Objective To explore electrophysiological features of infantile spinal muscular atrophy (SMA), and to evaluate diagnostic value of electrophysiological examinations in patients with SMA.Methods Tweenty-seven SMA children from Jan 2011 to Nov 2015 diagnosed in Wuxi People''s Hospital were enralled.All patients had neurogenic changes by EMG and finally confirmed by genetic test as SMA.Basic clinical data were retrospectively analyzed.Nerve conduction velocity was tested in each patient;While EMG was performed in no less than six muscles in each patient.Results All these patients were characterized by progressive flaccid paralysis in limbs.In all cases, amplitude of CMAP in median nerve was significantly decreased, apparent decreased in ulnar nerve and peroneal nerve;while mild decrease of MCV was appeared in ulnar nerve.Nothing abnormal were detected in sensory nerve conduction.EMG demonstrated neurogenic damage.Conclusion Typical clinical symptoms of infantile SMA are progressive symmetrical loss of muscle control and atrophy in limbs, and specificity electrophysiological representation provides very important basis for the diagnosis.

BACKGROUND:Aging, lack of estrogen and few activities may lead to the decrease of resting energy expenditure in menopause women so as to induce the body composition changes, which can result in disease, such as obesity and fracture. OBJECTIVE:To explore the change of body composition and resting metabolic rate among premenopausal, perimenopausal and postmenopausal women. METHODS:2 312 women who came to outpatient clinic were recruited, including 1 310 premenopausal women, 790 perimenopausal women and 212 postmenopausal women. Body composition and resting energy expenditure were measured in each woman. RESULTS AND CONCLUSION:(1) Body fat percentage of perimenopausal and postmenopausal women was significantly higher than that of pre-menopausal women. (2) There was no significant difference in resting metabolic rate among the three groups. When adjusted body weight, the resting energy expenditure per kilogram was significantly lower in perimenopausal women than in premenopausal women. (3) Bone mineral density, femoral neck strength, lower limb maximal strength, and leg muscle distribution coefficient were significantly lower in postmenopausal women than in perimenopausal and premenopausal women (P < 0.05). (4) Weight and leg muscle distribution coefficient were positively correlated with the resting energy expenditure per kilogram, and height, body mass index, body fat percentage were negatively correlated with the resting energy expenditure per kilogram. These findings indicate that the body composition can change in women after menopause, such as body fat increasing, muscle content decreasing, and bone mass loss. There is a certain relationship between the change in body composition and resting energy expenditure.

Objective To explore the value of endothelial dysfunction assessment in predicating major adverse cardiac and cerebrovascular events (MACCE) in peritoneal dialysis (PD) patients.Methods A prospective cohort study included 136 end stage renal disease (ESRD) patients from Jan 1,2009 to Dec 31,2011 was conducted.Endothelial function was assessed by flowmediated dilation (FMD) of brachial artery.Kaplan-Meier method was used to estimate survival rate.The survival difference between the two groups was compared by the log-rank test.Multivariate Cox proportional hazards regression was used to determine the independent risk factors of MACCE.Results In the follow-up period,18 patients in low FMD (FMD≤2.7％) group occurred MACCE,and 13 patients in high FMD (FMD ＞ 2.7％) group occurred MACCE.Compared with high FMD group,MACCE-free survival rate in the low FMD group had a significantly decreased (x2=4.190,P=0.041).Multivariate Cox proportional hazards regression analysis showed that higher level of total cholesterol,lower FMD,longer PD time and higher levels of hs-CRP were all independent predictors of MACCE.Conclusion Reduced brachial artery FMD is an independent risk factor of MACCE,and the application of FMD contributes to the risk stratification of cardiac and cerebrovascular disease in PD patients.

Objective To investigate the related factors of the prognosis of arterial embolectomy of acute cardiogenic cerebral embolism caused by atrial fibrillation.Methods The clinical data of using vein thrombolysis bridging artery embolectomy or arterial embolectomy alone for the treatment of patients with acute cardiogenic cerebral embolism of cerebral large artery occlusion due to atrial fibrillation were analyzed retrospectively.From January 2015 to December 2016,22 consecutive inpatients with cardioembolic cerebral embolism caused by paroxysmal or persistent atrial fibrillation were enrolled,including 10 patients with the 90-day modified Rankin Scale (mRS) score 0-2 (good recovery group) and 12 patients with mRS scores 3-6 (poor recovery group).The clinical features,imaging data,and treatment of the patients in both groups were compared.The factors such as age,gender,preoperative international standardization ratio (INR),embolism position,whether bridging vein thrombolysis before thrombectomy,National Institutes of Health Stroke Scale (NIHSS) score at the onset,time of onset to reperfusion (TOR),whether using tirofiban,times of thrombectomy,modified Thrombolysis In Cerebral Infarction (mTICI) blood flow grade,and postoperative intracranial symptomatic intracerebral hemorrhage were analyzed.Results There were no significant differences in age,gender,preoperative INR,embolism position,the number of intravenous thrombolysis before thrombectomy,the number of using tirofiban in surgery,the proportion of the above mTICI 2b grade,and the proportion of symptomatic cerebral hemorrhage after surgery of the patients between the two groups (P>0.05).The NIHSS score 15.2±2.0 at the onset in the good recovery group was lower than 22.9±8.4 in the poor recovery group.There was significant difference between the two groups (P<0.05).The TOR time (307±86 min) in the good recovery group was less than that of the poor recovery group (426±145 min).There was significant difference between the two groups (P<0.05).Embolectomy was performed 1.5 (0.5,3.0) times in the good recovery group,which was less than the poor recovery group (4.0 [2.0,7.0] times).There was significant difference between the two groups (P<0.05).Conclusions Shortening the time of reperfusion and reducing the number of embolectomy during operation are the important factors for improving the prognosis of patients when atrial fibrillation causes arterial embolectomy in patients with acute cerebral embolism.However,a study of larger sample is needed for further exploration.

AIM: To study the effect of hypoxia and hypercapnia on nitric oxide (NO) in plasma and superoxide dismutase (SOD), catalase (CAT), soluble guanylate cyclase (sGC), cyclic guanosine monophospholate (cGMP) in lung tissue in rats, and to explore the effect of NO- and H_2O_2-sGC pathway on the development of the pulmonary hypertension. METHODS: The model of hypoxic and hypercapnic 1, 2, 4-week group (HH 1 week, HH 2 weeks, HH 4 weeks) and control group was set up. NO content in plasma, CAT and SOD in rat lung were determined by spectrophotometry. The sGC activity in lung tissue was detected by enzyme kinetic analysis. cGMP content in lung tissue was examined with ~ 125 I-radioimmunoassay. RESULTS: The mean pulmonary artery pressure (mPAP) showed significantly higher in HH 1 week, HH 2 weeks and HH 4 weeks groups compared with control group (all P

Objective To study the impact of sucrose analgesia on pain response and salivary cortisol levels in preterm infants.Method Preterm infants admitted to our hospital between January 2014 and October 2016 with gestational age ＜ 34 weeks,birth weight ＜ 2 000 grams,and length of hospital stay ≥ 14 days were prospectively assigned into two groups.The intervention group received 0.3 ～ 0.5 ml of 12％ sucrose solution two minutes before each painful procedure,while the control group received none.At time of discharge and at 8 months of corrected age (CA),pain response was measured,saliva samples were collected and salivary cortisol levels were assayed using Enzyme Immunoassay Kit before and after pain stimulus.Result A total of 82 infants were included in our study,42 in the intervention group,and 40 in the control group.There were no statistically significant differences between two groups in pain response at discharge and 8 months of CA.At time of discharge and at 8 months of CA,infants in intervention group had higher salivary cortisol levels than in control group at time of discharge and 8 months of CA after pain stimulus [6.8 (5.6,11.7) ng/ml vs.5.4 (2.6,10.8) ng/ml,5.0 (3.3,5.6) ng/ml vs.4.8 (3.0,5.5) ng/ml] after log transformation,two groups were statistically significant (P ＜ 0.05).However,before the pain stimulus,no differences were found between two groups.Multiple stepwise regressions analysis showed that salivary cortisol level post pain stimulus was negatively related to the total number of pain stimulus,and positively related to sucrose analgesia at discharge and 8 months of CA.Conclusion Sucrose analgesia may mitigate the negative effect of repeated pain stimulus on cortisol regulation in preterm infants,however,may have no influence on pain response of them.

Objective To summarize the surgery nursing cooperation points of liver procurement of brain death contributions (DBD) donor in the uninterrupted blood flow way . Methods Complete the following preoperativepreparation such as personnel,brain death donation donor,environment ,surgical content,multiple organ repair system and other related equipments;intraoperative preparation includes surgical instruments and related equipments ,assisting intubation of arteria lienalis ,portal vein and the choledochus and the organ procurement . Result About 3 cases of donor liver procurement were successfully implemented in the interrupt blood flow way, operation time was 3~4 h,bleeding was 200~400 mL,an average of 300 mL. Conclusions Uninterrupted flow liver transplantation can protect liver function to the greatest extent , thus greatly avoids the common complication of organ transplantation.The tacit understanding surgery cooperation improves the rate of surgery successfully.

Objective:To predict the risk of cryptogenic stroke (CS) patients with right-to-left shunt (RLS) by machine learning, and provide potential solutions for accurate and efficient prediction of CS.Methods:A retrospective analysis of clinical data on 289 subjects with positive RLS detected by contrast-enhanced transcranial Doppler tests (c-TCD) treated in the Department of Neurology at Laoshan Campus, the Affiliated Hospital of Qingdao University, from January 2018 to September 2023, including demographic information, medical history, laboratory test indicators, diagnosis, and treatment.The dataset was randomly divided into a training set and a testing set by the machine learning function train_test_split(), with a ratio of 8∶2.Risk prediction models for CS in RLS subjects were constructed by algorithms such as Logistic regression, decision trees, random forests, extreme gradient boosting, artificial neural networks, gradient boosting, extra trees, and adaptive Boosting.The model performance was evaluated by receiver operating characteristic curves (ROC), area under curve (AUC), confusion matrix, precision, recall, accuracy, F1 score, calibration curves, and decision curve analysis.The optimal model was subjected to interpretability analysis by feature importance and SHAP values.The t-test, Mann-Whitney U test and χ2 test were used for data analysis by SPSS 25.0 software.Delong test was used to compare the differences in AUC between the two models. Results:In 289 RLS subjects, there were 166 cases of CS (57.5%) and 123 cases of non-CS (42.5%).The statistical analysis results showed that blood biochemical indicators such as D-dimer, mean platelet volume, and fibrinogen in CS patients were higher than those in non-CS patients (all P<0.01).There were no statistically significant differences in variables between the training and testing sets(all P>0.05).Random forest model achieved the highest AUC (0.885), precision (0.806), recall (0.879), accuracy (0.810), and F1 score (0.841) for CS risk prediction in the testing set.The calibration curve showed that the random forest model was closest to the reference line, and the decision curve analysis indicated that it had a greater net benefit.The interpretability analysis revealed that high-risk factors included mean platelet volume, D-dimer, international normalized ratio, body mass index, and age. Conclusion:The random forest-based prediction tool exhibits excellent performance, demonstrating high accuracy in predicting CS risk in RLS population.

Objective:To investigate whether the fluctuation of blood pressure variability (BPV) before carotid endarterectomy (CEA) is related to postoperative cerebral perfusion changes in patients with carotid artery stenosis.Methods:A prospective observational cohort study was performed. Forty-seven patients with carotid artery stenosis accepted CEA in Department of Neurosurgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University from January 2019 to December 2022 were chosen. Patients' blood pressure was closely monitored 3 d before surgery (4 times/d) to obtain their BPV (the maximum △, based on the maximum absolute differences between systolic or diastolic blood pressures measured continuously during the observation period). At the same time, the changes of cerebral perfusion 3 d after surgery were monitored (criteria of cerebral hyperperfusion: newly-appeared delirium and hyperactivity after anesthesia resuscitation or intracranial hemorrhage found by imaging examination; criteria of cerebral hypoperfusion: newly-appeared speech and motor function deficits or aggravation of original cerebral ischemia symptoms after anesthesia resuscitation, or new-found cerebral infarction by imaging examination). Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of BPV before CEA in postoperative cerebral perfusion changes.Results:In these 47 patients, 9 patients (19.1%) had postoperative cerebral perfusion changes: 2 had neurological deficits due to postoperative cerebral infarction, and the other 7 had short-term postoperative delirium or focal neurological deficits (returned to normal after appropriate adjustment of blood pressure). Area under the ROC curve (AUC) of BPV before CEA in predicting postoperative cerebral perfusion changes was 0.876 ( P=0.001, 95% CI: 0.775-0.977). These 47 patients were divided into high BPV group ( n=16) and low BPV group ( n=31) according to the optimal index threshold (27.00), and the statistics showed that significant difference in incidence of cerebral perfusion changes after CEA was noted between the 2 groups ( P<0.05); incidence of postoperative cerebral perfusion changes in the high BPV group was 15.5 times higher than that in the low BPV group ( RR=15.500, P<0.001, 95% CI: 2.120-113.320). Conclusion:BPV before CEA in patients with carotid artery stenosis can well predict the occurrence of postoperative cerebral perfusion changes.

Objective To investigate the antithrombotic function of traditional medicine salvia and aspirin in the myocardial infarction rats. Methods The myocardial infarction animal model was established by ligating left anterior descending coronary artery. The rats were randomly divided into the model group, the aspirin group, the salvia miltiorrhiza group, and the combination therapy group, with 8 rats in each group. The salvia miltiorrhiza group was injected with Danshen freeze-dried powder 17 mg/kg via tail vein injection, aspirin group was given aspirin 10 mg/kg, the combination group was given aspirin 10 mg/kg with the tail vein injected with Danshen freeze-dried powder 17 mg/kg, and the model group was given an equal volume of normal saline with an equal volume of saline injected into the tail vein. Continuous administration last 10 days, once daily. The blood coagulation, platelet aggregation, thromboxane B2, 6-Keto-F1α and von Willebrand factor were detected and compared. Results Compared with the model group, the maximum platelet aggregation rate(32.55％ ± 9.57 ％, 32.16％ ± 10.76％, 19.74％ ± 6.70％ vs. 58.75％ ± 4.81％) in the rats of the aspirin group, the salvia group and the combined treatment group significantly decreased, and the contents of TXB2 (70.58 ± 9.31 ng/ml, 73.10 ± 11.33 ng/ml, 49.25 ± 5.33 ng/ml vs. 107.86 ± 17.45 ng/ml) decreased (P<0.01). The maximum platelet aggregation rate and contents of TXB2 in the combination group were lower than those in the aspirin group and the salvia group (P<0.01). Compared with the model group, the 6-Keto-PGF1α content (67.64 ± 7.12 ng/ml, 81.72 ± 10.72 ng/ml vs. 57.80 ± 11.19 ng/ml) of the aspirin group and the combined treatment groupwas increased (P<0.05), prothrombin time (13.11 ± 0.67 s, 15.85 ± 0.25 s vs. 10.77 ± 0.46 s) prolonged (P<0.05), vWF (51.31 ± 4.12 ng/ml, 47.72 ± 10.32 ng/ml vs. 128.81 ± 11.14 ng/ml) decreased (P<0.05). The contents of 6-Keto-PGF1α of the combined treatment group was increased compared with aspirin group and salvia group (P<0.05), prothrombin time decreased than aspirin group (P<0.05) and Salvia group and vWF decreased than Salvia group (P<0.05). Conclusions The salvia miltiorrhiza and aspirin combination therapy has synergistic effect on anti-platelet aggregation and anticoagulant effect. The salvia miltiorrhiza and aspirin combination therapy showed small bleeding risk.