Objective To explore the relationship of white matter lesions to delayed perihematomal edema expan-sion and functional outcome in intracerebral hemorrhage.Methods The clinical and imaging data of 209 patients with su-pratentorial intracerebral hemorrhage in the First Affiliated Hospital of Zhengzhou University,from September 2021 to January 2023 were retrospectively analyzed.White matter lesions were graded using the van Swieten Scale(vSS)score.Delayed perihematomal edema expansion was defined as absolute volume growth of perihematomal edema(ΔPHE)≥7.5 ml from 4-7 days to 8-14 days.Logistic regression analysis was performed to identify risk factors for delayed perihematomal edema expansion and 90-day poor outcomes.Multiple linear regression analysis was utilized to identify risk factors for ΔPHE.Results Of 209 patients,93 patients had white matter lesions,91 patients had delayed perihematomal edema ex-pansion,and 104 patients had 90-day poor outcomes.Regression analyses showed that vSS score,the National Institutes of Health Stroke Scale(NIHSS)score at admission,and initial hematoma volume were independent risk factors for de-layed perihematomal edema expansion after intracerebral hemorrhage and for ΔPHE vSS score,NIHSS score at admission,initial hematoma volume,and age were significant factors affecting the 90-day poor outcome after intracerebral hemor-rhage.Compared with non/mild white matter lesions,moderate/severe white matter lesions were more likely to have poorer functional outcomes.Conclusion Severity of white matter lesions,NIHSS score at admission,and initial hematoma vol-ume were independent risk factors for delayed perihematomal edema expansion after intracerebral hemorrhage,and were correlated with 90-day poor outcomes.Delayed perihematomal edema expansion may be a potential mechanism of white matter lesions affecting the prognosis of intracerebral hemorrhage,which needs to be confirmed by further prospective studies.

Objective To evaluate the diagnostic value of cardiac magnetic resonance(CMR)in patients with severe connective tissue disease-associated pulmonary hypertension(CTD-PAH).Methods A total of 48 patients diagnosed with CTD-PAH by right heart catheterization(RHC)in Tianjin Medical University General Hospital from June 2018 to July 2021 were retrospectively included.The parameters of right ventricular(RV)morphology,function and ventricular septum(IVS)were obtained by manual delineation on CMR images and corrected by body surface area.The late gadolinium enhancement(LGE)myocardial mass(MM)and its percentage in left ventricular(LV)MM were manually sketched and calculated on LGE images.The patients were divided into the mild-moderate group and the severe group according to mean pulmonary arterial pressure(mPAP).CMR parameters were compared between the two groups.The diagnostic value of CMR for severe CTD-PAH was analyzed by receiver operating characteristic(ROC)curve.Results A total of 48 patients with CTD-PAH were included in this study.The curvature of interventricular septum(CIVS)and RV ejection fraction(EF)were lower in the severe group than those in the mild-moderate group,and the time proportion of IVS deformation,RV end-diastolic volume index(EDVI),RV end-systolic volume index(ESVI)and RV MM were higher than those in the mild-moderate group(P＜0.05).ROC curve analysis showed that RV MM,time proportion of IVS deformation and RV ESVI had better diagnostic efficacy in severe CTD-PAH patients(AUC was 0.792,0.766 and 0.731,respectively).The combined AUC of the three parameters was 0.840,specificity was 85.7%and sensitivity was 79.4%.Conclusion The parameters of RV and IVS measured by CMR can effectively evaluate patients with severe CTD-PAH and directly reflect serverity of cardiac impairment in patients with severe CTD-PAH from the morphological and functional perspective.

Objective:To ulteriorly explore the differences of psychotic symptoms and neurocognitive between patients with first-episode deficit subtype of schizophrenia (FDS) and patients with first-episode nondeficit subtype of schizophrenia (FNDS).Methods:From January 2021 to September 2021, a total of 88 first-episode treatment-naive schizophrenia were recruited from the Mental Health Center of West China Hospital and divided into FDS group( n=44) and FNDS group( n=44) according to the schedule for the deficit syndrome (SDS), and 44 healthy subjects were included as healthy control group (HC group, n=44). Positive and negative syndrome scale (PANSS) was used to assess psychotic symptoms of patients and Wechsler adult intelligence scale, trail making test and logic memory test were used to evaluate intelligence quotient and neurocognitive function of all subjects.SPSS 22.0 was used for statistical analysis, and independent samples t-test and one-way analysis of variance (ANOVA) were used to compare variables that met normal distribution, while the Mann-Whitney U test and Kruskal-Wallis H test were used to compare variables that did not meet normal distribution. Results:(1) There were significant differences in psychotic symptoms between the FDS group and the FNDS group.Compared with the FNDS group, the FDS group had higher total score of PANSS ((95.95±16.82) vs (88.39±16.29)), negative symptoms ((27.57±7.52) vs (16.57±5.76)) and anergastic reaction ((13.43±3.82) vs (7.00(5.00, 9.00)), and lower positive symptoms scores ((21.95±6.88) vs (25.41±6.07)), activation ((8.00(5.00, 9.00) vs (9.27±3.47)), depression ((5.50(4.00, 9.00) vs (8.00(6.00, 12.00)) and supplementary item ((13.60±4.17) vs (17.30±5.39))(all P<0.05). (2) There were differences in neurocognitive functions between FDS group and FNDS group, and which in FDS and FNDS group were worse than that in HC group.Spatial memory (block design test: (23.70±11.05) vs (31.72±11.49)) and information processing speed (digit symbol test: (38.38±15.85) vs (47.97±14.99)) of FDS group were significantly lower than those of FNDS group(both P<0.05). Intelligence quotient, information processing speed and spatial memory of FDS group and FNDS group were lower than those of HC group(all P<0.05). Conclusion:FDS patients has more severe negative symptoms and anergastic reaction, and exit worse information processing speed and spatial memory dysfunction than FNDS patients.This unique pattern of impairment suggests that information processing speed and spatial memory may be important classification indicators for differentiating the deficit subtype of schizophrenia in the early stage.

Humans ; Bipolar Disorder ; Schizophrenia ; Depression ; Electroencephalography

Objective:To explore the effects of "rain classroom" wisdom teaching on geriatric students′ autonomous learning ability and self-efficacy.Methods:From June to August, 2021, 61 nursing students who practiced in the department of gerontology of the Second Xiangya Hospital, Central South University were selected as research subjects, and divided into experimental group (30 students) and control group (31 students) by random number table method. In the experimental group, wisdom teaching based on "Rain classroom" was carried out at the same time as conventional teaching, while in the control group, conventional teaching was carried out, and the teaching effect was evaluated by the independent learning ability measurement scale and academic self-efficacy scale of nursing students.Results:The score of autonomous learning ability of nursing students in the experimental group was 68.55 ± 11.06, and that in the control group was 74.29 ± 9.16. The difference between the two groups was statistically significant ( t = -2.01, P<0.05). The academic self-efficacy scores of nursing students in experimental group and control group were 52.27 ± 11.56 and 52.64 ± 9.28 respectively. There was no significant difference between the two groups ( P>0.05). Conclusions:The wisdom teaching of "rain classroom" improves the independent learning ability of geriatric nursing students, and attaches importance to the cultivation of self-efficacy of nursing students, and the improvement of self-efficacy needs further research.

Objective:To explore the pathogenesis and prognostic factors of brain metastasis of hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods:Retrospective review was performed for 17 HCC cases with brain metastasis after liver transplantation from 2000 to 2020.All cases were diagnosed as hepatitis B cirrhosis complicated with HCC.All of them were beyond the Milan Criteria.The immunosuppressive regimen consisted of baliximab + mycophenolate mofetil + calcineurin inhibitors(CNIs)+ corticosteroids in early postoperative period with a gradual tapering of corticosteroids and mycophenolate mofetil.Three patients received sirolimus immunotherapy after tumor recurrence and withdrew CNIs.One of three cases received sorafenib.Results:Other organ involvements included lung metastasis( n=16, 94.1%), bone metastasis( n=5, 29.4%)and liver metastasis( n=6, 35.3%). The median survival time after brain metastasis was 7 months and the 1-year cumulative survival rate 29.4%.The median survival time post-LT was 14 months and the 1-year cumulative survival rate 64.7%.Among 7 patients with a resection of brain metastasis, two deaths at Month 1 post-operation were due to cerebral hemorrhage.The longest survival time was 214 months and the median survival time 9 months. Conclusions:The prognosis of brain metastasis post-LT remains poor.However, early detection and reasonable treatment can prolong patient survival time and even achieve long-term survival.Most brain metastases are accompanied by lung metastases.And the finding of lung metastatic tumor hints at a presence of intracranial lesions.

Objective:To observe the clinical effect of pelvic floor ultrasound in the diagnosis and rehabilitation training of postpartum stress urinary incontinence(SUI).Methods:From May 2017 to May 2019, 200 SUI patients and 200 healthy pregnant women in the same period admitted to the First People's Hospital of Huzhou were selected in this study.All the subjects were tested by perineum and pelvic floor ultrasound, and the patients with SUI were instructed to carry out pelvic floor muscle rehabilitation training, the level of rehabilitation training effect was evaluated, and to statistically analyze the difference of pelvic floor ultrasound parameters between the patients with SUI and the healthy women, and the patients with different levels of efficacy.Results:The results of pelvic floor ultrasound in SUI patients were significantly higher than those in healthy women( t=6.536-14.925, all P<0.05). The rate of urinary leakage in SUI patients [88.50%(177/200)] was significantly higher than that in healthy women [10.50%(21/200)](χ 2=243.384, P<0.05). The total effective rate of rehabilitation training was 79.50%(159/200). The bladder neck moving distance, urethra rotation angle, posterior angle of bladder urethra in resting state and posterior angle of bladder urethra in Valsalva state in SUI patients with ineffective rehabilitation training were significantly higher than those in SUI patients with general effective rehabilitation training( t=4.662-12.537, all P<0.05). The formation rate of urethra infundibulum in SUI patients with ineffective rehabilitation training [70.73%(29/41)] was significantly higher than that in SUI patients with effective rehabilitation training [19.50%(31/159)](χ 2=40.744, P<0.05). Conclusion:The rehabilitation training of discoid muscles can effectively relieve the related clinical symptoms of postnatal SUI patients.The detection of pelvic ultrasound has a certain clinical value in the diagnosis of postpartum SUI and evaluation of rehabilitation training effect.

OBJECTIVE: To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. METHODS: The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. RESULTS: The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. CONCLUSIONS The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
China ; Humans ; Liver Transplantation

OBJECTIVE： To establish a quantitative analysis of multi-components by singer marker （QAMS） for determining the contents of diosgenin， 5-hydroxymethylfurfural， vanillic acid， rutin， quercetin， kaempferol in Polygonati Rhizoma and its decoction piece. METHODS： HPLC external standard method was used to determine the contents of 6 components in Polygonati Rhizoma and its decoction piece simultaneously [the separation was carried out on Diamonsil-C18 column with mobile phase consisted of acetonitrile-water （gradient elution）； the detection wavelengths of 5-hydroxymethylfurfural， vanillic acid， rutin， quercetin and kaempferol were set at 254 nm（0-60 min）； the detection wavelength of diosgenin was set at 202 nm （60-75 min） at the flow rate of 1.0 mL/min. The column temperature was 30 ℃]. Using vanillic acid as internal standard， relative correction factors （RCFs） of aother 5 components were calculated and to investigate durability. Relative retention method was used to accurately locate the chromatographic peaks of the components to be determined， and then the contents of the aother 5 components in Polygonati Rhizoma were calculated according to RCFs， and the results were compared with those determined by external standard method. The method was validated by Polygonati Rhizoma decoction piece. The contents of 6 components were determined by QAMS method and external standard method respectively， and then the differences of content determination were compared between 2 methods. RESULTS： The methodology investigation results of HPLC method were in line with related requirements. Within the linear range， the RCFs of diosgenin， 5-hydroxymethylfurfural， rutin， quercetin， kaempferol were 0.195， 0.025， 0.263， 0.345 and 0.075， respectively. Under different experiment conditions， RCFs showed good reproducibility； there was no statistical significance of 6 components in Polygonati Rhizoma and its decoction piece determined by external standard method and QAMS method （P＞0.05）. CONCLUSIONS： Established QAMS method is suitable for simultaneous determination of 6 components in Polygonati Rhizoma and its decoction piece.