Objective To investigate the risk factors of cerebral microbleeds (CMBs) in patients with acute isch?emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar?tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni?versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age (61.620±11.479 vs. 70.620±11.185), serum uric acid (UA) level (278.920±69.512 vs. 353.460±111.206), serum creatinine (Cr) level (71.360±19.797 vs. 90.450±44.989), serum ho?mocysteine (Hcy) level (12.587±2.664 vs. 21.715±10.437) between the two groups (P<0.05). There were significant differ?ences in constituent ratio of Fazekas' s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups (P<0.05). The results of multivariate analysis showed that age (OR=0.963, 95%CI:0.905~1.025, P<0.05) and serum Hcy level (OR=1.487, 95%CI:1.219~1.813, P<0.05) were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde?pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.

Objective To investigate the CT findings of primary abdominal dedifferentiated liposarcoma(DDL),and to improve the diagnostic accuracy.Methods CT images of 23 cases with primary abdominal DDL confirmed by pathologically were analyzed retrospectively,and the CT findings were compared with pathological results.Results The masses in 20 cases out of 23 cases were located in retroperitoneal region,2 in abdominal cavity and 1 in the pelvic extraperitoneal space.The mean diameter of the masses was 26.5 cm.CT showed the fatty and non-fatty regions in the masses.In 2 1 cases,the non-fatty region was manifested as a single mass and was located at the edge or on the surface of fatty region.In 2 cases,the non-fatty region was manifested as multiple well-defined masses and was located within the fatty region.In 2 1 cases,the fatty region showed misty density with strip and reticular septa.In 2 other cases,the fatty region showed slightly low density,mingled with some fat tissue density,which showed no enhancement with mild enhanced internal septa.In 20 cases,the non-fatty region showed soft tissue density,with mild to moderate heterogeneous enhancement.In 3 other cases,the density of non-fatty region varied between liquid and soft tissue with patchy enhancement on delayed phase.In addition,stippled calcification was found in 4 cases.Conclusion The primary abdominal DDL has relatively specific CT findings,which different dedifferentiated components pro-duce different CT characterizes.Finding well-differentiated fat components around non-fatty mass may help to improve the accuracy of diagnosis and reduce the misdiagnosis.

OBJECTIVETo intervene the health behavior of lead exposed workers by setting down and implementing a series of measures and evaluating the effects of these measures so that the occupational lead poisoning would be decreased.

METHODS105 lead exposed workers in a factory were chosen as subjects. Blood lead concentration and rate of cognition on relevant health knowledge were examined before and after intervened measures.

RESULTSThe cognition rate raised from 56.6% to 97.3% after training. Lead concentration in blood decreased by 17.7% (t = 4.10, P = 0.000) and delta-ALA in urine decreased by 23.9% (t = 4.248, P = 0.000) 12 months after intervention. The prevalence of occupational lead absorption and poisoning also decreased. The number of workers with blood lead content > 2.41 mumol/L was decreased from 6 to 3, and > 1.93 mumol/L from 14 to 10.

CONCLUSIONTo develope occupational health promotion, enhance health education and improve health behavior are the effective way to prevent from occupational lead poisoning.

Health Behavior ; Health Education ; Health Promotion ; Humans ; Lead ; blood ; Lead Poisoning ; prevention & control ; Occupational Diseases ; prevention & control ; Occupational Exposure

Objective To investigate the surgical method and clinical outcome using the free an-terolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of com-plex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage Ⅰ.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restora-tion of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S3 in 2 patients and S2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100％.Conclusion The me-dial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.

Objective:To explore the clinical outcomes of locking compression plating (LCP) in the treatment of periprosthetic fracture (PPF) of the distal femur in the aged patients.Methods:A retrospective study was performed to analyze the 31 aged patients who had been treated at Department of Orthopedic Surgery, The Affiliated Hospital to Nantong University for PPF of the distal femur with LCP between June 2012 and May 2023. There were 27 females and 4 males with an age of (80.2±6.1) years. According to the Unified Classification System (UCS), 18 PPFs were classified as type Ⅴ.3B1 and 6 PPFs as type Ⅴ.3B2 after total knee arthroplasty and 7 PPFs as type Ⅳ.3C after total hip arthroplasty. The patients were fixated with a lateral single plate in 25 cases, and with lateral and medial dual plates in 6 cases. The surgical time, intraoperative blood loss, hospitalization time, postoperative weight-bearing time, fracture healing time, and knee joint function and complications during follow-up were recorded.Results:For the 25 patients undergoing fixation with a lateral single plate, the surgical time was (58.7±7.9) minutes, the intraoperative blood loss (78.0±15.1) mL, the hospitalization time (6.9±1.6) days, the postoperative weight-bearing time (5.9±1.4) days, and the follow-up time 37 (15, 51) months. For the 6 patients undergoing fixation with lateral and medial dual plates, the surgical time was (186.6±9.8) minutes, the intraoperative blood loss (1,256.7±231.2) mL, the hospitalization time (17.8±3.3) days, the postoperative weight-bearing time (3.6±0.6) days, and the follow-up time 17 (16, 21) months. The fracture healing time was (14.9±2.0) and (18.7±2.6) weeks, respectively, for patients fixed with single and double steel plates. By the scoring criteria of the American Hospital for Special Surgery (HSS), the knee joint function was evaluated at the last follow-up as excellent in 10 cases and as good in 15 cases for the 25 patients undergoing fixation with a lateral single plate, and as good for all the 6 patients undergoing fixation with lateral and medial dual plates. No patient experienced such complications as incision infection, bone nonunion, or internal fixation failure during the follow-up period.Conclusions:LCP fixation can achieve satisfactory outcomes in the treatment of PPF of the distal femur in the aged patients. As fixation with a single lateral femoral plate is suitable for most of the aged patients with PPF of the distal femur, it can be used as the first choice. Fixation with dual plates can provide stronger stability, but its indications should be strictly controlled.

Objective To investigate the surgical method and clinical outcome using the free an-terolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of com-plex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage Ⅰ.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restora-tion of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S3 in 2 patients and S2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100％.Conclusion The me-dial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.

Alzheimer's disease（AD） is an irreversible neurodegenerative disease with clinical manifestations such as memory impairment， aphasia， impaired visuospatial skills， executive function impairment， and personality changes. AD has brought a heavy burden to the family and society due to its unrevealed pathogenesis and the lack of therapeutic approaches. Saponins， a group of oligoglycosides whose aglycones are triterpenes or spirosteroids， are divided into triterpene saponins and steroidal saponins， which have a variety of biological activities. At present， there is no systematic review on the anti-AD effect of saponins. According to the literature published in recent years， the authors summarized the studies of saponins in improving AD based on animal experiments. The results indicated that saponins enhanced learning ability and improved cognitive impairment by inhibiting amyloid β-protein （Aβ） cascade activity， suppressing microtubule-associated protein （tau） hyperphosphorylation， inhibiting neuronal oxidative stress， inhibiting inflammatory factors， regulating apoptosis， inhibiting cholinergic neuronal degeneration， promoting mitochondrial autophagy， regulating intestinal flora， and enhancing energy metabolism， which in turn improved the pathological state of AD animal models. The therapeutic effects of different saponins on AD are different. The present study discussed the effect of different aglycones and sugar chains on the anti-AD activity based on saponins and anti-AD effect to provide new ideas and a theoretical basis for the development and utilization of saponins.

Objective To investigating the microbial communities and physicochemical properties of soil and distribution of Oncomelania hupensis snails in marshlands along the Yangtze River basin at different types of land use, and to examine the effects of soil microorganisms and physicochemical properties on snail distribution, so as to provide insights into snail control and schistosomiasis prevention in marshland along the Yangtze River basin. Methods Marshlands with four types of land use were selected along the Yangtze River basin on April 2021, including poplar forest-crops integrated planting, reed areas, agricultural cultivation lands and ditches. The distribution of snails and physicochemical properties of soil were investigated in marshlands with different types of land use, and the V3 to V4 regions of the bacterial 16S ribosomal RNA (16S rRNA) gene, fungal internal transcribed spacer-1 (ITS1) gene and algal ribulose-bisphosphate carboxylase (rbcL) gene in soils were subjected to high-throughput sequencing. The occurrence of frames with living snails and density of living snails were compared in marshland with different types of land use. The associations of soil microorganisms and physicochemical properties with the density of living snails were examined using Pearson correlation analysis, and the contributions of soil microorganisms and physicochemical properties to the density of living snails were evaluated using variance partitioning analysis. Results In marshlands with four types of land use, the greatest occurrence of frames with living snails [(4.94 ± 2.14)%] and density of living snails [(0.070 ± 0.026) snails/0.1 m²] were seen in ditches, and the lowest were found in [(1.23 ± 1.23)%] agricultural cultivation lands [(0.016 ± 0.019) snails/0.1 m²]. A total of 2 phyla, 5 classes, 8 orders, 9 families and 11 genera of algae were detected in soils at four types of land use, with Chlorophyta as the dominant phylum and Pseudoneochloris as the dominant genus. A total of 44 phyla, 134 classes, 281 orders, 338 families and 516 genera of bacteria were detected in soils at four types of land use, with Proteobacteria and Acidobacteriota as the dominant phyla and uncultured Acidobacterium, MND1, Mitrospira, Haliangium and Sphingomonas as dominant genera. A total of 11 phyla, 41 classes, 108 orders, 223 families and 408 genera of fungi were detected in soils at four types of land use, with phyla Ascomycota, Basidiomycota and Mortierellomycota presenting high relative abundances and genera Cladorrhinum, Mortierella and Humicola presenting high relative abundances. Pearson correlation analysis revealed that the density of living snails correlated negatively with the relative abundance of Proteobacteria (r = −0.965, P < 0.05) and soil electronic conductivity (r = −0.962, P < 0.05) and positively with soil moisture (r = 0.951, P < 0.05). Variance partitioning analysis demonstrated that the physicochemical properties and microorganisms of soil contributed 69% and 10% to the density of living snails, respectively. Conclusion The diversity of microbial communities varies in soils at different types of land use in marshland along the Yangtze River basin, and the physicochemical properties and microorganisms of soils may affect the distribution of O. hupensis snails.