Objective To investigate the safety and effectiveness of digital subtraction angiography (DSA) in the surgical treatment of intracranial arteriovenous malformations (AVMs) in children.Methods Between December 2015 and February 2017,the clinical and imaging data of 9 children with AVM (2-14 years) underwent hybrid surgery at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.According to the Spetzler-Martin grade,there were 2 patients with grade Ⅰ,3 with grade Ⅱ,2 with grade Ⅲ,and 2 with grade Ⅳ.All the children were treated with microsurgery,and their AVMs were removed by real-time assistance using DSA technique during the operation.The imaging cure rate of surgical treatment and the complications of intraoperative angiography of the children were analyzed.The children were followed up clinically after procedure.According to the modified Rankin scale (mRS) score,their prognoses were evaluated.Results Intraoperative angiography revealed that the AVMs in 8 of 9 children were resected completely,and 1 had a residual lesion,then it was resected completely.Immediately after the resection of the nidi,the angiography confirmed that the nidi of 9 children were resected completely.No related complications caused by intraoperative angiography were observed.Nominal aphasia occurred in 1 child after procedure,and he recovered gradually after 6 months.Pulmonary infection occurred in 2 children,and they were cured after anti-infection treatments.Postoperative follow-up mRS scores were 0-1 in 8 children,2 in 1 child,and no rebleeding was observed.Conclusions In children undergoing AVM surgery,initial observation of DSA is safe and effective.Intraoperative angiography can guide the complete resection of the lesions in real time,improve the surgical cure rate of AVMs,and improve the prognosis of children.

Objective Toinvestigatetheroleofcontrolledanticoagulationinocclusionofvertebral arteriesforthetreatmentofgiantfusiformaneurysmsofthebasilartrunkinchildren.Methods The clinical data of 3 children with giant fusiform aneurysms of the basilar trunk were analyzed retrospectively. Three children underwent bilateral vertebral artery occlusion with endovascular intervention,and conducted controlled anticoagulation by intravenous infusion of heparin sodium (10-30 U/[kg·h])after procedure. Results Intheprocessofanticoagulation,2patientshadsomeseverebleedingcomplications,including epistaxis,gastrointestinal bleeding,and after transient cessation of anticoagulation,they had severe brainstem ischemic symptoms,including vomiting,hemiplegia,loss of consciousness and respiratory dysfunctions (one recovered after using low-molecular weight heparin and one died),another patient did not have any serious complicationsandwascuredafteradjustingtheanticoagulationstrategy.Conclusion Inthetreatmentof basilar artery trunk giant fusiform aneurysms in children through the bilateral vertebral artery occlusion,the controlled anticoagulation after procedure may reduce the occurrence of brain stem infarction and severe bleeding complications. It may be an important measure for improving the safety and effectiveness of bilateral vertebral artery occlusion.

Objective To study the effects of protein kinase A (PKA) phosphorylation site' s mutation of mitofusin-2 (Mfn2) on intimal proliferation after balloon injury of carotid artery of rats. Method Rat model of carotid artery balloon injury was established and infected with Adv-LacZ, Adv-Mfn2, AdvMfn2-S442A or Adv-Mfn2-S442D from the peri-arterial sheathes of vessels, while phosphate buffered solution (PBS) used instead of above infectious adenovirus as uninfected group and sham operation as control group. The rats were sacrificed 14 days after balloon injury of carotid artery in order to measure the level of Mfn2 protein and the prol9iferation cell nuclear antigen (PCNA) with immunohistochemistry staining. The morphology of vessels was observed with HE staining. All data were statistically analyzed with ANOVA and Dunnett-t test. Results Fourteen days after surgery, the levels of Mfn2 protein significantly increased in arteries infected with Adv-Mfn2, Adv-Mfn2-S4442A and Adv-Mfn2-S442D compared with those in control group, sham operation group and Adv-LacZ infected group. The ratio of intimal area/medial area (I/M) and percentage of PCNA positive cells in both Adv-Mfn2 and Adv-Mfn2-S442A groups markedly decreased compared with control group (P ＜0. 01 ) . Compared with the Adv-Mfn2 group, the I/M and the percentage of PCNA positive cells reduced more significantly in Adv-S442A group (P ＜ 0. 01 ) . However,the I/M and the percentage of PCNA positive cells in Adv-LacZ and Adv-S442D groups were not significantly different from those found in the control group. Conclusions The over-expression of Mfn2 gene may effectively inhibit intimal proliferation after balloon injury of carotid artery of rats. The inhibitory effects of Mfn2-S442A are more obvious than those of Mfn2. However, the Mfn2-S442D is out of the inhibitory effect on neo-intimal proliferation.

Objective To investigate the association between parental environmental risk factors exposure and the risk for childhood acute lymphoblastic leukemia (ALL).Methods A total of 179 ALL children cases were selected in Tianjin Blood Disease Hospital and 136 healthy children matched by age,gender and living place were selected in 2015 for a case control study.The data were analyzed with univariate and multivariate non conditional logistic regression models.Results The results of multivariate logistic regression analysis indicated that sex,history of abortion,exposure in a smoking environment during pregnancy,catching a cold,taking antipyretic analgesics,maternal exposure to air purifying agent,father's occupational exposure to petroleum products and home decoration during pregnancy were associated with the risk of childhood ALL (P＜0.05) and the results of multivariate logistic regression analysis indicated that sex,history of abortion,catching a cold,father's occupational exposure to petroleum products and home decoration during pregnancy were associated with the risk of childhood ALL (P＜0.05).Conclusion The five factors including sex,history of abortion,catching a cold,father's occupational exposure to petroleum products and home decoration during pregnancy were risk factors for childhood ALL.

【Objective】 To explore the predictive value of combined thromboelastography(TEG), coagulation index and platelet parameters in evaluating the risk of thrombosis in patients with chronic venous insufficiency(CVI). 【Methods】 A total of 359 patients with CVI were enrolled in our hospital from November 2020 to March 2022, and divided into VTE group and non-VTE group according to the occurrence of venous thromboembolism (VTE).The baseline characteristics of the two groups and the value of combined TEG, coagulation index and platelet parameters in predicting the risk of VTE in patients with CVI were analyzed. The risk factors were screened by univariate logistic regression analysis, and the prediction model was constructed by multivariate logistic regression. The performance of the model was evaluated by area under the curve (AUC) and sensitivity specificity. 【Results】 Compared with the non-VTE group, the R value (3.27±0.71 vs 3.87±1.16, P<0.05), the prothrombin time (PT)(11.08±3.02 vs 12.86±3.48, P<0.001)and the platelet distribution width (PDW) (12.01±3.87 vs 13.98±3.20, P<0.001)of the VTE group decreased, while fibrinogen (Fib) (3.46 vs 3.10, P<0.05) and D-dimer (DD) (3.00 vs 1.12, P<0.001)increased. It was found that the area under the ROC curve of the thrombosis prediction model based on PT, DD, R value, Fib and PDW was 0.842 8, with the sensitivity and specificity of 36.78% and 95.59%, respectively. The decision curve analysis(DCA)indicated that patients would benefit when the model′s predicted probability ranged from 0.1 to 0.7. 【Conclusion】 The combination of TEG, coagulation index and platelet parameters is effective in predicting the risk of VTE in patients with CVI.

To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT.
Male ; Humans ; Adult ; Hypercalcemia/diagnosis* ; Hyperparathyroidism, Primary/surgery* ; Parathyroid Hormone ; Hypocalcemia/complications* ; Thyroid Gland ; Calcium

OBJECTIVE：To stu dy the improvem ent effect and mechanism of Guizhi fuling pill （GZFLP） on rats with phlegm-dampness type polycystic ovary syndrome （PCOS）.METHODS：Totally fifty female SD rats with regular estrous cycle were randomly divided into blank control group （n＝10） and model group （n＝40）. The model group received letrozole intragastrically [1 mg/（kg·d），for 21 d ] to induce phlegm-damp PCOS rat model. Forty model rats were randomly divided into model group ，metformin group [positive control ，0.135 g/（kg·d）] and GZFLP low-dose ，high-dose groups [4.49，17.96 g/（kg· d）]，with 10 rats in each group. Each medicine group was given intragastric administration ，once a day ，for 30 consecutive days. Blank control and model group were given intragastric administration of equal volume normal saline.After last medication ，oral glucose tolerance test （OGTT）was used to detect the level of blood glucose in rats at 0，30，60 and 120 min. ELISA assay was used to detect the levels of follicle-stimulating hormone （FSH），luteinizing hormone （LH），estradiol（E2）and testosterone （T）； body weight ，the weight of uterus ，bilateral ovaries and paragonadal fat were weighed. HE staining was used to observe morphological changes of ovarian tissue sections. RT-PCR method and Western blotting assay were used to detect mRNA and protein expression of CYP 19a1 in ovary and Glut 4 in uterine. RESULTS ：Compared with blank control group ，the levels of blood glucose 30，60，120 min after intragastric administration of glucose solution as well as serum levels of LH ，E2 and T were increased significantly in model group （P＜0.05）；the body weight ，the weight of uterus ，bilateral ovaries and paragonadal fat were increased significantly （P＜0.05）；the volume of thecal cells increased significantly and showed spherical shape ；the mRNA and protein expression of CYP 19a1 in ovarian tissue and Glut 4 in uterine tissue were decreased significantly （P＜0.05 or P＜0.01）. Compared with model group ，above indexes of administration groups were improved significantly （P＜0.05 or P＜0.01）；the thickness of theca cell layer and the volume of theca cells in GZFLP low-dose and high-dose groups were also improved. CONCLUSIONS：GZFLP can up-regulate the expression of CYP19a1 in ovary and Glut4 in uterus ，so as to improve the abnormal glucose metabolism in phlegm-dampness type PCOS model rats ，reduce insulin resistance ，lower serum estrogen levels ，and reduce the degree of polycystic changes in ovary ，thereby playing a role in the treatment of PCOS.

Objective To explore the effect of decreased air pollutants concentrations on the incidence of Type 2 Diabetes Mellitus (T2DM). Methods A prospective cohort was designed in Tianjin where the air quality gradually improved from 2014 to 2018. A total of 5 077 community residents (18-90 years old) were recruited as the baseline population from 2013 to 2014. From 2014 to 2018 follow-up was carried out year by year to observe the new incidence of T2DM in the cohort. The HR and 95%CI (95% confidence interval) were calculated with the multiple Cox proportional hazard regression model to evaluate the effect of the decrease in the concentrations of SO₂, NO₂, and particulate matters with diameters <10μm and <2.5μm (PM₁₀, PM_2.5) on the incidence of T2DM. Results The cohort was followed up year by year from 2014 to 2018, with a cumulative follow-up of 25 385 person-years over the 5 years. At the same time, the air quality of Tianjin was significantly improved. Statistical analysis results after covariate adjustment revealed that the risk of T2DM in the population decreased by 0.172, 0.124, and 0.210 times, for a decrease of 10 μg/m³ in the annual average concentrations of SO₂, PM₁₀, and PM_2.5 each, respectively (SO2：HR=0.828，95%CI=0.757-0.907；PM₁₀：HR=0.876，95%CI=0.816-0.941；PM_2.5：HR=0.790，95%CI=0.694-0.899). Conclusion The implementation of environmental protection measures to improve air pollution could reduce the risk of T2DM in the population and control the increasing prevalence.

【Objective】 To explore the risk factors for platelet transfusion refractoriness(PTR)in patients with hematological disorders, construct a prediction model and validate the model efficacy. 【Methods】 Patients with hematological disorders who received platelet transfusion therapy in the Chengdu Second People′s Hospital from December 2021 to December 2022 were retrospectively included to judge the effectiveness of platelet transfusion and screened for risk factors by univariate and multivariate logistic regression. A prediction model for PTR was constructed using receiver operating characteristic(ROC) curve, calibration curve and decision curve(DCA) to assess the differentiation, calibration and clinical value of the model, respectively. 【Results】 A total of 334 hematological patients were included, including 168 males and 176 females, with a PTR incidence of 40.4%. Univariate and multivariate logistic regression analysis showed that platelet transfusion volume, erythrocyte transfusion volume, and neutrophil ratio were risk factors for PTR(P<0.05). A prediction model for PTR in hematological patients was established based on these risk factors. The area under the model′s curve was 0.8377(95% CI: 0.723-0.772), the sensitivity was 58.52%, and the specificity was 89.95%. The calibration curve showed that the S∶P was 0.964, the maximum absolute difference Emax was 0.032, and the average absolute difference Eavg was 0.009. The DCA analysis showed that the model had clinical application value when the risk threshold ranged from 0.2 to 0.9. 【Conclusion】 The PTR prediction model based on platelet transfusion volume, erythrocyte transfusion volume and neutrophil ratio can provide a basis for effective platelet transfusion in hematological patients.