Primary assessment of the diversity of Omicron sublineages and the epidemiologic features of autumn/winter 2022 COVID-19 wave in Chinese mainland / 医学前沿

With the recent ongoing autumn/winter 2022 COVID-19 wave and the adjustment of public health control measures, there have been widespread SARS-CoV-2 infections in Chinese mainland. Here we have analyzed 369 viral genomes from recently diagnosed COVID-19 patients in Shanghai, identifying a large number of sublineages of the SARS-CoV-2 Omicron family. Phylogenetic analysis, coupled with contact history tracing, revealed simultaneous community transmission of two Omicron sublineages dominating the infections in some areas of China (BA.5.2 mainly in Guangzhou and Shanghai, and BF.7 mainly in Beijing) and two highly infectious sublineages recently imported from abroad (XBB and BQ.1). Publicly available data from August 31 to November 29, 2022 indicated an overall severe/critical case rate of 0.035% nationwide, while analysis of 5706 symptomatic patients treated at the Shanghai Public Health Center between September 1 and December 26, 2022 showed that 20 cases (0.35%) without comorbidities progressed into severe/critical conditions and 153 cases (2.68%) with COVID-19-exacerbated comorbidities progressed into severe/critical conditions. These observations shall alert healthcare providers to place more resources for the treatment of severe/critical cases. Furthermore, mathematical modeling predicts this autumn/winter wave might pass through major cities in China by the end of the year, whereas some middle and western provinces and rural areas would be hit by the upcoming infection wave in mid-to-late January 2023, and the duration and magnitude of upcoming outbreak could be dramatically enhanced by the extensive travels during the Spring Festival (January 21, 2023). Altogether, these preliminary data highlight the needs to allocate resources to early diagnosis and effective treatment of severe cases and the protection of vulnerable population, especially in the rural areas, to ensure the country's smooth exit from the ongoing pandemic and accelerate socio-economic recovery.

Research on the mining, sorting and transforming of traditional exercise prescription from the perspective of sports and health integration / 中华行为医学与脑科学杂志

Based on promoting the " sports and health integration" and with the aim of the positive role of traditional sports in promoting public health in an all-round and whole-cycle way, this paper uses the literature research method to explore the connotation of traditional sports in ancient Chinese books and literatures, such as " treating no diseases" , " treating mild diseases" , " treating desired diseases" and " treating existing diseases" . The traditional exercise prescription is interpreted from the modern language such as the amount of exercise and intensity, application time, role, standardization and matters needing attention, so as to provide the theoretical basis for the integration of traditional exercise prescription into grassroots health management by providing exercise promotion services for healthy, sub-healthy, sick and rehabilitated people.

Current Status and Ethical Considerations of Data Collection and Application in Rare Disease Research / 中国医学伦理学

The research on rare diseases in China started relatively late, with scattered research resources and weak data foundation in epidemiology, diagnosis and treatment, and medication, which hinders its research progress. The rare disease data system is the foundation of rare disease research, and the ethical constraint on rare disease data collection is not only the protection of rare disease population, but also the need for the safety and quality of rare disease data. By analyzing and prospecting the current status of the construction of rare disease data systems, including the data of epidemiology, clinical diagnosis and treatment, drug trials, and follow-up to provide reference for the improvement of rare disease data systems. This paper explored the ethical issues to be followed in the process of rare disease data collection from the perspectives of justice, no harm, respect, sharing, and legalization, so as to improve the standardization of rare disease data collection and the understanding of data ethical review.

SARS-CoV-2 vaccine research and immunization strategies for improved control of the COVID-19 pandemic / 医学前沿

The record speed at which Chinese scientists identified severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and shared its genomic sequence with the world, has greatly facilitated the development of coronavirus disease (COVID-19) diagnostics, drugs, and vaccines. It is unprecedented in pandemic control history to develop a dozen successful vaccines in the first year and to immunize over half of the global population in the second year, due to the efforts of the scientific community, biopharmaceutical industry, and regulatory agencies worldwide. The challenges are both great and multidimensional due to the rapid emergence of virus variants and waning of vaccine immunity. Vaccination strategies need to adapt to these challenges to keep population immunity above the herd immunity threshold, by increasing vaccine coverage, especially for older adults and young people, and providing timely booster doses with homologous or heterologous vaccine boosts. Further research should be undertaken to develop more effective vaccines against SARS-CoV-2 variants and to understand the best prime-boost vaccine combinations and immunization strategies to provide sufficient and sustainable immune protection against COVID-19.

Early assessment of the safety and immunogenicity of a third dose (booster) of COVID-19 immunization in Chinese adults / 医学前沿

Inducing durable and effective immunity against severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) via vaccination is essential to combat the current pandemic of coronavirus disease 2019 (COVID-19). It has been noticed that the strength of anti-COVID-19 vaccination-induced immunity fades over time, which calls for an additional vaccination regime, as known as booster immunization, to restore immunity among previously vaccinated populations. Here we report a pilot open-label trial of a third dose of BBIBP-CorV, an inactivated SARS-CoV-2 vaccine (Vero cell), on 136 participants aged between 18 to 63 years. Safety and immunogenicity in terms of neutralizing antibody titers and cytokine/chemokine responses were analyzed as the main endpoint until day 28. While systemic reactogenicity was either absent or mild, SARS-CoV-2-specific neutralizing antibody titers rapidly arose in all participants within 4 weeks, surpassing the peak antibody titers elicited by the initial two-dose immunization regime. Broad increases of cellular immunity-associated cytokines and chemokines were also detected in the majority of participants after the third vaccination. Furthermore, in an exploratory study, a newly developed recombinant protein vaccine, NVSI-06-08 (CHO Cells), was found to be safe and even more effective than BBIBP-CorV in eliciting humoral immune responses in BBIBP-CorV-primed individuals. Together, these results indicate that a third immunization schedule with either homologous or heterologous vaccine showed favorable safety profiles and restored potent SARS-CoV-2-specific immunity, providing support for further trials of booster vaccination in larger populations.

Establishment and validation of a risk prediction model for early-stage complications after liver transplantation / 临床肝胆病杂志

Objective To investigate the risk factors for early-stage complications among liver transplant recipients, and to establish and validate a risk prediction model for early-stage complications after transplantation. Methods A retrospective analysis was performed for the clinical data of 234 patients who underwent orthotopic liver transplantation in Department of Liver Transplantation, Tianjin First Central Hospital, from January 2016 to December 2018. According to the presence or absence of Clavien-Dindo grade ≥Ⅲ complications after liver transplantation, the patients were divided into complication group with 97 patients and non-complication group with 137 patients. The two groups were compared in terms of the indices including age, sex, body mass index (BMI), blood type, psoas muscle thickness/height (PMTH), Controlling Nutritional Status (CONUT) score, Model for End-Stage Liver Disease (MELD) score, total serum bilirubin, serum creatinine, international normalized ratio of prothrombin time, blood urea nitrogen, hemoglobin, white blood cell count, platelet count, amount of intraoperative red blood cell transfusion, amount of frozen plasma transfusion, blood loss, anhepatic phase, time of operation, donor age, donor BMI, cold ischemia time of donor liver, and warm ischemia time of donor liver. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate analysis and the binary logistic regression analysis were used to investigate the risk factors for early-stage complications after liver transplantation, and a risk prediction model for complications after liver transplantation was established based on the method for establishing a scoring system using the logistic model provided by Framingham Research Center. Internal validation of the model was performed by C-index, receiver operating characteristic (ROC) curve, calibration curve, and the Hosmer-Lemeshow test, and the decision curve was used to evaluate the clinical applicability of the model. The Kaplan-Meier method was used to compare the incidence rate of early-stage complications after liver transplantation between the patients with different risk scores. Results Compared with the non-complication group, the complication group had significantly higher MELD score, proportion of patients with low PMTH, total serum bilirubin, serum creatinine, blood urea nitrogen, CONUT score, amount of intraoperative red blood cell transfusion, and amount of frozen plasma transfusion, as well as a significantly lower level of hemoglobin (all P < 0.1). The multivariate binary logistic regression analysis showed that MELD score (odds ratio [ OR ]=1.104, 95% confidence interval [ CI ]: 1.057-1.154, P < 0.05), PMTH ( OR =2.858, 95% CI : 1.451-5.626, P < 0.05), and CONUT score ( OR =1.481, 95% CI : 1.287-1.703, P < 0.05) were independent risk factors for grade ≥Ⅲ complications in the early stage after liver transplantation. MELD score, PMTH, and CONUT score were included in a predictive model, and this model had the highest score of 24 points, a C-index of 0.828, an area under the ROC curve of 0.812( P < 0.001), a sensitivity of 0.792, and a specificity of 0.751, suggesting that this predictive model had good discriminatory ability. The calibration curve of this model was close to the reference curve, and the Hosmer-Lemeshow test obtained a chi-square value of 8.528( P =0.382), suggesting that this predictive model had a high degree of fitting. The decision curve showed that most patients were able to benefit from the predictive model and achieved a high net benefit rate, suggesting that this predictive model had good clinical applicability. The score of 11 was selected as the cut-off value according to the optimal Youden index of 0.507, and the patients were divided into low-risk (< 8 points) group with 55 patients, moderate-risk (8-10 points) group with 63 patients, high-risk (11-14 points) group with 67 patients, and extremely high-risk (≥15 points) group with 49 patients. These four groups had a 90-day cumulative incidence rate of early-stage postoperative complications of 3.6%, 28.6%, 59.7%, and 75.5%, respectively, and the incidence rate of complications increased with the increase in risk score ( P < 0.001). Conclusion MELD score, PMTH, and CONUT score are independent risk factors for early-stage complications among liver transplant recipients, and the risk prediction model established based on these factors has a high predictive value in high-risk patients.

The importance of "Four Beams and Eight Pillars" matching theory / 国际中医中药杂志

This paper summarizes the current situation and problems of the research on the theory of "Taibai Seven Medicines" through literature summary and surveys. Although the "Four Beams and Eight Pillars" theory of compounding has a long history, the current research progress of "Taibai Seven Medicines" is mostly focused on plant resources. There lacks researches on the theory of compounding, or development of compounding and large varieties based on "Taibai Seven Medicines". We call for the inheritance and protection of folk experience, and hope that the "Four Beams and Eight Pillars" theory can guide the application and development of the seven Taibai medicines. Therefore, increasing the research on the theory and teaching in undergraduate courses formulary in Chinese medicine are necessary in our province.

Effects of Plaque Classification and Bifurcation Angle on Coronary Plaques: A Hemodynamic Simulation / 医用生物力学

Objective To analyze the influence of plaque classification and bifurcation angle on hemodynamics in coronary artery, so as to further discuss the influence on vulnerable atherosclerotic plaques. Methods Based on average geometric parameters of human coronary bifurcation vessels, the model of fluid-solid interaction for coronary bifurcation vessels with different plaque classifications and vessel bifurcation angles was constructed, and the distributions of blood flow velocity, pressure and shear stress at critical positions were investigated. Results The upstream shoulder of the plaque was the site with the highest shear stress on plaque surface, which was prone to ulceration or rupture with further growth. When there were plaques on one side of the bifurcation vessels, the shear stress at the carina of bifurcations was greater than that at the bilateral plaques. The pressure and shear stress at the carina of bifurcations gradually increased as the bifurcation angle decreased. Conclusions When there are plaques on one side of the bifurcation vessels, the probability of ulceration or rupture is greater. The presence of plaque in main vessels can promote formation and growth of the plaque at bifurcations. The inner wall of blood vessels at the carina of bifurcations is more easily damaged in the case of small angle vessels. The results can provide theoretical references for the design and optimization of vulnerable atherosclerotic plaque treatment.

Modified Shengjiangsan Inhibits Necroptosis by Mediating RIP1/RIP3/MLKL Signaling Pathway and Reduces Renal Fibrosis in Rats with Diabetic Nephropathy / 中国实验方剂学杂志

ObjectiveTo observe the mechanism of modified Shengjiangsan in necroptosis and renal fibrosis of rats with diabetic nephropathy based on receptor-interacting protein （RIP）1/RIP3/mixed lineage kinase domain-like protein （MLKL） signaling pathway. MethodSeventy-five SD rats were randomly divided into a model group， a normal group， three high， medium， and low-dose modified Shengjiangsan groups （4.365， 8.73， 17.46 g·kg-1）， and an irbesartan group （0.013 5 g·kg-1）. After 4 weeks of intragastric administration， the levels of 24 h urine protein （UTP）， tumor necrosis factor-α （TNF-α）， and interleukin-1β （IL-1β） of rats in each group were determined， as well as the changes in degree of renal pathology. Real-time quantitative polymerase chain reaction （Real-time PCR） and immunohistochemistry were used to detect the mRNA and protein expression levels of IL-1β， TNF-α， monocyte chemoattractant protein-1 （MCP-1）， transforming growth factor-β1 （TGF-β1）， and nuclear factor kappa B （NF-κB） in kidney tissues of rats. Western blot assay was used to detect the expression levels of key proteins in the RIP1/RIP3/MLKL signaling pathway. ResultAs compared with the normal group， the renal interstitial fibrosis in the model group was obvious， and the 24 h UTP， IL-1β， TNF-α levels were significantly increased （P<0.05）. In the model group， the mRNA and protein expression levels of IL-1β， TNF-α， MCP -1， TGF-β1， and NF-κB in the kidney tissues were significantly increased （P<0.05）， and protein expression levels of RIP1， RIP3， p-MLKL， and MLKL were significantly increased （P<0.05）. Compared with the model group， all modified Shengjiangsan groups and the irbesartan group improved the levels of renal interstitial fibrosis in rats to varying degrees. As compared with the model group， the 24 h UTP levels in all modified Shengjiangsan groups and the irbesartan group were decreased to varying degrees （P<0.05）， the content of IL-1β and TNF-α in the serum were decreased （P<0.05）， the mRNA and protein expression levels of IL-1β， TNF-α， MCP-1， TGF-β1， and NF-κB in renal tissues was down-regulated （P<0.05）， and the protein expression levels of RIP1， RIP3， p-MLKL， and MLKL were down-regulated （P<0.05）. ConclusionModified Shengjiangsan ameliorates renal injury of rats with diabetic nephropathy， and the mechanism may be related to the down-regulation of the RIP1/RIP3/MLKL signaling pathway， the prevention of renal tissue necroptosis， and the inhibition of renal fibrosis.

Estrogen Receptor-A in Medial Preoptic Area Contributes to Sex Difference of Mice in Response to Sevoflurane Anesthesia / 神经科学通报·英文版

A growing number of studies have identified sex differences in response to general anesthesia; however, the underlying neural mechanisms are unclear. The medial preoptic area (MPA), an important sexually dimorphic structure and a critical hub for regulating consciousness transition, is enriched with estrogen receptor alpha (ERα), particularly in neuronal clusters that participate in regulating sleep. We found that male mice were more sensitive to sevoflurane. Pharmacological inhibition of ERα in the MPA abolished the sex differences in sevoflurane anesthesia, in particular by extending the induction time and facilitating emergence in males but not in females. Suppression of ERα in vitro inhibited GABAergic and glutamatergic neurons of the MPA in males but not in females. Furthermore, ERα knockdown in GABAergic neurons of the male MPA was sufficient to eliminate sex differences during sevoflurane anesthesia. Collectively, MPA ERα positively regulates the activity of MPA GABAergic neurons in males but not in females, which contributes to the sex difference of mice in sevoflurane anesthesia.

Establishment of acute radiation-induced esophagitis model of Wistar rats based on a small animal precision radiotherapy platform / 中华放射医学与防护杂志

Objective:To establish an in vivo model of acute radiation esophagitis in Wistar rats based on a small animal precision radiotherapy platform (SARRP). Methods:Thirty-six Wistar rats were randomly divided into control group, 40, 60 and 75 Gy groups. Based on MRI images, the esophageal target area of rats was outlined and the radiotherapy plan was formulated. The rats were respectively irradiated with 0, 8, 12 and 15 Gy per day for 5 consecutive days. The changes of body weight, food intake, esophageal pathology and magnetic resonance imaging were observed.Results:The body weight of rats in 75 Gy group decreased significantly on the 6th day after irradiation (IR) ( P<0.05). The esophageal tissue of rats in each IR group was thicker than that in control ( F = 14.20, P < 0.05). HE staining showed that the formation rate of radiation-induced esophagitis in 40 Gy and 60 Gy groups were 4/5 and 5/5, respectively, mainly mild. In 75 Gy group, the incidence of radiation-induced esophagitis approached to 5/5, of which 3/5 was severe at 9 d post-IR. The pathological injury scores [ M( Q1, Q3)] of rats in each group were 0, 1.0 (0.5, 2.5), 1.0 (1.0, 2.5) and 4.0 (1.5, 6.0) on the 9th day after IR. There was significant difference between the 75 Gy group and the control group ( H=12.69, P<0.05). After dynamic monitoring of neck MRI images, it was found that the esophageal signal of rats in each IR group increased and widened at 9 d post-irradiation. Conclusions:The animal model of acute radiation-induced esophagitis in rats was successfully established based on a small animal precision radiotherapy platform combined with MRI. 75 Gy was the best irradiation dose and the 9th day was the best observation time point.

《2020 ESC/HFA Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies》: What is new? / 中华检验医学杂志

Detection of serum biomarkers is an important strategy for the diagnosis of cardiovascular diseases. The roles of serum biomarker detection have become increasingly valuable in the baseline risk stratification among cancer patients in recent years. The Cardio-oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology newly proposed the “role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies”. By evaluating the characteristics of cardiac biomarkers in cancer patients receiving cardiotoxic cancer therapy, this statement discussed the mechanism, clinical application, value on monitoring and prognosis of the two main biomarkers,cardiac troponin and natriuretic peptide on chemotherapy induced cardiac toxic responses. The purpose of this statement is to help establish the multidisciplinary collaborative diagnosis and treatment strategies and provide a clinical framework, and guide clinicians to select appropriate serum biomarker monitoring programs based on risk stratification to prevent cardiovascular disease in cancer patients.

An fMRI study on the specific modulation of brain responses to transient pain by anxiety in college students / 中华行为医学与脑科学杂志

Objective:To investigate whether anxiety state and anxiety trait modulate specifically pain-induced brain responses by comparing the brain activations induced by painful stimulation and those by tactile stimulation in college students with different levels of anxiety state or anxiety trait.Methods:From April 2017 to September 2017, sixty-two college students were tested in Tianjin Medical University General Hospital.Each subject’s anxiety trait and anxiety state were assessed by the state-trait anxiety inventory (STAI) prior to the fMRI experiment.During the fMRI experiment, each subject received painful and tactile stimuli.Their brain responses to each stimulus were collected by the MRI scanner, and the perceived intensity rating of each stimulus was collected using the visual analogue scale (VAS). The pain and tactile brain activation values of subjects with different state anxiety levels and different trait anxiety levels were compared.The fMRI brain activation was detected using general linear model.For each type of anxiety (state or trait), two-way ANOVA was performed to detect the interaction between anxiety level and stimulus modality on brain responses and two-sample t-tests were performed to analyze the specific form of interaction in each brain region. Results:There were interactions between state anxiety and stimulation modality on the activation intensity of bilateral posterior parietal lobe, dorsolateral prefrontal lobe and other brain regions( P<0.05, cluster-level FWE corrected) .The brain responses to tactile stimuli (5.66±0.65) in these areas were significantly stronger than those to painful stimuli (1.24±0.55) in the group of middle-level anxiety state ( P<0.001), but no significant difference was found in the other two groups (both P>0.05). For anxiety trait, a few brain areas in bilateral occipital cortex showed significant interactions between anxiety level and stimulus modality.The brain responses to tactile stimuli (8.38±1.00) in these areas were significantly stronger than those to painful stimuli (3.19±1.12) in the group of high-level anxiety trait ( P=0.001), but no significant difference was found in the other two groups (both P>0.05). Conclusion:The modulatory effects of anxiety (both state and trait) on brain responses are different between painful and tactile conditions.It provides important evidence for unveiling the brain mechanisms of the specific modulation of anxiety on pain, and suggests that patients' anxiety trait and anxiety state should be considered during clinical treatment of pain.

Effect of target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia on the postoperative changes of serum neuron specific enolase, β-amyloid protein and cognitive function in elderly patients with non-small cell lung cancer / 中国医师进修杂志

Objective:To investigate the effect of target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia on the postoperative changes of serum β-amyloid protein (β-AP), neuron specific enolase (NSE) and cognitive function in elderly patients with non-small cell lung cancer (NSCLC).Methods:The clinical data of 78 elderly patients with NSCLC who underwent thoracoscopic surgery from December 2017 to December 2019 in Jinhua Hospital of Traditional Chinese Medicine of Zhejiang Province were retrospectively analyzed. Among them, target-controlled infusion propofol to maintain anesthesia was in 39 cases (control group), and target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia was in 39 cases (study group). The serum levels β-AP, NSE and cognitive function (assessed by mini mental state examination, MMSE) before and after operation, the postoperative recovery (eye opening time, response time and extubation time) and incidence of adverse reactions were compared between 2 groups.Results:There were no statistical differences in β-AP and NSE before operation between 2 groups ( P>0.05); the β-AP and NSE immediately and 6 h after operation in study group were significantly lower than those in control group, β-AP: (416.13 ± 22.81) μg/L vs. (510.73 ± 24.27) μg/L and (373.53 ± 21.72) μg/L vs. (430.68 ± 22.15) μg/L, NSE: (8.35 ± 0.66) μg/L vs. (11.13 ± 0.73) μg/L and (7.81 ± 0.61) μg/L vs. (9.12 ± 0.68) μg/L, and there were statistical differences ( P<0.01); there were no statistical differences in β-AP and NSE 24 h after operation between 2 groups ( P>0.05). There was no statistical difference in MMSE score before operation between 2 groups ( P>0.05); the MMSE score 6, 24 and 72 h after operation in study group was significantly higher than that in control group: (22.32 ± 2.05) scores vs. (20.54 ± 2.31) scores, (25.19 ± 1.33) scores vs. (23.61 ± 1.08) scores and (26.84 ± 0.97) scores vs. (25.01 ± 1.15) scores, and there was statistical difference ( P<0.01); there was no statistical difference in MMSE score 7 d after operation between 2 groups ( P>0.05). The eye opening time, response time and extubation time in study group were significantly shorter than those in control group: (14.15 ± 3.20) min vs. (19.32 ± 3.14) min, (18.08 ± 3.52) min vs. (24.63 ± 4.10) min and (16.21 ± 4.40) min vs. (22.31 ± 4.71) min, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of adverse reactions between 2 groups ( P>0.05). Conclusions:Target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia in elderly patients with NSCLC can reduce the increase of serum levels of β-AP and NSE, reduce the damage to cognitive function, make patients recover quickly after operation, and will not increase the incidence of adverse reactions. Its security is higher.

Fasting blood glucose predicts the outcome after intravenous thrombolytic therapy in patients with severe acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the predictive value of fasting blood glucose on clinical outcome after intravenous thrombolysis in patients with severe acute ischemic stroke (AIS).Methods:From January 2016 to November 2020, consecutive patients with severe AIS receiving intravenous thrombolysis in the Department of Neurology, Shengli Oilfield Central Hospital were enrolled retrospectively. Severe AIS was defined as the baseline National Institutes of Health Stroke Scale (NIHSS) score ≥15. The primary endpoint was the clinical outcome evaluated according to the modified Rankin Scale at 90 d after onset. 0-2 was defined as a good outcome and a score of >2 were defined as a poor outcome. The secondary endpoint events were any intracranial hemorrhage and symptomatic intracranial hemorrhage (sICH). Intracranial hemorrhage was defined as any local or distant parenchymal hemorrhage shown by craniocerebral imaging during the hospitalization. sICH was defined as any intracranial hemorrhage and the NIHSS score increased by ≥4 within 7 d after treatment. Univariate and multivariate logistic regression analysis were used to determine the independent influencing factors of various endpoint events. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of fasting blood glucose levels for endpoint events. Results:A total of 113 patients with severe AIS treated with intravenous thrombolysis were included, and 73 (64.6%) had a poor outcome; 29 (25.7%) had intracranial hemorrhage, of which 10 (8.8%) were sICH. Multivariate analysis showed that fasting blood glucose was the independent risk factors for poor outcome (odds ratio [ OR] 1.451, 95% confidence interval [ CI] 1.053-2.000; P=0.023) and sICH ( OR 1.235, 95% CI 1.013-1.504; P=0.036). The ROC curve analysis showed that the area under the curve of fasting blood glucose predicting poor clinical outcome at 90 d after onset was 0.731 (95% CI 0.637-0.824), the optimal cut-off value was 6.25 mmol/L, and the corresponding sensitivity and specificity were 63.0% and 82.5% respectively. The area under the curve of fasting blood glucose predicting sICH was 0.728 (95% CI 0.577-0.878), the optimal cut-off value was 7.98 mmol/L, and the corresponding sensitivity and specificity were 70.0% and 77.7% respectively. Conclusion:Fasting blood glucose is an independent predictor of sICH and poor outcome at 90 d after onset in patients with severe AIS receiving intravenous thrombolysis.

Association of muscle mass loss with atherosclerosis in elderly patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To investigate the association of muscle mass loss with atherosclerosis in elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 322 patients with T2DM aged≥60 years old were divided into muscle mass loss group( n=152) and non-muscle mass loss group( n=170) according to their appendicular skeletal muscle mass index(ASMI). All participants underwent physical examination, dual-energy X-ray absorptiometry check, carotid and lower extremity ultrasound, as well as laboratory tests. Results:Among 322 patients, 49(15.22%) patients were suffered from sarcopenia and 152(47.2%) patients with reduced muscle mass. The carotid and lower extremity atherosclerosis grades in the muscle mass loss group were significantly higher than those in the non-muscle mass loss group( P<0.05), with lower body mass index(BMI), T-score, ASMI, uric acid, and homeostasis model assessment of insulin resistance index( P<0.05). Multivariate logistic regression analysis showed that carotid atherosclerosis and lower extremity atherosclerosis were risk factors for muscle mass loss while BMI and 25-(OH)D 3 were protective factors for muscle mass loss. There existed a consistency in carotid atherosclerosis grade and lower extremity atherosclerosis grade of elderly patients with T2DM( P<0.01). Conclusion:Atherosclerosis has a predictive value for early sarcopenia in elderly patients with T2DM.

Lateral Hypothalamic Area Glutamatergic Neurons and Their Projections to the Lateral Habenula Modulate the Anesthetic Potency of Isoflurane in Mice / 神经科学通报·英文版

The lateral hypothalamic area (LHA) plays a pivotal role in regulating consciousness transition, in which orexinergic neurons, GABAergic neurons, and melanin-concentrating hormone neurons are involved. Glutamatergic neurons have a large population in the LHA, but their anesthesia-related effect has not been explored. Here, we found that genetic ablation of LHA glutamatergic neurons shortened the induction time and prolonged the recovery time of isoflurane anesthesia in mice. In contrast, chemogenetic activation of LHA glutamatergic neurons increased the time to anesthesia and decreased the time to recovery. Optogenetic activation of LHA glutamatergic neurons during the maintenance of anesthesia reduced the burst suppression pattern of the electroencephalogram (EEG) and shifted EEG features to an arousal pattern. Photostimulation of LHA glutamatergic projections to the lateral habenula (LHb) also facilitated the emergence from anesthesia and the transition of anesthesia depth to a lighter level. Collectively, LHA glutamatergic neurons and their projections to the LHb regulate anesthetic potency and EEG features.

Anaesthesia effect of ropivacaine in different concentrations on intermuscular sulcus brachial plexus block under ultrasound guidance / 中国基层医药

Objective:To explore the anesthetic effect of different concentrations of ropivacaine in intramuscular sulcus brachial plexus block under ultrasound guidance.Methods:From April 2016 to April 2018, 120 patients with upper limb orthopedic surgery who received muscle under the ditch brachial plexus block guided by ultrasound in Jinhua Hospital of Traditional Chinese Medicine were randomly divided into group A (40 cases, application of 0.375% ropivacaine), group B (40 cases, application of 0.50% ropivacaine), group C (40 cases, application of 0.75% ropivacaine). The anesthetic effect, onset time of sensory block, onset time of motion block, duration of analgesia, recovery time of motion block, serum troponin level, creatine kinase isozyme level and incidence of adverse reactions in the three groups were compared.Results:The excellent and good anesthesia rate of group A, group B and group C was 100.00%, and there was no statistically significant difference among the three groups ( P>0.05). The onset time of sensory block[(5.29±1.32)min], the onset time of motion block[(7.42±1.36)min] in group C were shorter than those in group A[(9.32±1.52)min, (13.32±2.46)min] and group B[(7.89±1.63)min, (9.12±2.20)min]( F=4.652, 6.365, all P<0.05). The analgesic duration in group C[(10.71±1.52)h] was longer than that in group A[(6.89±2.23)h] and group B[(8.69±2.12)h]( F=5.120, P<0.05), but the recovery time of motion block in group C was longer than that in group A and group B ( P<0.05). The serum troponin level and creatine kinase isozyme level at 24 h after injection in group C were significantly higher than those in group A and group B( P<0.05), and the serum troponin level and creatine kinase isozyme level in group B were significantly higher than those in group A ( P<0.05). With the increase of concentration, the incidence of adverse reactions gradually increased, but there was no statistically significant difference among the three groups ( P>0.05). Conclusion:With the increase of ropivacaine concentration, the onset time of anesthesia is shorter and the analgesic time is longer, but the incidence of adverse reactions is also higher.In a comprehensive consideration, 0.50% ropivacaine can be applied to patients with intermuscular sulcus brachial plexus block under ultrasound guidance.

Application progresses of multiparameter MRI in bladder cancer / 中国医学影像技术

Bladder cancer is one of the most common malignant tumors in the world, incidence in male is higher. Multiparameter MRI (mp-MRI) has advantages of high soft tissue resolution, multi-directional imaging and functional imaging in guiding the staging and treatment of bladder cancer. The application progresses of mp-MRI in staging, grading and prediction of recurrence, survival and therapeutic effect of bladder cancer were reviewed in this article.

Multivariate analysis of muscle mass loss in patients with type 2 diabetes / 中华内分泌代谢杂志

Objective:To explore the related factors of muscle mass loss in patients with type 2 diabetes mellitus, and to provide evidence for prevention of sarcopenia in type 2 diabetic patients.Methods:A cross-sectional survey was used to select type 2 diabetic patients admitted to the Department of Endocrinology, Affiliated Hospital of Qingdao University from January 2019 to August 2019. All subjects underwent dual-energy X-ray absorptiometry check. According to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS), the subjects were divided into a muscle reduction group and a non-muscle reduction group. Data including age, gender, body mass index, course of disease, blood index, urinary albumin-creatinin ration (UACR), and appendicular skeletal muscle index (ASMI) were collected. The relevant clinical data of viscera fat/subcutaneous fat (VAT/SAT), percentage of abdominal fat/percentage of hip fat (A/G), grip strength, and pace were analyzed for the related factors of muscle mass loss in type 2 diabetic patients.Results:A total of 369 patients with type 2 diabetes were enrolled, including 42 patients with sarcopenia (an incidence rate of 11.38%), and 155 patients with reduced muscle mass (an incidence of 42.01%). Age, systolic blood pressure, high density lipoprotein-cholesterol, UACR, VAT/SAT, and A/G in the muscle reduction group were higher than those in the non-muscle reduction group ( P<0.05). The parameter of body mass index, homeostasis model assessment for insulin resistance, estimated glomerular filtration rate (eGFR), ASMI, and grip strength were lower in the muscle reduction group than in the non-muscle reduction group ( P<0.05). Multivariate logistic regression analysis showed age, UACR, A/G, and VAT/SAT were risk factors for muscle loss, body mass index, eGFR, and grip strength were protective factors for muscle mass reduction. Conclusion:It is of great practical significance for type 2 diabetic patients, especially those with advanced age, central obesity, low body mass index, low grip strength, low glomerular filtration rate, and high UACR to perform an early screening and to begin an early intervention.