypoperfusion,defective cerebrovascular reactivity,and blood-brain barrier dysfunction.Notably,studies on small vessel disease suggest that blood-brain barrier dysfunction is among the earliest mechanisms in small vessel disease and might contribute to the development of the hallmarks of small vessel disease.Therefore,the purpose of this review is to provide a new foundation in the study of small vessel disease pathology.First,we discuss the main structural domains and functions of the blood-brain barrier.Secondly,we review the most recent evidence on blood-brain barrier dysfunction linked to small vessel disease.Finally,we conclude with a discussion on future perspectives and propose potential treatment targets and interventions.

Cognitive impairment in cerebral small vessel disease induced by hypertension

Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.

Effects of Progressive Muscle Relaxation Training on Anxiety, Depression, and Quality of Life in Patients with Cerebral Small Vessel Disease

Objective:To explore the effects of progressive muscle relaxation training on anxiety,depression,and quality of life in patients with cerebral small vessel disease(CSVD).Methods:Sixty-one patients with CSVD in the Department of Neurology of a tertiary hospital were divided into an observation group(28 patients)and a control group(33 patients)by lottery method.The control group received conventional nursing care,while the observation group received progressive muscle relaxation training interventions in addition to the conventional care.The Hamilton Anxiety Scale(HAMA),the Hamilton Depression Scale(HAMD),and the Stroke-Specific Quality of Life Scale(SS-QOL)were used to compare the effects before the intervention,7 days after the intervention,and 30 days after the intervention.Results:Over time,at different time points after the intervention,the anxiety and depression scores of patients with CSVD in the observation group were significantly lower than those in the control group(P<0.05).The quality of life scores were significantly higher in the observation group compared to the control group(P<0.05),and these differences were statistically significant.Conclusion:Progressive muscle relaxation training can improve anxiety and depression in patients with cerebral small vessel disease and can effectively enhance their quality of life.

Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Exosomal miR-320e through wnt2targeted inhibition of the Wnt/β-catenin pathway allevisate cerebral small vessel disease and cognitive impairment

BACKGROUND Exosomal miRNAs play crucial roles in many central nervous system diseases.Cerebral small vessel disease(CVSD)is a small vessel disease that is affected by various factors.This study aimed to investigate the role of exosomal miR-320e in the Wnt/β-catenin pathway stimulated by oxidative stress and assess its clinical correlation with psychiatric symptoms in patients with CVSD.AIM To explore whether exosomal miR-320e could suppress the Wnt/β-catenin pathway and play a protective role in CVSD progression,as well as examine its potential correlation with cognitive impairment and depression in patients with CVSD.METHODS Differentially expressed exosomal miRNAs were filtered by sequencing plasma exosomes from patients with CVSD and healthy controls.Bioinformatics and dual luciferase analyses were used to confirm the binding of miR-320e to Wnt2,and the mRNA and protein levels of downstream components in the Wnt/β-catenin pathway were evaluated when overexpressed or with knockdown of miR-320e under H2O2-induced oxidative stress.In addition,Wnt2-targeting siRNA was used to confirm the role of miR-320e in the Wnt2-mediated inhibition of the Wnt/β-catenin pathway.A retrospective analysis was conducted among patients with CVSD to confirm the correlation between miR-320e expression and the severity of cognitive impairment and depression,which were quantified using the Montreal Cognitive Assessment(MoCA)/Executive Function Assessment(EFA),and the Hamilton Depression Scale(HAMD)/Beck Depression Inventory(BDI),respectively.RESULTS High-throughput sequencing revealed that exosomal miR-320e was downregulated in patients with CVSD.Bioinformatics analysis and dual-luciferase reporter gene experiments showed that exosomal miR-320e inhibited the Wnt/β-catenin pathway in response to oxidative stress by targeting the 3'noncoding region of Wnt2.Uptake of exosomes carrying miR-320e into endothelial cells could also target Wnt2 and inhibit the Wnt2/β-catenin pathway.Elevated miR-320e expression may protect patients with CVSD from relatively severe cognitive impairment and depression,as it was found to have a positive correlation with the MoCA/EFA and HAMD/BDI scores.CONCLUSION Our results suggest that exosomal miR-320e suppresses the Wnt/β-catenin pathway and may play a protective role in CVSD progression.

Pathological Changes of Small Blood Vessels in Maxillofacial Region Following High Velocity Missile Wound:an Experimental Study in Dogs

In order to provide an experimental foundation and pathological base for earlyreconstruction of maxillofacial tissues defects after firearms wound using microsurgicalmethods,an experiment,was made to study the microvascular pathological changesthrough light and electron microscopy observation.In the experiment we found somepathological changes of small vessels in wounded region,such as mierothrombi forma-tion,endothelial loss,internal elastic membrane break and some degenerations,necrosis within endothelial and smooth muscle cells of vessel.The nearer the woundededge was,the more evident injury was.The microvascular injurous range was 3 cm dis-tant from wounded edge,which recovered in 7 days later after wounding.The experi-ment indicated that if we used the vascularized free tissue transfer to repair defects ofmaxillofacial firearms wounds,the pedicles of flap should be anastomosed to distant re-cipient vesseles which could be chosen beyond 3 cm from wounded edge.Thereconstructive operation should be done 7 days later after wound.

The Clinical and Angiograghic Outcome of 190 Cases after Stent Placement in Small Coronary Vessels

Objectives To invest the success procedure, immediate outcome after procedure, the rate of main adverse cardiac events after procedure and restenosis after stent placement in small coronary vessels. Methods 290 patients with selected or emergency stent implantation in small vessels from April, 1997 to March,2002. Total 299 vessels,304 lesions and 316 stents were statisted. The successs rate of procedure, immediate outcome after procedure, the rate of main adverse cardiac events after procedure and restenosis after stent placement in small coronary vessels were assessed. The patients were followed up 1 month to 4 years. Re-catheter angiography were done in 122/290 patients. Results The narrow rate of lesion dropped from 89% ± 12% before procedure to 5% ±5% after procedure (diameter). 202 patients were followed up 1 month (69.7%). 197/202 cases were survival. 5/202 cases died in 3hrs to 7days. 2/5 cases died of persistent hypotension after procedure. 1/5 case died of acute left heart failure. 2/5 cases died of sudden death. 180 cases were followed up 5 months to 4 years. The non-event survival (NES) rate was 73.3% (132/180). The re-angiography were done in 122 cases. Restenosis happened in 39 cases (30.3%). 37 patients repeated PCI. 2 patients went to CABG. 2 cases got angina recurrence and were proved second time restenosis by re-angiography. The third time PCI was done in 1 patient. The other patients went to CABG. 1 case died of chronic heart failure after 2 years, 1 case suffered acute myocardial infarction on artery stent implanted. Conclusions There are high success rate of procedure and perfect immediate outcome in stent placement in small vessels. Main adverse cardiac events did not increased. Non-event survial was satisfied in long term follow -up. Restenosis rate was showed slightly higher than the one of main vessels.

The role of small vessel disease in development of Alzheimer's disease

Classically Alzheimer＇s disease and vascular dementia have been considered as two different entities, with their own clinical criteria, but relatively recent epidemiological and clinicopathological studies suggest an overlap between them sharing not only most of the risk factors and some clinical aspects but also pathophysiological mechanisms. Cerebrovascular lesions, especially small vessel disease （lacunar infarcts, white matter hyperintensities and microbleeds）, may magnify the effects of mild Alzheimer＇s disease pathology and promote the progression of cognitive decline and may also be a precursor of neuronal damage and dementia. ＂Vascular hypothesis＂ of Alzheimer＇s disease would open a window for new approaches and treatments.

The effectiveness and safety of the RESTORE R drug-eluting balloon versus a drug-eluting stent for small coronary vessel disease： study protocol for a multi-center, randomized, controlled trial

bjective Small coronary vessel disease （disease affecting coronary vessels with main branch diameters of 〈 2.75 mm） is a common and intractable problem in percutaneous coronary intervention （PCI）. This study was designed to test the theory that the effectiveness and safety of drug-eluting balloons for the treatment of de novo lesions in small coronary vessels are non-inferior to those of drug-eluting stents. Methods We designed a prospective, multicenter, randomized, controlled clinical trial aiming to assess the effectiveness and safety of the RESTORE R （Cardionovum, Bonn, Germany） drug-eluting balloon （DEB） versus the RESOLUTE R （Medtronic, USA） drug-eluting stent （DES） in the treatment of small coronary vessel disease. This trial started in August 2016. A total of 230 patients with a reference vessel diameter （RVD） 〉 2.25 mm and 〈 2.75 mm were randomly assigned to treatment with a DEB or a DES at a 1：1 ratio. The study was also designed to enroll 30 patients with an RVD 〉 2.00 mm and 〈 2.25 mm in the tiny vessel cohort. Results The key baseline data include demographic characteristics, relative medical history, baseline angiographic values and baseline procedural characteristics. The primary endpoint is in-segment diameter stenosis at nine months after the index procedure. Secondary endpoints include acute success, all-cause death, myocardial infarction, target vessel revascularization, target lesion revascularization and stent thrombosis. Conclusions The study will evaluate the clinical efficacy, angiographic outcomes, and safety of DEBs compared to DESs in the treatment of de novo coronary artery lesions in small vessels.

中国脑小血管病的神经影像学诊断标准及名词标准化定义——来自中国卒中学会的专家共识

脑小血管病(small vessel disease,SVD)是一类以脑内小血管受损为主的临床影像综合征,可能会导致卒中、血管性认知障碍、神经心理疾病与其他功能障碍等。自2013年血管性神经病变的影像报告标准(standards for reporting vascular changes on neuroimaging,STRIVE)发布以来,SVD的神经影像学特征得到了初步的分类与标准化。然而,在临床实践与科学研究中,对SVD影像特征的认识和应用仍存在诸多不一致和不规范之处。随着对SVD病理生理机制的深入探索与影像技术的不断进步,新的SVD影像特征和定量标志物被相继发现,为SVD的诊断和评估提供了更为全面且精准的信息。在此基础上,STRIVE-2应运而生,以期能更全面地揭示SVD对脑功能与结构的影响。为了规范中国SVD的神经影像学评估和诊断,本共识将在STRIVE-2的基础上,结合中国具体国情,对SVD的神经影像学特征进行深入解读,旨在推动SVD影像学诊断术语的标准化,提高临床诊断的准确性,进一步促进相关领域的研究与进步。

脑小血管病的病因和发病机制的最新进展

脑小血管病(CSVD)是一种大脑微血管疾病,是脑卒中的常见原因,也是导致老年人认知障碍的主要原因,但其发病机制尚不清楚,本文对目前主要的脑小血管病的病因及发病机制进行综述,为临床对该病的诊治提供参考。

脑小血管病的诊治现状及未来探索之路

脑小血管病(cerebral small vessel disease,CSVD)是一组临床、影像、病理综合征,主要累及颅内小血管,起病隐匿。CSVD与卒中、认知下降、情感障碍、步态异常及尿便失禁密切相关,给家庭和社会带来沉重的疾病负担和经济负担。但CSVD的致病机制仍不明确,临床诊断标准不统一,临床诊疗和试验研究面临重大挑战。本文旨在汇总当前CSVD的可能病因、发病机制和临床诊疗研究的进展及局限性,展望CSVD未来可能的临床研究方向。

老年无症状颅内动脉延长扩张症与脑小血管病综合评分的相关性

目的探讨老年无症状颅内动脉延长扩张症(IADE)与脑小血管病(CSVD)综合评分的相关性。方法回顾性分析2019年1月至2021年12月北京医院神经内科门诊查体或就诊且完成3 T头部磁共振成像(MRI)平扫、头部磁共振血管造影(MRA)和头部磁敏感加权成像(SWI)的CSVD患者。通过影像学诊断IADE并进行CSVD综合评分。根据有无IADE,将所有患者分为IADE组与非IADE组;依据CSVD综合评分,将患者分为CSVD无-轻度组与中-重度组,分别比较各组患者的基线资料和影像学资料,采用多因素Logistic回归分析IADE与CSVD总负荷之间的关系。结果共纳入230例CSVD患者,其中IADE组86例、非IADE组144例,CSVD综合评分无-轻度组157例、中-重度组73例。与非IADE组相比,IADE组患者的脑梗死史〔16例(18.6%)比13例(9.0%)〕、口服抗血小板聚集药物〔45例(52.3%)比51(35.4%)〕及CSVD综合评分为中-重度的患者〔36例(41.9%)比37例(25.7%)〕比例更高(均P<0.05)。230例患者中,CSVD综合评分中-重度组IADE患者比例高于无-轻度组〔36例(49.3%)比50例(31.8%),χ2=6.495,P值=0.011〕。多因素Logistic回归分析显示年龄〔OR(95%CI)=1.777(1.124~2.808),P=0.014〕、脑梗死史〔OR(95%CI)=15.481(4.565~52.496),P<0.001〕、颅内外动脉狭窄/闭塞〔OR(95%CI)=0.961(1.003~6.804),P=0.049〕和IADE〔OR(95%CI)=0.037(0.879~2.563),P=0.037〕是中-重度CSVD综合评分的独立危险因素,血红蛋白(≥135.5 g/L)〔OR(95%CI)=0.283(0.114~0.701),P<0.01〕是中-重度CSVD综合评分的保护因素。结论CSVD伴IADE患者在颅内影像表现上全脑受损更明显,且IADE、脑梗死史及颅内动脉狭窄/闭塞是CSVD严重程度的独立危险因素。

基于fMRI图论网络探索脑小血管病性轻度认知障碍的虚、实证候拓扑属性对照研究

目的基于图论网络探索性分析皮质下脑小血管病性轻度认知障碍虚证、实证的全脑及局部脑网络拓扑属性组间差异。方法前瞻性招募诊断为皮层下小血管病所致轻度血管性认知障碍患者和健康对照,基于GRETNA平台,计算虚证、实证和健康对照比较的组间全局小世界拓扑属性和局部节点强度、节点效率的组间差异。结果三组均具有小世界属性,但仅实证组患者在稀疏度为0.05-0.26内小世界属性δ显著低于对照组(P<0.05);同时,涉及额、顶及小脑等多个脑区的节点效率和节点强度指标均显著区分实证组、虚证组,但虚证患者在节点效率上无阳性脑区(P>0.05),在节点强度上仅表现为少数脑区的节点效率增高(P<0.05)。结论实组在全局拓扑属性及局部拓扑属性上均显著有别于虚证组,说明虚实证候具有显著差异的影像表型,为进一步探讨中医证候在疾病生物学分型的作用提供研究基础。

药物涂层球囊与雷帕霉素洗脱支架治疗冠状动脉小血管病变患者的效果比较

目的:比较药物涂层球囊与雷帕霉素洗脱支架治疗冠状动脉小血管病变患者的效果。方法:选取2021年3月至2022年2月该院收治的60例冠状动脉小血管病变患者进行前瞻性研究,依据随机数字表法将其分为对照组与研究组各30例。两组均接受经皮冠状动脉介入治疗,对照组植入雷帕霉素洗脱支架,研究组使用药物涂层球囊治疗,术后随访1年。比较两组术前、术后即刻、术后1年时病变血管最小管腔直径(MLD)和狭窄程度,晚期管腔丢失情况以及并发症发生率。结果:术后即刻,两组MLD均大于术前,狭窄程度均低于术前,但组间比较差异均无统计学意义(P>0.05);术后1年,两组MLD均小于术后即刻,狭窄程度均高于术后即刻,但研究组MLD大于对照组,狭窄程度低于对照组,差异有统计学意义(P<0.05);术后1年,研究组晚期管腔丢失小于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为13.33%(4/30),低于对照组的36.67%(11/30),差异有统计学意义(P<0.05)。结论:药物涂层球囊治疗冠状动脉小血管病变患者近期疗效与雷帕霉素洗脱支架相当,但远期疗效更好,术后1年时MLD更大、狭窄程度更低,可减少晚期管腔丢失,降低支架内血栓形成、再狭窄等并发症发生率。

脑小血管病患者近期皮质下小梗死与认知功能的相关性研究

目的 探讨脑小血管病(CSVD)患者近期皮质下小梗死与认知功能的相关性。方法 回顾性连续纳入2018年2月―2022年9月就诊于北京大学第一医院神经内科经头部MRI诊断的CSVD患者,收集一般人口学资料和临床资料,使用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,根据磁共振DWI分为近期皮质下小梗死(RSSI)组和非RSSI组,统计RSSI的部位和数目。比较两组患者的一般人口学资料、临床资料、认知功能,分析RSSI影像学特征与认知功能的关系。结果 共纳入CSVD患者181例,RSSI组91例,非RSSI组90例。RSSI组与非RSSI组相比,BMI高[(25.43±3.53)kg/m^(2) vs(24.27±3.33)kg/m^(2),t=2.228, P=0.027],收缩压高[(145.3±16.2)mmHg vs(139.6±20.2)mmHg,t=2.013,P=0.046],MoCA总分较低[22(18.8,26) vs 24(21,27),Z=-1.980,P=0.048],视空间与执行能力[3(2,4) vs 4(3,5),Z=-2.756,P=0.006]、语言[2(2,3) vs 2(1,2), Z=-2.020,P=0.043]、抽象[2(1,2) vs 2(1,2)分,Z=-2.052,P=0.04]得分均较低,差异均具有显著性统计学意义(P<0.05)。RSSI基底节梗死组与非RSSI组相比,MoCA总分较低[21(17,23) vs 24(21,27),Z=-2.018,P=0.044],视空间与执行[3(1.5,3.5) vs 4(3,5),Z=-2.601,P=0.009]得分较低,RSSI脑干梗死组与非RSSI组相比,视空间与执行[3(2,4) vs 4(3,5),Z=-2.325,P=0.020]、语言[2(1,2) vs 2(2,3),Z=-2.338,P=0.019]得分较低,差异具有显著性统计学意义。结论 CSVD患者中RSSI可导致认知功能障碍,与RSSI梗死部位相关,RSSI不同梗死部位导致不同的认知损害模式。预防RSSI发生,对于预防CSVD相关认知功能障碍具有重要意义。

波浪作用下小尺度多船并排锚泊横摇运动试验研究

采用物理模型试验方法研究双船、三船和四船并排锚泊时各船的运动量,并与单船艏艉锚泊情况进行了对比,重点分析了横浪作用下各船的横摇运动规律,探究了波浪周期和并排锚泊船数对多船并排锚泊时横摇运动的影响。结果表明,多船并排锚泊时,横摇运动响应随着波浪周期的增大而逐渐减小。双船并排锚泊时,横摇运动响应同单船相比减少了40%~50%;三船和四船并排锚泊时,横摇运动响应同单船相比减少50%~60%,四船并排锚泊时横摇运动响应减小的幅度与三船并排时相比差别不大。

脑白质高信号消退的研究进展

脑白质高信号(WMH)普遍存在于老年人群中,与卒中、认知、步态不稳和神经精神症状相关。WMH负荷通常随着年龄的增长而增加,但随着研究的不断深入,发现WMH是动态可变的,在发展过程中可能会部分消退,且可能伴随脑萎缩减缓和认知功能改善,但其确切发生机制、影响因素及临床意义目前尚不明确,且缺少有效逆转WMH的方法。作者综述了WMH消退的相关研究,为临床医师积极干预WMH相关影响因素,促进其在早期阶段逆转,改善患者脑健康提供参考。