Objective:To investigate the clinical efficacy and safety of Butylphthalide combined with Donepezil in the treatment of vascular dementia.Methods:A total of 214 patients with vascular dementia admitted to our hospital from December 2018 to December 2020 were divided into control(n=107)treated with Donepezil tablets, and study group(n=107)treated with Butylphthalide capsule plus Donepezil tablets in a multicenter single-blind randomized control trial.Clinical efficacy, dementia degree, cognitive function, behavioral ability, homocysteine(Hcy), brain-derived neurotrophic factor(BDNF), glial fibrillary acidic protein(GFAP)and neuron-specific enolatase(NSE)expression were compared between the two groups before versus after 24 weeks of treatment.And their safety was also evaluated.Results:The total effective rate was statistically significantly higher in study group than in the control group(93.46% and 80.37%, χ2=8.054, P<0.05). The scores of Hasegawa Dementia Scale(HDS), mini mental state examination scale(MMSE)and blessed Behavior Scale(BBS)in the treatment group before treatment were(17.2±2.4)points, (19.0±2.2)points and(25.1±1.8)points respectively; After 24 weeks of treatment, the scores in the treatment group were(27.4±2.8)points, (26.8±1.9)points and(14.2±2.7)points respectively; Before treatment, the scores in control group were(17.4±2.0)points, (18.6±2.1)points and(25.4±1.7)points respectively; After 24 weeks of treatment, the scores in control group were(21.8±3.3)points, (22.3±1.6)points and(19.5±2.3)points respectively.Hcy, BDNF, GFAP and NSE in the treatment group before treatment were(34.5±4.3)μmol/L、(3.5±0.4)μg/L、(13.2±0.8)μg/L and(18.9±1.7)μg/L; After 24 weeks of treatment, the scores in treatment group were(15.9±2.9)μg/L respectively μmol/L、(5.3±0.3)μg/L、(9.7±0.6)μg/L and(18.9±1.7)μg/L; Before treatment, the scores in control group were(35.3±4.4)μmol/L、(3.4±0.4)μg/L、(13.1±0.9)μg/L and(19.2±1.3)μg/L; After 24 weeks of treatment, the scores in control group was(23.3±4.9)μmol/L、(4.5±0.4)μg/L、(10.8±0.7)μg/L and(14.3±2.1)μg/L respectively.Before treatment, there was no significant difference in the expression of HDS scale, MMSE score, BBS score, Hcy, BDNF, GFAP and NSE between the two groups of patients with vascular dementia( t=0.662, 1.360, 1.253, 1.345, 1.829, 0.859, 1.450, all P>0.05); After treatment 24 weeks, the ADAS-Cog score, BBS score, Hcy, GFAP and NSE expressions of the two groups of vascular dementia patients were lower than that before treatment, while the HDS scale score, MMSE score and BDNF expression were higher than that before treatment(in treatment group: t=34.746, 31.273, 36.204, 36.289, 28.610, 27.256, 37.239; in control group: t=21.339, 18.849, 20.866, 20.522, 11.795, 14.497, 20.115, all P<0.05), the differences were statistically significant; After treatment for 24 weeks, the BBS score, Hcy, GFAP and NSE expression in the treatment group were lower than in control group, while the HDS scale score, MMSE score and BDNF expression were higher than in control group( t=15.457, 11.623, 16.551, 12.342, 13.385, 18.740, 11.547, all P<0.05), the differences were statistically significant.In the control group, there were 2 cases of mild gastrointestinal reaction and 3 cases of dizziness, with the incidence of 4.67%; Slight gastrointestinal reaction occurred in 4 cases and dizziness in 5 cases in the treatment group, with an incidence of 8.41%.There was no significant difference in the incidence of adverse reactions between the two groups( χ2=1.223, P>0.05). Conclusions:Butylphthalide soft capsules combined with Donepezil hydrochloride tablets have significant clinical effects on patients with vascular dementia, effectively reduce the degree of dementia, and improve the cognitive function and behavioral ability of patients, with good security.Therefore, it is worthy of clinical promotion.

Objective:To investigate the relationship between serum transferrin(TRF)and the characteristics and prognosis of elderly patients with sepsis.Methods:A retrospective analysis was conducted on 49 elderly patients with sepsis treated at the Department of Critical Medicine and the Department of Respiratory and Critical Medicine of the First Affiliated Hospital of Suzhou University between October 2020 and March 2022 who had met the inclusion criteria.These patients were divided into a shock group(n=18)and a non-shock group(n=31); Based on outcomes, they were also divided into a death group(n=16)and a survival group(n=33).Through the random number table method, 30 healthy elderly people from the physical examination center of our hospital were selected as the control group.TRF and ferritin(SF)were measured on the 1st, 3rd and 7th day after admission, and the correlation between TRF and the sequential organ failure assessment score(SOFA)was analyzed.The predictive value of TRF on prognosis was evaluated via the receiver operating characteristic curve.Finally, the influence of multiple factors on prognosis was analyzed using the binary logistic regression model.Results:Compared with the control group at admission, SF levels of elderly patients with sepsis increased[709.20(402.40, 2000.00)μg/L vs.102.05(79.55, 199.75)μg/L, Z=-5.482, P<0.01], but TRF levels decreased[1.43(1.12, 1.72)g/L vs.2.23(1.80, 3.12)g/L, Z=5.395, all P<0.01], with statistical significance.On the 3rd and 7th day, TRF levels in the shock group were lower than in the non-shock group[(1.25±0.35)g/L vs.(1.55 ±0.51)g/L, 1.15(9.68, 1.34)g/L vs.1.56(1.19, 2.03)g/L]( t=-2.186, Z=3.258, P<0.05).There was a linear correlation between TRF and SOFA score on the 1st, 3rd and 7th day( R2=0.177, 0.176, 0.275, all P<0.01).TRF levels in the death group were lower than in the survival group on the 3rd and 7th day( Z=2.208, 3.423, P<0.05 for both).TRF levels on the 3rd and 7th day in elderly patients with sepsis had predictive value in evaluating the prognosis[area under receiver operating characteristic curve( AUC)values=0.696, 0.804, P<0.05, P<0.01].The survival curves based upon the best cutoff values(TRF=1.085 g/L on the 3rd day, TRF=1.330 g/L on the 7th day)between the two groups were statistically significantly( χ2=10.903, 13.318, P<0.01 for both).With TRF<1.085 g/L on the 3rd day, the risk of death in elderly patients with sepsis on the 28th day was 9.388 times the usual risk( OR=9.388, P<0.01), and with TRF<1.330 g/L on the 7th day, the risk of death was 14.625 times the usual risk on the 28th day( OR=14.625, P<0.01). Conclusions:Increased SF in elderly patients with sepsis is not related to disease severity, but the level of TRF is related to disease severity, and the level of TRF on the 3rd and 7th day is related to the prognosis and is an independent risk factor for all-cause death on the 28th day.

Objective:To investigate the efficacy of Xiaoshuan Changrong Capsules combined with donepezil hydrochloride in the treatment of patients with vascular dementia and their effects on serum cytokines and oxidative stress. Methods:A total of 102 patients with vascular dementia who received treatment in Hangzhou Seventh People's Hospital, China between January 2019 and January 2021 were included in this study. They were randomly divided into control and observation groups, with 51 patients per group. The control group was treated by oral donepezil hydrochloride. The observation group was given oral Xiaoshuan Changrong Capsules combined with oral donepezil hydrochloride. All patients were treated for 12 weeks. Efficacy was compared between the two groups. The Clinical Dementia Rating score, the Mini-Mental State Examination score, and serum levels of interleukin 6, insulin-like growth factor-1, tumor necrosis factor-α, superoxide dismutase and malondialdehyde were compared between before and after treatment. Results:Total response rate in the observation group was significantly higher than that in the control group [90.20% (46/51) vs. 70.59% (36/51), χ 2 = 6.22, P < 0.05]. At 12 weeks after treatment, the Clinical Dementia Rating score in the observation group was significantly lower than that in the control group [(1.34 ± 0.27) points vs. (1.89 ± 0.31) points, t = 9.55, P < 0.05]. At 12 weeks after treatment, the Mini-Mental State Examination score in the observation group was significantly higher than that in the control group [(25.45 ± 1.98) points vs. (22.32 ± 2.10) points, t = 7.74, P < 0.05]. At 12 weeks after treatment, interleukin-6, insulin-like growth factor-1, and tumor necrosis factor-α levels in the observation group were (31.28 ± 7.35) ng/L, (0.34 ± 0.08) ng/L and (9.46 ± 2.27) ng/L, respectively, which were significantly lower than those in the control group [(46.43 ± 6.28) ng/L, (0.48 ± 0.07) ng/L, (20.98 ± 3.56) ng/L, t = 11.19, 9.40, 19.48, all P < 0.05]. At 12 weeks after treatment, superoxide dismutase in the observation group was significantly higher than that in the control group [(98.91 ± 7.25) U/L vs. (86.59 ± 5.63) U/L, t = 9.58, P < 0.05] . At 12 weeks after treatment, malondialdehyde in the observation group was significantly lower than that in the control group [(3.25 ± 0.50) mmol/L vs. (4.81 ± 0.35) mmol/L, t = 18.25, P < 0.05]. Conclusion:Xiaoshuan Changrong Capsules combined with donepezil hydrochloride is highly effective on vascular dementia. It can reduce cellular inflammatory response and improve oxidative stress response. This study is of great innovation and science.

OBJECTIVETo assess the association between -1296T/C and -915A/G polymorphisms in the promoter region of matrix metalloproteinase inhibitor-3 gene (TIMP-3) and atherosclerotic cerebral infarction in an ethnic Han Chinese population.

METHODSPeripheral blood samples were collected from 485 patients with atherosclerotic cerebral infarction and 525 healthy controls. Serum levels of TIMP-3 were measured with an enzyme-linked immunosorbent assay (ELISA). The polymorphisms of the TIMP-3 gene were analyzed with DNA sequencing.

RESULTSThere were significant differences in genotype and allele frequencies in -1296T/C and -915A/G between the patients and healthy controls (chi-square: 5.227 and 5.869; P: 0.022 and 0.015, respectively). Besides, there was a strong linkage disequilibrium between -1296T/C and -915A/G (D'=1.0, r(2)=0.991). The serum levels of TIMP-3 in patients were significantly higher than the control group [(248.90 ± 97.10) pg/mL vs. (200.17 ± 79.70) pg/mL, t=2.098, P=0.039].

CONCLUSIONThe -1296T/C and -915A/G polymorphisms of the TIMP-3 gene are associated with increased risk for atherosclerotic cerebral infarction in ethnic Han Chinese and may be used as molecular markers for the disease. There is also strong linkage disequilibrium between the two loci.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; ethnology ; genetics ; Atherosclerosis ; blood ; epidemiology ; ethnology ; genetics ; Base Sequence ; Cerebral Infarction ; blood ; epidemiology ; ethnology ; genetics ; China ; epidemiology ; Female ; Gene Frequency ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Polymorphism, Single Nucleotide ; Risk Factors ; Tissue Inhibitor of Metalloproteinase-3 ; blood ; genetics

OBJECTIVETo assess the association of a disintegrin and metallo-proteinase with thrombospondin type 1 motifs (ADAMTS-1) gene polymorphism and ischemic stroke caused by large artery atherosclerosis (LAA).

METHODSIn total 767 patients and 506 controls were recruited. Single nucleotide polymorphisms (SNPs) rs416905 (T/C) and rs402007 (G/C) of the ADAMTS-1 gene were genotyped by polymerase chain reaction and DNA sequencing.

RESULTSFrequencies of the rs402007 GC+CC genotype and the C allele were significantly different between the two groups (68.84% vs. 60.67%, χ2=9.012, P=0.003, OR=1.432; 45.24% vs. 38.54%, χ2=11.208, P=0.001, OR=1.318). Binary logistic regression has confirmed that the above difference was significant (P=0.001, OR=1.521, 95%CI: 1.183-1.955). The frequencies of TC+CC and GC+CC genotypes were similar between the two groups, and so was it with the C allele. The two SNPs had been in complete linkage disequilibrium (D'=1.0, r2=1.0).

CONCLUSIONThe rs416905 and rs402007 polymorphisms of the ADAMTS-1 gene may be associated with ischemic stroke caused by LAA. The C allele of the rs402007 locus may be a susceptibility factor for this subtype of stroke.

ADAM Proteins ; genetics ; ADAMTS1 Protein ; Aged ; Alleles ; Atherosclerosis ; complications ; Base Sequence ; Blood Glucose ; metabolism ; Brain Ischemia ; complications ; Fasting ; blood ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; genetics ; Genotype ; Humans ; Logistic Models ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Risk Factors ; Sequence Analysis, DNA ; Smoking ; Stroke ; blood ; etiology ; genetics

Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.

Objective To understand the epidemiological characteristics of acute respiratory virus infection in hospitalized patients, and to provide reference for clinical diagnosis and treatment, and to develop relevant intervention measures. Methods A total of 414 hospitalized patients with respiratory virus infection admitted to our hospital from March 2019 to March 2021 were selected. Immunofluorescence method was used to qualitative detect parainfluenza virus type 1-3, influenza A virus, respiratory syncytial virus (RSV), influenza B virus and adenovirus. Results Among the 414 ARTI patients, 84 cases were positive for respiratory virus, with a positive detection rate of 20.29% (84/414 ) . 76 cases were positive for single virus infection, with a positive detection rate of 18.36% (76/414) . The positive detection rate was 1.93% (8/414). The most common pathogens of virus infection were influenza A virus (25.00%), influenza B virus (20.23%) and RSV(17.86%). There was statistical significance in the positive rate of ARTI among different age groups (χ², P<0.05). The positive rate of respiratory virus in 1-8 years group was the highest (38.93%). There was statistical significance in the positive rate of 7 viruses (P<0.05). The patients with viral mixed infection were mainly children under 8 years old; There was statistical significance in the positive rate of ARTI in different seasons (χ², P<0.05). There was no significant difference in the seasonal distribution of PIV1, PIV2, ADV and mixed infection rates ( P>0.05). The positive rate of PIV3 was the highest in spring (4.04%), and the positive rate of RSV in spring and winter was 24.24% and 25.20%, respectively. The positive rates of influenza A virus and influenza B virus were the highest in winter (9.45%) and (7.09%). There was statistical significance in the positive rate of ARTI among different clinical diagnoses (χ², P<0.05). The positive rates of PIV2, PIV3, influenza A virus and influenza B virus were significantly different (P<0.05). The positive rate of bronchopneumonia virus was the highest (27.48%). Conclusion: RSV infection is the most common in patients with acute respiratory virus infection in Chengdu area, which mostly occurs in autumn and winter, and the main clinical manifestation is bronchopneumonia. The main infected population is children under 8 years old, and the surveillance of respiratory syncytial virus should be strengthened in the future.

OBJECTIVETo investigate the spiral ganglion degeneration and the expression of EFR3A in the cochlea of the deaf mice induced by co-administration of kanamycin and furosemide.

METHODSEight weeks old C57BL/6J mice were administered with a single dose of kanamycin followed by furosemide, then fluorescent immunohistochemistry staining and transmission electron microscopy were applied to observe the SGNs' degeneration process and extent characteristics at 1, 5, 15, 30 and 60 days following treatment. We detected the expression of EFR3A during the degeneration of SGNs via fluorescent immunohistochemistry and western blotting.

RESULTSCo-administration of kanamycin and furosemide quickly induced cochlear hair cell death in mice, and then caused progressive degeneration of SGNs. Our results showed that the abnormal morphology of SGNs occurredat day 5 following administration, and the number of SGNs began to decrease at day 15. Compared to the control group, it was found the remarkable increase of the EFR3A protein at the fifth day after co-administration, then decreased to the nearly normal at 15 days following treatment, and no further significant changes thereafter.

CONCLUSIONThe changes of the EFR3A protein expression in the spiral ganglion of the cochlea in mice are coincidence with the time of the SGNs degeneration to happen, which imply that EFR3A may play an important role in the occurrence of the SGNs' degeneration in the cochlea in mice following hair cells loss.

Animals ; Cochlea ; metabolism ; Furosemide ; Hair Cells, Auditory ; Kanamycin ; Membrane Proteins ; metabolism ; Mice ; Mice, Inbred C57BL ; Saccharomyces cerevisiae Proteins ; metabolism ; Spiral Ganglion ; metabolism ; pathology

OBJECTIVETo explore the best administration for the differentiated thyroid cancer in children under 14 years by reviewing of their clinical characteristics, treatment methods and results.

METHODSClinical data of 29 patients under 14 years with differentiated thyroid cancer in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine between January 1998 and July 2014 were reviewed respectively.

RESULTSNeck mass was the chief complaint in 27 of 29 patients. Unilateral thyroid carcinoma was found in 16 cases, and bilateral in 13 cases. Solid tumor with multiple punctate calcification was observed in 21 cases (72.4%). Cervical lymph nodes enlargement was found in 24 cases (82.8%), and 15 cases (62.5%) were bilateral. Among 20 patients received primary thyroid surgery in our hospital, 18 cases presented with T2 or advanced diseases and 16 cases had cervical lymph nodes enlargement. The resection of unilateral lobe with isthmus was performed in 2 cases, and total thyroidectomy in 18 patients, including 1 case with partial trachea resection. Neck dissection was performed in 16 patients. Of 9 patients received primary thyroid surgery in other hospitals, 8 cases presented with cervical lymph node enlargement after surgery and 6 cases with pulmonary metastasis, of them 5 patients received neck dissection, 4 patients underwent resection of residual thyroid cancer plus neck dissection. Twenty-seven of all patients were treated postoperatively with 131I. All patients received follow-up, and the meaning follow-up time was 6 years and 10 months (0.5 years-16 years). No cases with death, local recurrence, and metastasis were observed in the follow-up period.

CONCLUSIONSDifferentiated thyroid cancer is more invasive in children compared with adults. Comprehensive treatment including total thyroidectomy, neck dissection and postoperative 131I therapy may be a basic approach for the differentiated thyroid cancer in children.

Child ; China ; Follow-Up Studies ; Humans ; Neck Dissection ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; surgery ; Postoperative Period ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; pathology ; surgery ; Thyroidectomy