Objective To investigate the strategies of reducing the incidence of missed diagnosis of severe traumatic brain injuries combined with multiple trauma. Methods Data of 432 patients with severe traumatic brain injuries and multiple trauma (ISS≥20) from January 2000 to August 2007 were analyzed retrospectively. All patients were divided into missed diagnosis group (MD group, n =54) and non-missed diagnosis group (NMD group, n =378) for correlation analysis on ISS, GCS, anatomical locations of the missed diagnosis, the time of delayed diagnosis and the prognosis. Results ISS was (42.97±10.94) points in MD group, with statistical difference compared with NMD group (P < 0.05). The patients with GCS≤8 in MD group was more than those in NMD group (P < 0.05). Conclusions It is effective to prevent missed diagnosis and improve the survival of patients with severe traumatic brain injuries combined with multiple trauma by judging injury severity quickly and precisely based on the principle of "life first" and repeated and systemic physical examination.

In recent years, the chimeric antigen receptor T-cell (CAR-T) therapy has achieved breakthrough progress in the treatment of hematologic malignancies. However, when it comes to solid tumors, numerous challenges persist.These include limited CAR-T cell infiltration, susceptibility to T cell exhaustion, off-target effects, and more.Thus, novel therapeutic strategies are imperative to enhance the efficacy of CAR-T therapy for solid tumors. In comparison to standalone CAR-T approaches, the combination of CAR-T with other tumor treatment modalities has demonstrated remarkable effectiveness in both preclinical and clinical research.This review article summarizes the advancements in combining CAR-T with various solid tumor treatments: antibody drugs, oncolytic viruses, tumor vaccines, and nanomedicines.The objective is to furnish a theoretical foundation and novel perspectives for the development of innovative CAR-T combination strategies tailored for solid tumor therapy.

Objective:To elucidate the spatial distribution patterns of the right hepatic vein by analyzing the image information obtained after CT three-dimension reconstruction of liver to provide guidance in surgical planning of anatomical hepatectomy.Methods:A retrospective analysis was performed on the clinical data of 77 subjects who underwent CT examination of the liver at the Second Affiliated Hospital of Harbin Medical University from September 2018 to October 2021. There were 42 males and 35 females, aged (50.2±12.8) years old. CT DICOM data of the patients were collected, and the two-dimensional image data were reconstructed into a three-dimensional model by using the 3D reconstruction software. The characteristics and typing were studied by analyzing the number of branches of the right hepatic vein and the spatial location of the main trunk.Results:Of 77 subjects, 645 branches of the right hepatic vein were observed in the liver CT 3D reconstruction model, including 268 (41.6%) right-sided branches, 240 (37.2%) dorsal branches, 70 (10.9%) left-sided branches, and 67 (10.3%) ventral branches. Each right hepatic vein possessed 3 (3, 4) right-sided branches, 3 (3, 4) dorsal branches, 1 (0, 1) left-sided branch, and 1 (0, 1) ventral branch. The numbers of branches in the four directions were significantly different ( H=175.89, P<0.001). Comparison showed that the number of right-sided branches was significantly more than that of the left-sided (χ 2=136.86) and ventral (χ 2=140.07), respectively. The number of dorsal branches was more than that of left-sided (χ 2=-123.36) and ventral (χ 2=126.57) branches, respectively. The differences were significant ( P<0.001). There were no significant differences between the number of ventral and left-sided branches, and between the dorsal and right-sided branches (all P>0.05). Conclusion:The right hepatic vein had fewer ventral and left-sided branches. It is relatively safe to dissect the right hepatic vein from the ventral or the left side during surgery. For resection of the central liver segments or segment VIII of the liver, it is reasonable to transect the liver along the left border of the right hepatic vein.

Objective To observe the application effect of magnetic resonance imaging technology in evaluating the brain structure and function of patients with type 2 diabetic painful neuropathy(PDN).Methods Forty patients with type 2 diabetes mellitus hospitalized in our hospital were se-lected as the study objects,and were divided into diabetes mellitus(DM)group(n=12),peripheral neuropathy(DPN)group(n=14)and PDN group(n=14).General clinical biochemical indexes of three groups were analyzed.The structural brain and function of brain area in three groups were com-pared.Results Age,duration of diabetes,systolic blood pressure,diastolic blood pressure,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),free fatty acid(FFA),albumin(ALB),creatinine(Cr),uric acid(UA),estimated glomerular filtration rate(eGFR),cystatin C(Cys-C),total cholesterol(TC),triglyceride(TG)of the three groups were compared,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),triiodothyronine(T3),thyroxine(T4),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb),thyroid peroxidase anti-body(TPO-Ab)and serum calcium(Ca)in the three groups showed no significant differences(P＞0.05).Compared with the DM group,the gray matter volume(GMV)in the DPN group was signifi-cantly decreased(P＜0.05).Compared with the DM group,amplitude of low frequency fluctuation(ALFF)and fractional amplitude of low frequency fluctuation(fALFF)of left medial superiorfrontal gyrus in the PDN group were significantly decreased(P＜0.05).Conclusion Abnormal GMV in the left angular gyrus in DPN patients may be associated with a higher risk of concomitant cognitive impairment.The decrease of ALFF in the right cerebellar vermis and fALFF in the left medial superior frontal gyrus in PDN patients may be related to the pathogenesis of pain.

Objective To observe the application effect of magnetic resonance imaging technology in evaluating the brain structure and function of patients with type 2 diabetic painful neuropathy(PDN).Methods Forty patients with type 2 diabetes mellitus hospitalized in our hospital were se-lected as the study objects,and were divided into diabetes mellitus(DM)group(n=12),peripheral neuropathy(DPN)group(n=14)and PDN group(n=14).General clinical biochemical indexes of three groups were analyzed.The structural brain and function of brain area in three groups were com-pared.Results Age,duration of diabetes,systolic blood pressure,diastolic blood pressure,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),free fatty acid(FFA),albumin(ALB),creatinine(Cr),uric acid(UA),estimated glomerular filtration rate(eGFR),cystatin C(Cys-C),total cholesterol(TC),triglyceride(TG)of the three groups were compared,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),triiodothyronine(T3),thyroxine(T4),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb),thyroid peroxidase anti-body(TPO-Ab)and serum calcium(Ca)in the three groups showed no significant differences(P＞0.05).Compared with the DM group,the gray matter volume(GMV)in the DPN group was signifi-cantly decreased(P＜0.05).Compared with the DM group,amplitude of low frequency fluctuation(ALFF)and fractional amplitude of low frequency fluctuation(fALFF)of left medial superiorfrontal gyrus in the PDN group were significantly decreased(P＜0.05).Conclusion Abnormal GMV in the left angular gyrus in DPN patients may be associated with a higher risk of concomitant cognitive impairment.The decrease of ALFF in the right cerebellar vermis and fALFF in the left medial superior frontal gyrus in PDN patients may be related to the pathogenesis of pain.

Objective : To explore the association of time in range(TIR) and glucose management indicator ( GMI) with the risk of type 2 diabetic nephropathy (DN) ． Methods : The clinical data of 215 patients with type 2 diabetes mellitus (T2DM) were collected and analyzed．According to the results of estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio( UACR) ，they were divided into 117 patients with T2DM and 98 patients with DN．The clinical data，biochemical indicators and continuous glucose monitoring ( CGM) indicators of the two groups were compared．Logistic regression was used to analyze the influencing factors of DN risk．The predictive value of TIR and GMI on the risk of DN was evaluated by receiver operating characteristic (ROC) curve. Results: There were significant differences in age，duration of diabetes，systolic blood pressure，glycosylated hemoglobin ( HbA1c) ，fasting plasma glucose (FPG) ，2 hour postprandial plasma glucose (2hPG) ，creatinine( Cr) ，UACR, eGFR between the two groups(P＜0. 05) ．There were statistically significant differences between the two groups in the CGM indexes of GMI，mean absolute difference of mean of daily differences ( MODD) ，glucose above target range time(TAR) and TIR(P＜0. 05) ．The results of logistic regression analysis showed that TIR was a protective factor of DN．In the ROC curve analysis of TIR prediction DN，the area under the ROC curve was 0. 718 (95% CI = 0. 648 ～0. 789，P＜0. 001) ，and the Yoden index was 0. 38．At this time，the sensitivity was 66. 7% ，and the specificity was 71. 3%．In the ROC curve analysis of GMI prediction DN，the area under the ROC curve was 0. 701 (95% CI = 0. 629 ～0. 774，P＜0. 001) ，and the Yoden index was 0. 368．At this time，the sensitivity was 63. 3% ， and the specificity was 73. 5%． Conclusion Specifically，lower TIR and higher GMI increase the risk of DN.