Purpose To observe white matter structure features of patients with early stage (Hoehn-Yahr 1-2 phase) Parkinson''s disease (PD) by using diffusion tensor imaging (DTI) based on the fiber bundle analysis tract-based spatial statistics (TBSS); and to explore the brain regions of PD patients in which DTI parameters are significantly correlated with unified Parkinson''s disease rating scale (UPDRS) score elevation. Materials and Methods DTI sequence was performed on 27 cases of PD and 30 cases of healthy volunteers. DTI parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were analyzed in all participants by using TBSS technique, and the parameters of two groups were compared. The correlation of clinical UPDRS score with FA value, MD and RD value in the PD group were analyzed.Results Compared with that in the control group, FA values of several brain regions in PD group decreased, while MD and RD value increased (P<0.05). AD showed no obvious change (P>0.05). UPDRS score of PD group was correlated with FA, MD and RD value (P=0.001). The brain regions that showed FA value decreased, MD and RD value increased included corpus callosum, left anterior limb of internal capsule, bilateral anterior radial crown, bilateral superior radial crown and left posterior thalamic radiation (P=0.001).Conclusion There is some changes in white matter structure of the patients with early stage Parkinson''s disease, which may due to demyelination or fiber integrity damaged.

Objective To investitate the efficacy of cannabinoid-2 receptor (CB2R) activation in preventing liver ischemia-reperfusion (I/R) injury in mice.Methods Forty-eight male C57BL/6J mice,weighing 20-30 g,were divided into 4 groups (n =12 each):sham operation group (group S),group I/R,CB2R agonist JWH133 group (group J),and CB2R agonist JWH133 + CB2R antagonist SR144528 group (group JS).Liver I/ R was produced by blocking the hepatic artery and portal vein for 30 min followed by 45 min of reperfusion in anesthetized mice.At 60 min before ischemia,JWH133 20 mg/kg was injected intraperitoneally in group J,and JWH133 20 mg/kg and SR144528 30 mg/kg were injected intraperitoneally in group JS.The liver was removed at 45 min of reperfusion for determination of tumor necrosis factor-α (TNF-α),macrophage inflammatory protein-1α (MIP-1α) and MIP-2 contents (using ELISA),and expression of TNF-α,MIP-1α,MIP-2 and intercellular adhesion molecule-1 (ICAM-1) mRNA (by RT-PCR) in the liver tissues and for microscopic examination of the pathological changes.Results Compared with group S,the contents of TNF-α,MIP-1α and MIP-2 were significantly increased,and the expression of TNF-α,MIP-1α,MIP-2 and ICAM-1 mRNA was up-regulated in J and JS groups.Compared with group I/R,the contents of TNF-α,MIP-1α and MIP-2 were significantly decreased,and the expression of TNF-α,MIP-1α,MIP-2 and ICAM-1 mRNA was down-regulated in J group,and no significant change was found in the parameters mentioned above in JS group.Compared with group J,the contents ofTNF-α,MIP-1α and MIP-2 were significantly increased,and the expression of TNF-α,MIP-1α,MIP-2 and ICAM-1 mRNA was up-regulated in JS group.The pathological changes of liver tissues were significantly attenuated in group J as compared with I/R and JS groups.Conclusion CB2R activation is effective in preventing liver I/R injury in mice and the mechanism is related to inhibitioni of inflammatory responses in liver tissues.

Objective:To investigate and analyze the anxiety problems in hospitalized COVID-19 patients so as to provide evidence for formulation of relevant mental health management strategies.Methods:A Psychological Questionnaire for Hospitalized COVID-19 Patients in Wuhan was used to investigate the anxiety status of the COVID-19 patients who had been hospitalized to Wuhan Tong Ji Hospital which had been assisted by Peking University People's Hospital. The patients were categorized into a mild group and a non-mild group according to The Diagnosis and Management Protocols for COVID-19 (Trial version 7). The population characteristics, anxiety status and disease recovery were analyzed in the 2 groups. Scores from 0 to 7 indicated no anxiety and ≥ 8 anxiety.Results:A total of 46 patients were included in this study, including 28 men and 18 women aged from 23 to 78 years (average, 60.9 years). There were 13 mild cases and 33 non-mild ones. There were no significant differences between the 2 groups in age or gender ( P>0.05). Of all the patients, 52.2% (24 cases) had a close relative or family member definitely diagnosed of COVID-19. To the question "Do you have any worry?" , 73.9% of the patients (34 cases) answered yes. The mild cases scored 7.3 points±2.0 points, showing mild anxiety; the non-mild cases scored 8.7 points±1.2 points, showing mild anxiety too. There were no significant differences between the mild and non-mild cases in any anxiety scoring item( P>0.05). The single factor analysis of the general data showed no significant correlation between anxiety and education, COVID-19 diagnosis of a close relative or family member, current situation of anti-COVID-19 or future life ( P>0.05), but a significant correlation between anxiety and therapeutic outcomes and the current situation of family members ( P<0.05). Conclusions:Anxiety is a common problem in hospitalized COVID-19 patients. Anxiety about prognosis and family members is the main factor affecting their psychological status. Attention should be paid to the mental health of COVID-19 patients by governments and medical staff.

Objective:To analyze the CT and MRI imaging features of Kimura disease in parotid region.Methods:This study was a cross-sectional study. From January 2018 to June 2023, a total of 40 patients with Kimura disease in parotid region who were initially diagnosed and confirmed by postoperative pathology were retrospectively collected in the Ninth People′s Hospital, School of Medicine, Shanghai Jiao Tong University. There were 36 male patients and 4 female patients, with an age of (46±19) years, ranging from 8 to 74 years old. The clinical data, preoperative CT and MRI findings were analyzed. For patients undergoing MRI examination, the apparent diffusion coefficient (ADC) value of the lesion was measured, and the type of time-signal intensity curve (TIC) was analyzed.Results:The ratio of male to female patients was 9∶1, with a long clinical history (1 month to 20 years). And 37 cases (37/40, 92.5%) were associated with elevated peripheral blood eosinophils. Among the 40 cases, there were 4 cases of nodular type, 34 cases of diffuse type, and 2 cases of intermediate type. Nodular type: All lesions were located in the superficial lobe of unilateral parotid gland, and 3 cases had multiple lesions. The lesions were round, well-defined, and homogeneous in density or signal intensity. Two lesions showed hyperintensity on T 2WI and obvious homogeneous enhancement. The TIC was plateau type, and the ADC values were 0.74×10 -3 mm 2/s and 0.82×10 -3 mm 2/s. Diffuse type: The 22 cases had multiple lesions, and 20 cases had subcutaneous lesions in other parts of the head and neck. The lesions were irregular in shape and ill-defined in boundary. The adjacent subcutaneous tissue and skin were involved in 33 cases. The density or signal intensity of the lesions was heterogeneous, and among the 15 patients who underwent MRI, 14 cases showed uneven slightly hyperintensity with hypointense strips on T 2WI, moderate or significant enhancement. TIC showed a persistent pattern in 9 cases, and a plateau pattern in 6 cases. The ADC value was (0.99±0.21)×10 -3 mm 2/s. Intermediate type: The 2 cases were single, irregular in shape, without involvement of adjacent subcutaneous tissue and skin, with obvious enhancement and no necrosis. And 28 cases of diffuse type and 2 cases of nodular type were accompanied by ipsilateral or bilateral cervical lymphadenopathy. The enlarged lymph nodes had clear boundaries, homogeneous density or signal intensity, and homogeneous enhancement. Conclusions:The Kimura disease in parotid region has a long clinical course and elevated peripheral blood eosinophils. The diffuse type is more common in the morphology, with multiple ill-defined lesions in and around the parotid gland, and can be accompanied by similar subcutaneous lesions in other parts of the head and neck with obvious enhancement, accompanied by cervical lymph node enlargement. TIC shows persistent pattern or plateau type, and the ADC value is low. The nodular type and intermediate type are rare.

Objective To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People′s Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m2, (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m2, (6.7±1.6) mmol/L, (6.1± 1.2) mmol/L; (22±3) kg/m2, (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM ( OR=2.799, 95% CI :1.186-6.604; P<0.05). Conclusion The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

Objective:To investigate the effect of early selective reduction of twin pregnancies or spontaneous reduction on the improvement of clinical outcome in IVF-ET treatment.Methods:The clinical data of 6535 cycles(6535 cases)of single or twin pregnancy obtained from fresh and frozen-thawed embryo transfer(FET)of IVF or ICSI-ET in the Department of Reproductive Medicine,Women and Children's Hospital Affiliated to Xiamen Univer-sity from November 2011 to December2021 were analyzed retrospectively,The propensity score matching(PSM)method(1∶4)was used to include the study subjects.The surgical reduction group and the spontaneous single-ton group were included in 128 cycles and 510 cycles,respectively.The spontaneous reduction group and the ini-tial singleton group were included in 511 cycles and 2038 cycles,respectively.The pregnancy outcomes of each groups were compared.Results:After PSM,the number of transferred embryos in the surgical and spontaneous reduction group was higher than that in the initial singleton group.The gestational week of delivery was earlier than that of the initial singleton group,and the birth weight of the newborn was lower than that in the initial single-ton group.The rate of premature delivery and low birth weight was higher than that in the initial singleton group,and the difference was statistically significant(P＜0.05).The incidence of pregnancy complications(postpartum hemorrhage,gestational diabetes,hypertensive disorders of pregnancy)and the rate of cesarean section were not significantly different(P＞0.05).The abortion rate and neonatal birth defect rate were missing after adjusting the PSM model.According to the calculation before adjustment,the early abortion rate of the surgical reduction group and the spontaneous reduction group were significantly lower than that in the initial singleton group(P＜0.05),and the late abortion rate of the spontaneous reduction group was lower than that in the initial singleton group,the difference was statistically significant(P＜0.05).There was no significant difference in the neonatal birth defect rate between the surgical/spontaneous reduction group and the initial singleton group(P＞0.05).Conclusions:Patients with multiple pregnancies caused by assisted reproductive technology(ART)may have a relatively poor prognosis in the perinatal period even if the effect of early pregnancy reduction surgery or spontaneous reduction is limited.Reducing the number of embryos transferred cannot completely reverse the pregnancy outcome.Limiting the number of embryos transferred is the fundamental solution to the adverse outcomes of ART assisted pregnancy.

OBJECTIVE To explore whether pyridoxine can protect acute kidney injury caused by cisplatin and to analyze its specific mechanism. METHODS After establishing an in vitro model of cisplatin-induced damage in HK-2 cells, different concentrations of pyridoxine were administered and cell survival was detected using SRB, the expression of apoptosis-related and antioxidant proteins were detected by Western blotting, and the activity of reactive oxygen species(ROS) and superoxide dismutase(SOD) were detected by kits. A cisplatin-induced mouse kidney injury model was further established, and the serum urea nitrogen level was detected after the administration of 40 mg·kg–1 pyridoxine treatment, the results of hematoxylin-eosin staining in renal tissue were analyzed, and the expression of NRF2 was detected by Western blotting. RESULTS Pyridoxine could protect kidney injury caused by cisplatin in HK-2 cells and mouse in vivo. In HK-2 cells, pyridoxine down-regulated ROS level, up-regulated SOD enzyme activity, and up-regulated the expression of NRF2 and its downstream antioxidant-related gene HO-1. Pyridoxine significantly reduced the level of serum urea nitrogen, repaired kidney tissue damage, and up-regulated the expression of NRF2 in kidney injury mice. CONCLUSION Pyridoxine protects against cisplatin-induced kidney injury through enhancing the level of anti-oxidative stress.

ObjectiveTo investigate the use of antidepressants in hospitalized patients with depression disorder from 2015 to 2019， and to analyze the changes of these antidepressants and medication regimens， so as to provide references for clinical drug use. MethodsUsing the Beijing-Tianjin-Hebei big data platform， the data of patients with depression in Beijing Anding Hospital， Capital Medical University from 2015 to 2019 were retrospectively analyzed. The changes of different types of drugs and medication regimens were described. ResultsFrom 2015 to 2019， a total of 6 043 cases of eligible patients were enrolled in analysis. Among selective serotonin reuptake inhibitors （SSRIs）， the prescription proportion of sertraline， citalopram and fluoxetine showed a trend of decline （P<0.05 or 0.01）， while the prescription proportion of escitalopram showed a trend of fluctuations （P=0.031）. In serotonin noradrenaline reuptake inhibitors （SNRIs）， the prescription proportion of duloxetine and milnacipran were rising （P<0.01）. The newer antidepressants agomelatine （P=0.001） and voltioxetine （P<0.01） also showed an upward trend. In terms of medication regimen， the proportion of single antidepressants and combined use of two antidepressants showed a downward trend （P<0.01）， while the proportion of antidepressants combined with mood stabilizers， antidepressants combined with mood stabilizers or antipsychotics showed an upward trend （P<0.05 or 0.01）. ConclusionIn the 5 years， the proportion of SSRIs decreased， and the proportion of SNRIs and newer antidepressants increased in hospitalized patients with depression. The proportion of antidepressants combined with mood stabilizers and antipsychotics in treatment regimens showed an increasing trend.

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m², (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m², (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m², (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

BACKGROUND: The presence of fibrosis is a criterion for subtype classification in the newly updated hypersensitivity pneumonitis (HP) guidelines. The present study aimed to summarize differences in clinical characteristics and prognosis of non-fibrotic hypersensitivity pneumonitis (NFHP) and fibrotic hypersensitivity pneumonitis (FHP) and explore factors associated with the presence of fibrosis. METHODS: In this prospective cohort study, patients diagnosed with HP through a multidisciplinary discussion were enrolled. Collected data included demographic and clinical characteristics, laboratory findings, and radiologic and histopathological features. Logistic regression analyses were performed to explore factors related to the presence of fibrosis. RESULTS: A total of 202 patients with HP were enrolled, including 87 (43.1%) NFHP patients and 115 (56.9%) FHP patients. Patients with FHP were older and more frequently presented with dyspnea, crackles, and digital clubbing than patients with NFHP. Serum levels of carcinoembryonic antigen, carbohydrate antigen 125, carbohydrate antigen 153, gastrin-releasing peptide precursor, squamous cell carcinoma antigen, and antigen cytokeratin 21-1, and count of bronchoalveolar lavage (BAL) eosinophils were higher in the FHP group than in the NFHP group. BAL lymphocytosis was present in both groups, but less pronounced in the FHP group. Multivariable regression analyses revealed that older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors for the development of FHP. Twelve patients developed adverse outcomes, with a median survival time of 12.5 months, all of whom had FHP. CONCLUSIONS Older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors associated with the development of FHP. Prognosis of patients with NFHP was better than that of patients with FHP. These results may provide insights into the mechanisms of fibrosis in HP.
Humans ; Bronchoalveolar Lavage Fluid ; Prospective Studies ; Alveolitis, Extrinsic Allergic/diagnosis* ; Fibrosis ; Carbohydrates