Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles(2023 edition)

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization,led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles,research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles,Professional Committee on Extracellular Vesicle Research and Application,Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles.Based on the collation of relevant literature,we have adopted the Delphi method,the consensus meeting method combined with the nominal group method to form a discussion draft of“Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles(2023)”.The first draft was discussed in online and offline meetings on October 12,14,November 2,2022 and April and May 2023 on the current status of research,nomenclature,isolation methods,quality standards and research applications of extracellular vesicles of Chinese herbal medicines,and 13 consensus opinions were finally formed.At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles,held on May 26,2023,Kewei Zhao,convenor of the consensus,presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles.The consensus highlights the characteristics and advantages of Chinese medicine,inherits the essence,and keeps the righteousness and innovation,aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad,decode the mystery behind Chinese herbal vesicles together,establish a safe,effective and controllable accurate Chinese herbal vesicle prevention and treatment system,and build a bridge for Chinese medicine to the world.

Optical Genome Mapping for Cryptic Chromosomal Rearrangements Identification in Clinical Practice

To editor:Balanced chromosomal rearrangements(BCRs),predominantly reciprocal translocations and inversions represent disease-related structural variations(SVs)that directly disrupt gene structure and function.Moreover,BCRs predispose offspring to unbalanced rearrangements,resulting in adverse pregnancy outcomes.1 The timely and accurate identification of carriers is crucial for minimizing the risk of associated adverse pregnancy outcomes,assessing recurrent risk,and planning appropriate management.Conventional cytogenetic karyotyping serves as the standard first-tier approach for BCR detection,yielding a rate of 2%–4%in the recurrent miscarriage population.2 However,its limited resolution(typically around 5–10 Mb)poses challenges in detecting cryptic BCRs with smaller or similarly banded segments,as well as complex SVs involving multiple chromosomes.Optical genome mapping(OGM),an emerging technology from Bionano Genomics,has a high resolution for detecting nearly all types of genomic SVs and has been recognized as a revolution in next-generation cytogenomic analysis.3,4 A growing number of studies have recently demonstrated the efficiency and superiority of OGM in various clinical settings,including both prenatal and postnatal congenital conditions,as well as various hematological and other malignancies.5–7 Here,we explore the value of OGM in identifying cryptic BCRs using a case series from our clinical practice.This study was approved by the ethics committee of the Nanjing Drum Tower Hospital affiliated with Nanjing University Medical School(no.2021-464-02).

Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

Background and purpose Symptomatic intracranial atherosclerotic stenosis(sICAS)is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment.Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics(CFD)models were associated with the risk of stroke recurrence.We aimed to develop and compare stroke risk prediction nomograms in sICAS,based on vascular risk factors and these metrics.Methods Patients with 50%-99%sICAS confirmed in CT angiography(CTA)were enrolled.Conventional vascular risk factors were collected.Severity of luminal stenosis in sICAS was dichotomised as moderate(50%-69%)and severe(70%-99%).Translesional pressure ratio(PR)and wall shear stress ratio(WSSR)were quantified via CTA-based CFD modelling;the haemodynamic status of sICAS was classified as normal(normal PR&WSSR),intermediate(otherwise)and abnormal(abnormal PR&WSSR).All patients received guideline-recommended medical treatment.We developed and compared performance of nomograms composed of these variables and independent predictors identified in multivariate logistic regression,in predicting the primary outcome,recurrent ischaemic stroke in the same territory(SIT)within 1 year.Results Among 245 sICAS patients,20(8.2%)had SIT.The D2H2A nomogram,incorporating diabetes,dyslipidaemia,haemodynamic status of sICAS,hypertension and age≥50 years,showed good calibration(P for Hosmer-Lemeshow test=0.560)and discrimination(C-statistic 0.73,95%CI 0.60 to 0.85).It also had better performance in risk reclassification and provided larger net benefits in decision curve analysis,compared with nomograms composed of conventional vascular risk factors only,and plus the severity of luminal stenosis in sICAS.Sensitivity analysis in patients with anterior-circulation sICAS showed similar results.Conclusions The D2H2A nomogram,incorporating conventional vascular risk factors and the haemodynamic significance of sICAS as assessed in CFD models,could be a useful tool to stratify sICAS patients for the risk of recurrent stroke under contemporarily optimal medical treatment.