Research on the effect of different acquisition duration on ROI quantitative parameters in the progress of 18F-FBB PET brain image acquisition / 中国医学装备

Objective:To investigate the effect of different acquisition duration of brain image of 18F-florbetaben(18F-FBB)positron emission tomography(PET)on standardized uptake value(SUV).Methods:Eight subjects who underwent 18F-FBB PET examination in Chinese PLA General Hospital from May 2021 to June 2021 were selected,including 5 persons of healthy control and 3 patients with mild cognitive impairment(MCI).All subjects underwent 18F-FBB PET imaging,and the dynamic PET images of them on brains were continuously acquired for 20 min between 90 and 110 min after the 18F-FBB injection was injected as(3.7-5.5 MBq/kg).Under the situation that other reconstruction parameters did not change,the images were reconstructed at 0-1,0-3,0-5,0-10,0-15 and 0-20 min,respectively.The same of region of interest(ROI)ranges were delineated in bilateral frontal cortex,bilateral temporal cortex,bilateral parietal cortex,posterior cingulate gyrus and cerebellar cortex of each group of images.And then,the corresponding mean standardized uptake value(SUVmean)of each region was obtained.The differences of SUVmean values of different ROI values between each group of data images and the images of 0-20 min were compared and analyzed.Results:There were significant differences in SUVmean between the acquired images in 0-1,0-3,0-5 and 0-10 min and the acquired standard images of 0-20 min(t=-7.569--2.410,P<0.05),respectively.There were no significant differences in SUVmean between the acquired images of 0-15 min and the acquired standard images of 0-20 min in the bilateral frontal lobe,bilateral temporal lobe,bilateral parietal cortex and posterior cingulate gyrus(P>0.05),only there was significant difference in the cerebellar cortex area between them(t=-5.597,P<0.001).Conclusion:The results of 15 min can reach to the similar results of 20 min in acquiring images,which can shorten the time of examination,and enhance the degrees of comfort and cooperation of patients in examination.It has clinical application value.

Analysis of risk factors of pleural effusion after spinal separation / 中华骨科杂志

Objective:To investigate the risk factors of pleural effusion after spinal separation surgery for patients with spinal metastatic tumors.Methods:A total of 427 patients with spinal metastatic tumors from January 2014 to January 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed. There were 252 males and 175 females, with an average age of 59±12 years (range, 15-87 years). All patients underwent separation surgery. Based on the chest CT within 1 month after surgery, the volume of pleural effusion was measured individually by reconstruction software. Pleural effusion was defined as small volume (0-500 ml), moderate volume (500-1 000 ml), and large volume (above 1 000 ml). Baseline data and perioperative clinical outcomes were compared between the groups, and indicators with statistically significant differences were included in a binary logistic regression analysis to determine the independent risk factors for the development of pleural effusion after isolation of spinal metastatic cancer. Receiver operating characteristic (ROC) curves were conducted to calculate the area under the curve (AUC) for each independent risk factor.Results:All patients successfully completed the operation. Among the 427 patients, there were 35 cases of large pleural effusion, 42 cases of moderate pleural effusion, and 350 cases of small pleural effusion. There were significant differences in tumor size (χ 2=9.485, P=0.013), intraoperative blood loss ( Z=-2.503, P=0.011), blood transfusion ( Z=-2.983, P=0.003), preoperative total protein ( Z=2.681, P=0.007), preoperative albumin ( Z=1.720, P= 0.085), postoperative hemoglobin ( t=2.950, P=0.008), postoperative total protein ( Z=4.192, P<0.001), and postoperative albumin ( t=2.268, P=0.032) in the large pleural effusion group versus the small and moderate pleural effusion group. Logistic regression analysis showed that decreased preoperative albumin ( OR=0.89, P=0.045) and metastases located in the thoracic spine ( OR=4.01, P=0.039) were independent risk factors for the occurrence of large pleural effusion after separation surgery. The ROC curve showed that the AUC and 95% CI for preoperative albumin, lesion location, and the combined model were 0.637 (0.54, 0.74), 0.421 (0.36, 0.48), and 0.883 (0.81, 0.92). The combined predictive model showed good predictive value. Conclusion:The volume of pleural effusion can be measured individually and quantitatively based on chest CT. Decreased preoperative albumin and metastases located in the thoracic spine are independent risk factors for the occurrence of large pleural effusion after separation surgery. The combined prediction of the two factors has better predictive efficacy.

Optimization of the clinical drug list of DRG based on data mining technology / 中国药房

OBJECTIVE To optimize the clinical drug list of diagnosis-related group （DRG）， reduce the drug cost of patients， and increase the DRG settlement rate. METHODS By selecting BR23 disease group in the department of neurology of a hospital as the research object， data mining technology was used to explore the medication rule of the disease group， and the key monitored drugs were scored by comprehensive evaluation of drugs， thus optimizing the clinical drug list of disease groups. The hospitalization information of patients enrolled in the disease group in December 2022 was selected as the pre-optimization data， and the hospitalization information of patients enrolled in the disease group in September 2023 was selected as the post-optimization data. The implementation effect of the optimized list was evaluated by comparing the medical quality and drug cost data between the two groups. RESULTS After optimizing the clinical drug list， the settlement rate of this disease group increased from 84.36% before optimization to 104.70%； there was significant reduction in hospitalization drug cost and total hospitalization cost （P＜ 0.05）； the consumption of key monitored drugs significantly decreased. CONCLUSIONS Data mining technology helps explore the clinical medication rules of disease groups， which can be used by pharmacists to improve the settlement rate of DRG through effective pharmaceutical intervention.

Early neurological deterioration in patients with minor ischemic stroke caused by large vessel occlusion: risk factors and the impact of rescue endovascular thromboectomy on outcomes at discharge / 国际脑血管病杂志

Objective:To investigate the risk factors of early neurological deterioration (END) in patients with minor ischemic stroke caused by large vessel occlusion (LVO) and the impact of rescue endovascular thromboectomy (REVT) on clinical outcomes of patients with END at discharge.Methods:Consecutive patients with acute minor ischemic stroke caused by LVO within 24 h of onset in the Third Affiliated Hospital, Soochow University from January 2021 to March 2023 were retrospectively enrolled. Minor ischemic stroke was defined as baseline National Institute of Health Stroke Scale (NIHSS) score ≤5 at admission. END was defined as an increase of ≥4 in the NIHSS score within 24 h after the best medical management. The modified Rankin Scale was used to evaluate the clinical outcomes of patients with END at discharge. 0-2 was defined as a good outcome. Multivariate logistic regression analysis was used to identify the independent risk factors for END and the impact of REVT on clinical outcomes in patients with END. Results:A total of 75 patients with minor ischemic stroke caused by LVO were included, of which 31 (41.3%) developed END and 13 (41.9%) underwent REVT after END. Multivariate logistic regression analysis showed that internal carotid artery occlusion was an independent risk factor for END (odds ratio 4.304, 95% confidence interval 1.213-15.270; P=0.024), and REVT was an independent protective factor for good outcomes in patients with END (odds ratio 0.068, 95% confidence interval 0.006-0.774; P=0.030). Conclusions:The incidence of END is higher in patients with minor ischemic stroke caused by LVO, and internal carotid artery occlusion is an independent risk factor for the occurrence of END. Providing REVT after END may improve the clinical outcomes of patients with END at discharge.

Mini-open excision of osteoid osteoma using burrs with the guidance of O-arm navigation / 中华骨科杂志

Objective:To investigate the surgical method and clinical effect of O-arm navigation mini-open burring for osteoid osteoma.Methods:Eighteen patients with osteoid osteoma were treated with O-arm guided grinding drill from June 2021 to May 2022, including 15 males and 3 females, the age was (18.4 ±10.9) years (range 2 to 44 years), and the course of disease ranged from 1 week to 3 years (mean 14.2 months). The lesions sites included 6 cases of proximal femur, 3 cases of distal femur, 4 cases of proximal tibia, 1 case of distal tibia, 2 cases of proximal fibula and 1 case of distal and proximal humerus. During the operation, the O-arm navigation was used to determine the location of the focus, the muscle and soft tissue was peeled off to the bone surface through a 1-4 cm small incision, the channel retractor was placed, and the burr was registered as a navigation recognition device to gradually remove the bone on the surface of the tumor nest, and the tumor nest was scraped with a curette for pathological examination; according to the navigation image, the focus was enlarged removed with burr and the grinding range was confirmed by the O-arm X-ray machine before the end of the operation. The patients were followed up for 6 to 15 months (mean 9.5 months). CT scans were performed before and after surgery for imaging comparison in order to figure out whether it had residual lesions or recurrence. The visual analogue score (VAS) of pain was used as a parameter for evaluating the clinical efficacy.Results:The operation time of 18 cases was 40-175 min, with an average of 89.3 min. The time required to establish navigation image was 18.0 ±4.1 min (range 13 ~ 22 min). The length of the incision was 2.7±1.1 cm (range 1-4 cm). All patients achieved complete curettage of the lesions, and osteoid osteoma was confirmed by pathology after operation. All the patients could move to the ground 24 hours after operation, and the pain was significantly relieved from 3 to 7 d after operation, and the pain almost disappeared 3 months after operation. The VAS score of 18 cases was 5.33±1.24 before surgery, 2.79±1.32 on the 3rd day, 1.86±1.21 on the 7th day, 0.86±0.93 on the 1st month, 0.33±0.48 on the 3rd month, and 0.09±0.29 on the 6th month after operation, and the difference was statistically significant ( F=58.50, P<0.001). There were no serious complications during and after operation, and the success rate of treatment (no recurrence of symptoms, no residual recurrence of imaging lesions, no serious complications after operation) was 100%. Conclusion:Treatment of osteoid osteoma with mini-open excision using burrs under the navigation of O-arm is a simple, safe, minimally invasive and efficient technique. Intraoperative precise positioning and the use of burr with navigation to remove a larger area than the tumor nest are the keys to successful treatment.

Risk factors and functional evaluation of recurrence after resection of thigh soft tissue malignant tumor / 中华骨科杂志

Objective:To explore the risk factors of recurrence after resection of thigh soft tissue malignant tumors and the evaluation of the postoperative lower limb function.Methods:A total of 211 patients who underwent thigh soft tissue malignant tumor resection in the Department of Orthopaedics of the second affiliated Hospital of Medical College of Zhejiang University from May 2011 to May 2021 were retrospectively analyzed, including 117 males and 94 females, aged 53 (43, 65) years. There were 59 cases of atypical/well-differentiated liposarcoma, 30 cases of other types of liposarcoma, 33 cases of malignant fibrous histiocytoma, 19 cases of fibrosarcoma, 12 cases of rhabdomyosarcoma, 12 cases of leiomyosarcoma, 9 cases of synovial sarcoma, and 37 cases of others. The tumor involvement of muscle, bone, blood vessel, nerve tissue and intermuscular compartment, postoperative Musculoskeletal Tumor Society (MSTS) functional score and recurrence were recorded. The relationship between anatomical structure and postoperative recurrence was analyzed by Cox logistic regression to determine risk factors; the cumulative recurrence rate of different compartment groups (medial compartment, anterior compartment, and posterior compartment) were compared; The Box plot was used to compare the postoperative function of patients with resection of different anatomical structures (e.g., vastus lateralis, biceps femoris, femur, etc.).Results:A total of 34 out of 211 patients relapsed, with a recurrence rate of 16.1%. The recurrence time ranged from 2.6 months to 91.6 months after operation, with a median recurrence time of 37.0 (18.2, 52.8) months. Three independent risk factors were found to be associated with recurrence, namely: pathological grade [ HR=3.86, 95% CI(1.75, 8.51)], involvement of vastus intermedius [ HR=3.05, 95% CI(1.53, 6.06)], and involvement of vastus medialis [ HR=3.17, 95% CI(1.56, 6.41)]. The recurrence rate of patients with anterior chamber tumor resection was 35.3%, which was higher than that of patients without tumor resection (16.2%), and the difference was statistically significant ( P=0.020). There was no significant difference in recurrence rate between patients with medial chamber tumor resection and patients without tumor resection ( P>0.05). The recurrence rate of patients with posterior compartment tumor resection was 12.3%, which was lower than that of unresectable patients (37.6%), and the difference was statistically significant ( P=0.002).The postoperative MSTS score of 167 patients averaged 26±3.2 points (9-30 points). After intraoperative resection of part of the femur, vastus intermedius, vastus medialis, and rectus femoris, the patient's function was relatively poor [corresponding median MSTS score: 25 (23, 28), 26 (24 28), 26 (24,28), 26(24, 27)]. Conclusion:The risk factors for local recurrence after resection of thigh soft tissue malignant tumors include: pathological grade of the tumor, and whether the vastus intermedius or vastus medialis is involved. Anterior compartment tumors have a higher recurrence rate after surgery. If the tumor involves the above-mentioned anatomical structures, more attention should be paid to the risk of local recurrence after surgery.

Progress of relationship between autophagy and hepatocellular carcinoma / 肿瘤研究与临床

Autophagy is an intracellular degradation process that delivers cytoplasmic constituents to the lysosome. Abnormality of autophagy is related to many human diseases, which provides a new clue to the pathophysiology of human cancer. However, the role of autophagy in normal liver physiology and the pathogenesis of liver diseases need to be further clarified. This article reviews the role of autophagy in the occurrence and development of hepatocellular carcinoma and the molecular mechanisms.

Health information needs of inpatients with chronic diseases and utilization of community health resources in the comprehensive hospitals in Shanghai / 上海预防医学

ObjectiveTo understand the health information needs of chronic disease inpatients and the current utilization of community health resources， and to analyze the influencing factors， so as to provide basis for personalized and high-quality health education for chronic disease inpatients and to guide them to make full use of community health resources. MethodsFrom November 2020 to February 2021， we conducted a face-to-face multi-center clinical epidemiological survey with paper questionnaire in three general hospitals of Shanghai. The study included 404 inpatients with diabetes， hypertension， coronary heart disease， chronic respiratory diseases， cancer and other chronic diseases. Results94.01% of the 404 respondents had different needs for disease or health related information， and there was no significant difference between patients of different ages， genders and educational backgrounds in their needs for health knowledge. Among these patients， only 39.11% of them participated in the establishment of a card for chronic disease management in the community or signed for a family doctor. The participation rate of male patients was lower than that of female patients （P<0.05）. ConclusionPatients with chronic diseases have a high demand for health related information， and we need to provide health information in multiple ways. We should increase investment in community health resources， improve service quality， and guide residents with chronic diseases to make full use of community health resources.

Diagnosis and treatment of 24 cases of primary urethral carcinoma / 现代泌尿外科杂志

【Objective】 To investigate the clinical characteristics,treatment and prognosis of primary urethral cancer (PUC). 【Methods】 The clinical data of 24 PUC patients treated in our hospital during Jan.2013 and Jul.2022 were retrospectively analyzed. The patients were followed up to monitor the metastasis,recurrence and survival. 【Results】 The patients included 17 male and 7 female,aged (57.6±12.8) years. The main pathologic type was squamous cell carcinoma,followed by urothelial carcinoma. Altogether 23 patients underwent surgical treatment,and 8 of them received postoperative radiotherapy or chemotherapy. During the follow-up of 1 to 92 months,17 patients were followed up,3 of the them had local recurrence,1 had metastasis,and 5 died. Survival analysis showed that patients survived (63.3±10.6) months,with a 21-month survival rate of 64.8% and progression-free survival of 22 (9,72) months. 【Conclusion】 PUC is a rare malignant tumor with poor prognosis. For early and distal PUC,urethra-preserving surgery can be adopted;for proximal or advanced PUC,surgery combined with radiotherapy or chemotherapy is recommended.

Research progress on traditional Chinese medicine compounds combined with external therapy in treatment of hyperplasia of mammary glands / 中国中药杂志

Hyperplasia of mammary glands is a benign breast disease with disordered breast structure. Nowadays, the incidence rate of breast hyperplasia in women is increasing year by year, and the etiology is related to the imbalance of estrogen and progesterone in the body. The symptoms include breast pain, breast nodules, or nipple discharge, which can develop into breast cancer in the context of psychological pressure. Therefore, it is timely and effectively necessary for people to treat the symptoms. At present, traditional Chinese medicine(TCM) often treats breast hyperplasia by oral drug, external application, acupuncture, moxibustion, and massage, while western medicine often uses hormone therapy or surgery. TCM can regulate hormone levels to treat breast hyperplasia. Acupuncture, moxibustion, and other methods can stimulate acupoints to reduce breast lumps. However, since TCM is easy to produce hepatorenal toxicity after long-term use and simple external treatment is slow to take effect, rapid and effective treatment is difficult to be achieved. Although western medicine can inhibit the disease, it is easy to produce toxic and side effects if taken for a long time. In addition, surgery can only remove the focus and the recurrence rate is high. Some studies have found that the combination of oral and external use of TCM compounds has a significant effect, with mild toxic and side effects, few adverse reactions, and a low recurrence rate. Based on the relevant literature in recent years, this article reviewed the combination of oral and external treatment of TCM in the treatment of hyperplasia of mammary glands, discussed the effectiveness, clinical evaluation indexes, and mechanism, and pointed out the existing shortcomings to explore a comprehensive therapy worthy of clinical application.

Risk factors for residual cancer or lymph node metastasis after endoscopic noncurable resection of early colorectal cancer / 中华肿瘤杂志

Objective: Risk factors related to residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer were analyzed to predict the risk of residual cancer or lymph node metastasis, optimize the indications of radical surgical surgery, and avoid excessive additional surgical operations. Methods: Clinical data of 81 patients who received endoscopic treatment for early colorectal cancer in the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences from 2009 to 2019 and received additional radical surgical surgery after endoscopic resection with pathological indication of non-curative resection were collected to analyze the relationship between various factors and the risk of residual cancer or lymph node metastasis after endoscopic resection. Results: Of the 81 patients, 17 (21.0%) were positive for residual cancer or lymph node metastasis, while 64 (79.0%) were negative. Among 17 patients with residual cancer or positive lymph node metastasis, 3 patients had only residual cancer (2 patients with positive vertical cutting edge). 11 patients had only lymph node metastasis, and 3 patients had both residual cancer and lymph node metastasis. Lesion location, poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion were associated with residual cancer or lymph node metastasis after endoscopic (P<0.05). Logistic multivariate regression analysis showed that poorly differentiated cancer (OR=5.513, 95% CI: 1.423, 21.352, P=0.013) was an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer. Conclusions: For early colorectal cancer after endoscopic non-curable resection, residual cancer or lymph node metastasis is associated with poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion and the lesions are located in the descending colon, transverse colon, ascending colon and cecum with the postoperative mucosal pathology result. For early colorectal cancer, poorly differentiated cancer is an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection, which is suggested that radical surgery should be added after endoscopic treatment.

Risk factors analysis and prediction model construction of submucosal deep infiltration of early colorectal tumor / 中华肿瘤杂志

Objective: To investigate the risk factors for the development of deep infiltration in early colorectal tumors (ECT) and to construct a prediction model to predict the development of deep infiltration in patients with ECT. Methods: The clinicopathological data of ECT patients who underwent endoscopic treatment or surgical treatment at the Cancer Hospital, Chinese Academy of Medical Sciences from August 2010 to December 2020 were retrospectively analyzed. The independent risk factors were analyzed by multifactorial regression analysis, and the prediction models were constructed and validated by nomogram. Results: Among the 717 ECT patients, 590 patients were divided in the within superficial infiltration 1 (SM1) group (infiltration depth within SM1) and 127 patients in the exceeding SM1 group (infiltration depth more than SM1). There were no statistically significant differences in gender, age, and lesion location between the two groups (P>0.05). The statistically significant differences were observed in tumor morphological staging, preoperative endoscopic assessment performance, vascular tumor emboli and nerve infiltration, and degree of tumor differentiation (P<0.05). Multivariate regression analysis showed that only erosion or rupture (OR=4.028, 95% CI: 1.468, 11.050, P=0.007), localized depression (OR=3.105, 95% CI: 1.584, 6.088, P=0.001), infiltrative JNET staging (OR=5.622, 95% CI: 3.029, 10.434, P<0.001), and infiltrative Pit pattern (OR=2.722, 95% CI: 1.347, 5.702, P=0.006) were independent risk factors for the development of deep submucosal infiltration in ECT. Nomogram was constructed with the included independent risk factors, and the nomogram was well distinguished and calibrated in predicting the occurrence of deep submucosal infiltration in ECT, with a C-index and area under the curve of 0.920 (95% CI: 0.811, 0.929). Conclusion: The nomogram prediction model constructed based on only erosion or rupture, local depression, infiltrative JNET typing, and infiltrative Pit pattern has a good predictive efficacy in the occurrence of deep submucosal infiltration in ECT.

Research progress and application prospect of stem cells in inflamed dental tissues on periodontal bone regeneration / 中华口腔医学杂志

Tissue engineering has become a research hotspot regarding periodontal bone regeneration in recent years. Generally, stem cells used in periodontal tissue engineering are derived from healthy dental tissues, while restricted due to the strict indication of tooth extraction and limited sources. Stem cells in inflamed dental tissues mainly derive from inflamed pulp, periapical and periodontal tissues. Stem cells in inflamed dental tissues are abundant and retain most of the basic characteristics of stem cell compared with the ones derived from healthy dental tissues, which can be a promising source of stem cells for periodontal bone regeneration. In this review, we summarize the current application and prospect of stem cells in inflamed dental tissues on periodontal bone regeneration, and then discuss their feasibility as seed cells, in order to provide a reference for future research and clinical application of stem cells in inflamed dental tissues.

CircFhit Modulates GABAergic Synaptic Transmission via Regulating the Parental Gene Fhit Expression in the Spinal Dorsal Horn in a Rat Model of Neuropathic Pain / 神经科学通报·英文版

Effective treatments for neuropathic pain are lacking due to our limited understanding of the mechanisms. The circRNAs are mainly enriched in the central nervous system. However, their function in various physiological and pathological conditions have yet to be determined. Here, we identified circFhit, an exon-intron circRNA expressed in GABAergic neurons, which reduced the inhibitory synaptic transmission in the spinal dorsal horn to mediate spared nerve injury-induced neuropathic pain. Moreover, we found that circFhit decreased the expression of GAD65 and induced hyperexcitation in NK1R+ neurons by promoting the expression of its parental gene Fhit in cis. Mechanistically, circFhit was directly bound to the intronic region of Fhit, and formed a circFhit/HNRNPK complex to promote Pol II phosphorylation and H2B monoubiquitination by recruiting CDK9 and RNF40 to the Fhit intron. In summary, we revealed that the exon-intron circFhit contributes to GABAergic neuron-mediated NK1R+ neuronal hyperexcitation and neuropathic pain via regulating Fhit in cis.

Design of intelligent positioning system for mobile medical equipment in operating room based on Bluetooth technology / 医疗卫生装备

Objective To develop an intelligent positioning system for mobile medical equipment in the operating room based on Bluetooth technology to enhance medical equipment management efficiency.Methods The intelligent positioning system for mobile medical equipment used received signal strength indication(RSSI)algorithm and multi-gateway trajectory filtering algorithm to realize Bluetooth positioning,which was composed of Bluetooth gateways,Bluetooth beacons,Bluetooth labels and a background data processing platform.The Bluetooth gateway consisted of an active power over ethernet(POE)module,a DC power module,a CPU,a Wi-Fi module and a Bluetooth module;the Bluetooth beacon included a beacon control unit,a Bluetooth transmitter module and a Bluetooth receiver module;the Bluetooth label was made up of a microcontroller unit(MCU),a Bluetooth module,an anti-temper switch and a accelerometer;the data processing platform had the front end developed with Vue architecture and the back end with Java language.Results The system developed could accurately locate the medical equipment in the operating room without electromagnetic interference to other medical devices.Conclusion The system developed gains advantages in high positioning accuracy,low electromagnetic interference,high stability and reliability and low cost,which improves the positioning and management efficiency of medical equipment under the premise of ensuring safety.[Chinese Medical Equipment Journal,2023,44(9):29-32]

Effect of endovascular therapy on the requirement for decompressive craniectomy and functional outcomes in patients with large anterior circulation ischemic stroke / 国际脑血管病杂志

Objective:To investgate the effect of endovascular therapy (EVT) on the requirement for decompressive craniectomy (DC) and functional outcomes in patients with large anterior circulation ischemic stroke.Methods:Patients with large anterior circulation ischemic stroke within 24 hours of onset admitted to the Department of Neurology, West China Hospital, Sichuan University between September 2017 and December 2019 were included. Outcome indicators included DC demand and poor outcome at 3 months. The latter was defined as a modified Rankin Scale score >2. Multivariate logistic regression analysis was used to determine independent factors of DC requirement and functional outcomes at 3 months. Results:A total of 381 patients with large anterior circulation ischemic stroke were enrolled, including 203 males (53.3%), and the mean age was 70.7±14.3 years. The median time from onset to admission was 4.5 hours. The median baseline National Institutes of Health Stroke Scale score was 17 and median baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was 7. Totally 139 patients (36.5%) received EVT, and 64 (16.8%) required DC; 376 patients (98.7%) completed a 3-month follow-up (5 who did not complete follow-up did not require DC, of which 2 received EVT), 312 (83.0%) had poor outcome at 3 months, and 146 (38.8%) died. Multivariate logistic regression analysis showed that EVT was an independent predictor for the requiremet of DC (odds ratio [ OR] 4.42, 95% confidence interval [ CI] 1.81-10.81; P=0.001), higher baseline ASPECTS ( OR 0.80, 95% CI 0.71-0.89; P<0.001) and successful recanalization ( OR 0.37, 95% CI 0.15-0.90; P=0.028) were independent protective factors of reducing the requirement of DC. Successful recanalization ( OR 0.09, 95% CI 0.01-0.72; P=0.023) and antiplatelet therapy ( OR 0.29, 95% CI 0.11-0.76; P=0.012) were independent predictors for reduced risk of poor outcome. In 139 patients who received EVT, 27 (19.4%) received intravenous thrombolysis, 96 (69.1%) achieved successful recanalization, 88 (63.3%) had hemorrhagic transformation, 61 (43.9%) had symptomatic hemorrhagic transformation, and 34 (24.5%) required DC; 137 (98.6%) completed a 3-month follow-up, 116 (84.7%) had poor outcome at 3 months, and 67 (48.9%) died. For patients receiving EVT, a higher baseline ASPECTS ( OR 0.72, 95% CI 0.60-0.88; P=0.001) and successful recanalization ( OR 0.35, 95% CI 0.14-0.90; P=0.029) were independent predictors of reducing the requirement of DC, while successful recanalization ( OR 0.09, 95% CI 0.01-0.71; P=0.022) was an independent predictor for reduced risk of poor outcome. Among 64 patients who required DC, 22 (34.4%) received DC. Receiving DC significantly reduced the mortality within 3 months ( OR 0.25, 95% CI 0.07-0.86; P=0.028), but had no significant effect on functional outcome at 3 months ( OR 0.35, 95% CI 0.03-4.38; P=0.412). There was no significant interaction of either EVT or successful recanalization in the effect of DC on 3-month death ( P for interaction > 0.05). Conclusions:Successful recanalization after EVT reduces requirement for DC in patients with large anterior circulation ischemic stroke and improves functional outcome at 3 months. DC can reduce the mortality in patients required DC, and have no interactive effect with EVT or successful recanalization.

Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province.@*METHODS@#Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression.@*RESULTS@#The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66).@*CONCLUSION@#The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

Regulation of Th17/Treg immune imbalance by β-sitosterol in an OVA-induced allergic asthma rat model / 中国免疫学杂志

Objective:To explore the interventional effect of β-sitosterol on ovalbumin(OVA)-induced allergic asthma rats and its potential mechanism.Methods:SD male rats were randomly divided into normal group(CON),model group(M),positive drug dexamethasone group(DEX,0.075 mg/kg)and β-sitosterol group(Sit,50 mg/kg).A rat model of allergic asthma was estab-lished by intraperitoneal injection of OVA with aluminum hydrogen solution,and nebulized inhalation of OVA to stimulate.Rats were given intragastric administration 30 min before aerosol challenge,and after continuous administration for 7 days,the indicators of cough and asthma and tracheal phenol red excretion were detected.HE staining was used to observe pathological changes of lung tis-sue.Flow cytometry was used to detect reactive oxygen species(ROS)generation,apoptosis level and ratios of Th17 and Treg cells in peripheral blood.Biochemical method was used to detect contents of MDA,and activities of T-SOD and GSH-Px in rat lung tissues.ELISA was used to detect levels of Th17 and Treg-related cytokines(TNF-α,IL-4,IL-6,IL-17A,and IL-35).Results:Compared with model group,β-sitosterol significantly prolonged the incubation period of cough and gasp in rats with allergic asthma,reduced the frequency of cough and gasping,and promoted the excretion of phenol red in trachea;significantly reduced inflammatory infiltration in lung tissue of asthmatic rats;observably reduced MDA content in lung tissue,ROS of primary lung cell and apoptosis levels of asthmatic rats,increased the activities of T-SOD and GSH-Px;markedly reduced proportion of Th17 cells and levels of pro-inflammatory cyto-kines TNF-α,IL-4,IL-6 and IL-17A,increased proportion of Treg cells and levels of anti-inflammatory cytokine IL-35.Conclusion:β-sitosterol can ameliorate airway inflammation and oxidative damage in OVA-induced allergic asthmatic rats,and its mecha-nism may be related to the regulation of β-sitosterol on Th17/Treg immune imbalance and oxidative stress response.

GPNMB regulates M2 polarization of microglia thereby alleviating nerve injury after cerebral ischemic stroke through PI3K/Akt pathway / 中国免疫学杂志

Objective:To investigate the mechanism by which glycoprotein non-transferable melanin B(GPNMB)regulates microglia M2 polarization to reduce nerve damage after cerebral ischemic stroke(CIS).Methods:SD rats were used for establishment of middle cerebral artery occlusion(MCAO)model.Neurons,astrocytes and microglia were cultured under oxygen and glucose depri-vation(OGD)conditions,and the expression of GPNMB in tissues and cells were measured by Western blot.Gpnmb wrapped with adeno-associated virus(AAV)or shRNA-Gpnmb were injected into rat brain tissues for overexpression or inhibition of GPNMB,modified neurological deficit score(mNSS),Rotarod fatigue test and tape removal test were used to evaluate rat nerve function,the proportion of cerebral infarction was determined by TTC staining,microglia M1/M2 polarization markers were detected by immunofluorescence and RT-PCR,and the expression of Phosphatidylinositol 3-kinase(PI3K)/Serine/threonine kinase(Akt)pathway was determined by Western blot.Microglia was cultured under OGD conditions in vitro,Gpnmb was overexpressed and PI3K expression were inhibited by LY294002,and M1/M2 polarization markers were measured.Results:Compared with normal rats or normal cultured cells,the expres-sion of GPNMB in MCAO model or OGD-intervened microglia was up-regulated(P<0.05);when Gpnmb was overexpressed in the brain tissue of MCAO rats,the mNSS score decreased,the Rotarod time of latency to fall lengthened,the contact time and removal time shortened in the tape removal test,the proportion of cerebral infarction decreased,the M1 polarization level of microglia decreased while the M2 polarization level increased,PI3K/Akt pathway activated,and these difference were statistically significant(P<0.05);inhibition of PI3K reversed the effect of overexpression of Gpnmb on promoting M2 polarization of microglia in vitro(P<0.05).Conclusion:GPNMB promotes M2 polarization of microglia by activating the PI3K/Akt pathway,thereby reducing nerve damage after CIS.

Epidemiological Investigation of Exercise-Induced Bronchoconstriction in Some Winter Sports Chinese Athletes / 中国运动医学杂志

Objective To investigate the incidence of exercise-induced bronchospasm(EIB)in athletes of winter sports in China,compare the incidence among athletes of different sports,genders and sports levels,and analyze the physiological differences in pulmonary ventilation function and blood in-flammatory factors between EIB and non-EIB athletes.Methods Ninety athletes(48 males and 42 fe-males)of four Winter Olympic events of cross-country skiing,short track speed skating,snowboard-ing,and freestyle skiing were recruited(including 61 national grade-2,20 national grade-1,and 9 na-tional excellent athletes).Venous blood was collected early in the morning on the test day for inflam-matory factor analysis.Moreover,the bronchial exercise provocation test was performed on the test day and pulmonary ventilation function parameters were obtained immediately before the test and at 1st,3rd,5th,7th,10th and 15th minute after the test.Results Thirty-three athletes were detected EIB out of 90,with a mean prevalence of 36.67%.In terms of incidence,athletes of cross-country skiing ranked the first(43.18%),followed by those of short track speed skating(38.46%),snowboarding(31.25%)and freestyle skiing(23.53%).Moreover,the incidence of female and male athletes was 42.86%and 31.25%,respectively.Meanwhile,the prevalence of national excellent sportsmen was 55.56%,followed by that of the national grade-1(40%)and grade-2(32.8%).According to the pulmo-nary ventilation indexes,the 1 s expiratory force volume(FEV1)and expiratory force volume(FVC)de-creased significantly(P<0.001)at the 1st and 3rd minutes after the provocation test among EIB ath-letes,but did not change significantly among the non-EIB athletes.Moreover,the FEV1/FVC ratio showed a downward trend among EIB athletes,but an upward trend among the non-EIB ones.As to the blood parameters,the level of the white blood cell count(109/L),interleukin-6 and CC16 of EIB athletes were significantly higher(P=0.02 and P=0.003),while that of immunoglobulin E(IgE)was low-er than the latter(P=0.07).Conclusion EIB troubles athletes of winter sports in China,characterized by a higher incidence among physical sportsmen than skill ones,among women than men,and high-level athletes than common ones.Moreover,inflammation of EIB athletes is more severe than the non-EIB ones,and partly due to airway injury.