Objective To investigate the clinical features of complex posterior communicating artery aneurysms and the outcome of microsurgical clipping.Methods The clinical and imaging data of the patients with posterior communicating artery aneurysm treated by craniotomy microsurgical clipping were analyzed retrospectively.The patients were divided into either a complex type group or a simple type group according to whether they had complex factors of surgical clipping or not.They were divided into a good outcome group and a poor outcome group according to their Glasgow Outcome Scale scores.Results A total of 55 patients with posterior communicating artery aneurysm were enrolled,and 17 (30.9％) of them were in the simple type group and 38 (69.1％) were in the complex type group.The proportion of higher Fisher grade in the patients of the simple type group was significantly lower than that of the complex type group (Z =-2.068,P=0.019).However,there were no significant differences in the proportions of age,sex,preoperative rupture,and Hunt-Hess grade between the two groups (all P ＞ 0.05).In the complex type group,the complex clipping (73.68％) and anterior clinoidectomy (42.11％) were the most common complex factors.Twenty-four patients (63.16％) had a number of complex factors.In the complex type cases,32 had good outcome,6 had poor outcome (3 of them died); in the simple type cases,15 had good outcome,2 had poor outcome (1 of them died).There was no significant difference in the good outcome rate between the complex type group and the simple type group (84.21％ vs.88.24％;x2 =0.153,P=0.696).In 55 patients with posterior communicating artery aneurysm,the age of the good outcome group was significantly lower than that of the poor outcome group (58.23 ± 12.41 years vs.68.38 ± 8.68 years,t =-2.212; P =0.031),and there were no significant differences in sex,Fisher grade,Hunt-Hess grade,factors of surgical complexity,and surgical clipping level (all P ＞ 0.05).Multivariate logistic regression analysis showed that only age was the independent risk factor for poor outcome of the complex posterior communicating artery aneurysm (odds ratio 1.142,95％ confidence interval 1.029-1.266; P =0.012).Conclusions Using the advanced microsurgical techniques,such as anterior clinoidectomy,anterior choroidal artery microdissection,and complex clipping for the treatment of complex posterior communicating artery aneurysm are no less favorable than the simple type,and age is an independent risk factor for the poor outcome of posterior communicating artery aneurysm.

ObjectiveTo explore the effect of the social support, coping styles and self-efficacy on depression of adults with epilepsy. Methods84 patients with epilepsy were evaluated with Zung's self rating depression scale (SDS), general conditions questionnaire, Social Support Scale, Coping Styles Questionnaire, General Self-efficacy Scale. Based on the SDS, they were divided into the depression group and the epileptic group.Results52 patients suffered from depression (61.2%). There were significant differences in general self-efficacy, coping styles and social support between the depression group and the epileptic group （P<0.05）. The score of SDS was positively correlated with the frequency of seizure, duration of epilepsy, fantasy, self-accusation and avoiding （P<0.05）, and negatively correlated with the economic status, total support, objective support, subjective support, utilization of support, problem solving, help seeking, rationalizing and self-efficacy （P<0.05）. Multiple regression analysis showed that the score of SDS was correlated with the self-efficacy, help seeking, self-accusation, economic status and frequency of seizure.ConclusionThe depression of adults with epilepsy are affected by the social support，coping styles and self-efficacy.

Objective:To disclose the epidemiological characteristics of severe fever with thrombocytopenia syndrome in Ningbo city from 2013 to 2021.Methods:Epidemic data and laboratory-confirmed results of SFTS patients in Ningbo city were analyzed in the past 10 years. Phylogenetic trees were constructed by using genomic sequences of severe fever with thrombocytopenia syndrome virus (SFTSV) strains isolated from the patients.Results:During 2013-2021, a total of 65 confirmed SFTS cases were reported with the mortality of 12.31%, including 8 dead cases. The average age was 53.65 years with higher incidence in 60-70 years old cases. Cases were reported in 6 districts (counties) from Ningbo city, of which Ninghai county (33 cases, 50.77%) and Xiangshan county (20 cases, 30.77%) reported the highest number of cases. The cases mainly occurred from April to August, accounting for 81.54% (53/65); 76.92% (50/65) of the patients were farmers; 92.31% (60/65) of patients lived in mountainous or hilly terrain. Of the 65 SFTS cases, 8 patients had a clear history of tick bites, and 20 patients had contact with domestic animals (pets) or rats in their residence. The evolution analysis on gene sequencing results showed that SFTSV epidemic strains in Ningbo city included genotype J2 and C4.Conclusion:Most of the SFTS patients were elderly people. The top two high-risk areas were Ninghai county and Xiangshan county. July was the peak month of the disease. Genotype J2 and C4 were epidemic strains in Ningbo city.

OBJECTIVETo evaluate the feasibility of genetic and prenatal diagnosis for a family affected with pyruvate kinase deficiency (PKD).

METHODSTargeted sequence capture and high-throughput sequencing technology was used to detect the exons and exon-intron boundaries of the PKLR gene in a clinically suspected PKD patient. Meanwhile, the genotype of the pedigree was validated by Sanger sequencing. Prenatal genetic diagnosis was performed by amniotic fluid sampling after genotype of the mother of the proband was determined.

RESULTSThe proband was found to harbor double heterozygous mutations, c.661G>A (Asp221Asn) and c.1528C>T (Arg510Ter), which resulted in amino acid substitution Asp221Asn and Arg510Ter. Such mutations were confirmed by Sanger sequencing. The mother and father of the proband were detected to have respectively carried c.1528C>T (Arg510Ter) and c.661G>A (Asp221Asn) mutation. The fetus was found to have carried the same mutations as the proband. Following selected abortion, analysis of fetal tissue was consistent with the result of prenatal diagnosis.

CONCLUSIONThe compound mutations of c.661G>A and c.1528C>T of PKLR gene probably underlie the PKD in the family. Prenatal diagnosis of the mutations analysis can facilitate detection of affected fetus in time.

Adult ; Anemia, Hemolytic, Congenital Nonspherocytic ; embryology ; enzymology ; genetics ; Base Sequence ; Child, Preschool ; DNA Mutational Analysis ; Exons ; Female ; Genotype ; Humans ; Male ; Molecular Sequence Data ; Mutation ; Pedigree ; Pregnancy ; Prenatal Diagnosis ; Pyruvate Kinase ; deficiency ; genetics ; metabolism ; Pyruvate Metabolism, Inborn Errors ; embryology ; enzymology ; genetics

Methamphetamine use disorder is an ongoing global public health problem with complex mechanisms involving multiple neural circuits and neurotransmitters in the brain,and there are currently no effective drugs and methods to treat it.This article reviews the role of endoplasmic reticulum stress in meth-amphetamine use disorder and discusses the treatment strategies that can be used to mitigate the methamphet-amine-induced neurotoxic damage,which will contribute to the exploration of methamphetamine use disorder mechanisms and the development of new target drugs.

Objective: To evaluate the safety and efficacy of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily combined with dasabuvir 250mg, twice daily in non-cirrhotic Chinese adult patients with newly diagnosed and treated chronic HCV genotype 1b infection. Methods: A randomized, double-blind, placebo-controlled, multicenter phase 3 clinical trial was conducted in mainland China, Korea, and Taiwan.Safety and efficacy of OBV/PTV/r plus DSV administered for 12 weeks were evaluated in a newly diagnosed and treated (interferon alpha /pegylated interferon alpha) and ribavirin non-cirrhotic adults with chronic HCVgenotype 1b infection. Patients randomly received OBV/PTV/r plus DSV for 12 weeks (Group A), or placebo for 12 weeks (Group B) followed by an open-label phase of OBV/PTV/r plus DSV for 12 weeks. Sustained response (SVR12) rate obtained at 12 weeks and (SVR24) 24 weeks after discontinuation of treatment, and the incidence of adverse events and laboratory abnormalities after double-blind and open-label phase treatment were assessed. Results: A total of 410 cases of Chinese patients were included and randomly assigned to group A and B (with 205 cases in each group) in a 1:1 ratio. The rates of SVR12 and SVR24 were 99% (95% CI: 94.8% - 99.8%) in the newly diagnosed patients in group A (205 patients) and the rates of SVR12 and SVR24 were 100% in treated patients (95% CI: 96.3% - 100%). Different baseline characteristics had no effect on SVR12 and SVR24 rates. Most of the adverse events occurred were mild, asymptomatic, and≥ 3 laboratory abnormalities during treatment were rare, including elevation of alanine aminotransferase (2 cases in double-blind stage A group), aspartate aminotransferase (Double-blind stage A (3 cases) and total bilirubin (1 case in open-label phase B group); however, those mild adverse events could be recovered after drug withdrawal or discontinuation. only1 person discontinued drugs due to adverse events (Group B, open-label phase). Conclusion The 12 weeks treatment course of OBV/PTV/r combined with DSV produced 99% ~ 100% rates of SVR12 and SVR24 in non-cirrhotic Asian adult patients with newly diagnosed and treated chronic HCV genotype 1b infection, and the tolerance and safety were good.

Objective: To investigate the efficacy and safety of the new investigational drug pegylated interferon α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 µg/week) combined with ribavirin in the treatment of patients with genotype 1/6 chronic hepatitis C (CHC), with standard-dose Peg-IFN-α-2a combined with ribavirin as a positive control. Methods: A multicenter, randomized, open-label, and positive-controlled phase III clinical trial was performed. Eligible patients with genotype 1/6 CHC were screened out and randomly divided into Peg-IFN-α-2b(Y shape, 40kD) group and Peg-IFN-α-2a group at a ratio of 2:1. The patients in both groups were given oral ribavirin for 48 weeks in addition and then followed up for 24 weeks after drug withdrawal. Abbott Real Time HCV Genotype II was used to determine HCV genotype, and Cobas TaqMan quantitative real-time PCR was used to measure HCV RNA level at 0, 4, 12, 24, 48, and 72 weeks. Adverse events were recorded in detail. The primary efficacy endpoint was sustained virological response (SVR), and a non-inferiority test was also performed. Results: A total of 561 patients with genotype 1/6 CHC were enrolled, among whom 529 received treatment; 90.9% of these patients had genotype 1 CHC. The data of the full analysis set showed that SVR rate was 69.80% (95% CI 65.00%-74.60%) in the trial group and 74.16% (95% CI 67.73%-80.59%) in the control group (P = 0.297 0). The data of the per protocol set (PPS) showed that SVR rate was 80.63% (95% CI 76.04%-85.23%) in the trial group and 81.33% (95% CI 75.10%-87.57%) in the control group (P = 0.849 8), and the 95% CI of rate difference conformed to the non-inferiority standard. The analysis of the PPS population showed that of all subjects, 47.9% achieved rapid virologic response, with a positive predictive value of 93.8%. The incidence rate of adverse events was 96.30% in the trial group and 94.94% in the control group, and the incidence rate of serious adverse events was 5.13% in the trail group and 5.06% in the control group. Conclusion In the regimen of Peg-IFN-α combined with ribavirin for the treatment of genotype 1/6 CHC, the new investigational drug Peg-IFN-α-2b(Y shape, 40 kD) has comparable clinical effect and safety to the control drug Peg-IFN-α-2a.