Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.

Background: and Purpose Performing the differential diagnosis of Parkinson’s disease (PD) and multiple-system atrophy of parkinsonian type (MSA-P) is challenging. The oculomotor performances of patients with PD and MSA-P were investigated to explore their potential role as a biomarker for this differentiation. Methods: Reflexive saccades and smooth pursuit were examined in 56 patients with PD and 34 with MSA-P in the off-medication state. Results: Patients with PD and MSA-P had similar oculomotor abnormalities of prolonged and hypometric reflexive saccades. The incidence rates of decreased reflexive saccadic velocity and saccadic smooth pursuit were significantly higher in MSA-P than in PD (p<0.05 for both). Multiple logistic regression analysis indicated that slowed reflexive saccades (odds ratio [OR]=8.14, 95% confidence interval [CI]=1.45–45.5) and saccadic smooth pursuit (OR=5.27, 95% CI=1.24–22.43) were significantly related to MSA-P. Conclusions The distinctive oculomotor abnormalities of saccadic smooth pursuit and slowed reflexive saccades in MSA-P may serve as useful biomarkers for discriminating MSA-P from PD.

SARS-CoV-2 infection causes complicated clinical manifestations with variable multi-organ injuries, however, the underlying mechanism, in particular immune responses in different organs, remains elusive. In this study, comprehensive transcriptomic alterations of 14 tissues from rhesus macaque infected with SARS-CoV-2 were analyzed. Compared to normal controls, SARS-CoV-2 infection resulted in dysregulation of genes involving diverse functions in various examined tissues/organs, with drastic transcriptomic changes in cerebral cortex and right ventricle. Intriguingly, cerebral cortex exhibited a hyperinflammatory state evidenced by significant upregulation of inflammation response-related genes. Meanwhile, expressions of coagulation, angiogenesis and fibrosis factors were also up-regulated in cerebral cortex. Based on our findings, neuropilin 1 (NRP1), a receptor of SARS-CoV-2, was significantly elevated in cerebral cortex post infection, accompanied by active immune response releasing inflammatory factors and signal transmission among tissues, which enhanced infection of the central nervous system (CNS) in a positive feedback way, leading to viral encephalitis. Overall, our study depicts a multi-tissue/organ transcriptomic landscapes of rhesus macaque with early infection of SARS-CoV-2, and provides important insights into the mechanistic basis for COVID-19-associated clinical complications.
Animals ; COVID-19/genetics* ; Macaca mulatta ; SARS-CoV-2/genetics* ; Transcriptome

Objective:To investigate the occurrence of pressure injury in infants undergoing operation and analyze the risk factors of pressure injury.Methods:Using the retrospective analysis method, a total of 657 infants and young children who were admitted to Department of Anesthesia Surgery and underwent operation in Hunan Children's Hospital from July 2018 to June 2021 were selected as research objects. According to National Pressure Ulcer Advisory Panel (NPUAP) , infants and young children undergoing operation were evaluated. They were divided into the pressure injury group ( n=15) and the no pressure injury group ( n=643) according to the occurrence of pressure injury. The age of infants and young children, operation time, body temperature of 30 minutes after operation, fasting time, body mass index (BMI) , operation position, pressure injury time, pressure injury location, pressure injury classification and operation type were collected. The occurrence of postoperative pressure injury was investigated and the related factors were analyzed. Results:Among the 657 infants and young children undergoing operation, 21 cases had pressure injury. Logistic regression analysis showed that the operation duration was≥3 h ( OR=4.362, 95% CI: 3.322-5.728) , the body temperature of 30 minues after surgery was lower than 34.0℃ ( OR=1.066, 95% CI: 1.009-1.127) and BMI greater than 17.9 kg/m 2 ( OR=2.683, 95% CI: 1.133-6.356) were risk factors for pressure injury in infants undergoing surgery ( P<0.05) . Conclusions:The incidence of pressure injury in infants and young children undergoing operation is relatively high. Therefore, it is necessary to focus on evaluating the influencing factors of pressure injury in the perioperative period and implement effective preventive measures to reduce the incidence of pressure injury as much as possible.

Background: and Purpose This study aimed to determine the clinical features, diagnosis, and treatment of patients with persistent geotropic (pG) and persistent apogeotropic (pAG) direction-changing positional nystagmus (DCPN). Methods: This retrospective study included 30 patients with pG-DCPN and 44 patients with pAG-DCPN. All patients underwent neurological and neurotological examinations, including an evaluation of gaze-evoked nystagmus, eye-movement tests, and assessments of limb ataxia and balance, as well as magnetic resonance imaging to exclude central causes. The characteristics of positional nystagmus were detected using the supine roll test (SRT) and bow-andlean test (BLT). The null point (NP) at which the nystagmus disappeared was determined. All patients were treated with the barbecue maneuver, and treatment efficacy was evaluated immediately, 1 week, and 1 month after treatment. Results: The history of diseases associated with atherosclerosis, peripheral vestibular disorders, otological disease, and migraine differed significantly between patients with pG-DCPN and pAG-DCPN. The affected sides of persistent horizontal DCPN can be determined using the SRT and the BLT, while determining the second NP and vestibular function as well as performing an audiological evaluation can be used to assist in identifying the affected side. The efficacy rates immediately and 1 week after treatment with the barbecue maneuver were higher in patients with pAG-DCPN than in patients with pG-DCPN. Conclusions pAG-DCPN was more compatible with the characteristics of cupulolithiasis, and pG-DCPN was more likely to be associated with a light cupula rather than canalolithiasis. pAG-DCPN was more likely to be accompanied by a disease associated with atherosclerosis, while pG-DCPN was often accompanied by autoimmune-related diseases and a history of migraine. The associations between pAG-DCPN, pG-DCPN, and the above-mentioned diseases need to be clarified further. The canalith-repositioning maneuver was effective in patients with pAG-DCPN and ineffective in patients with pG-DCPN, but most cases of pGDCPN are self-limiting.

Background: and Purpose This study aimed to determine the clinical features, diagnosis, and treatment of patients with persistent geotropic (pG) and persistent apogeotropic (pAG) direction-changing positional nystagmus (DCPN). Methods: This retrospective study included 30 patients with pG-DCPN and 44 patients with pAG-DCPN. All patients underwent neurological and neurotological examinations, including an evaluation of gaze-evoked nystagmus, eye-movement tests, and assessments of limb ataxia and balance, as well as magnetic resonance imaging to exclude central causes. The characteristics of positional nystagmus were detected using the supine roll test (SRT) and bow-andlean test (BLT). The null point (NP) at which the nystagmus disappeared was determined. All patients were treated with the barbecue maneuver, and treatment efficacy was evaluated immediately, 1 week, and 1 month after treatment. Results: The history of diseases associated with atherosclerosis, peripheral vestibular disorders, otological disease, and migraine differed significantly between patients with pG-DCPN and pAG-DCPN. The affected sides of persistent horizontal DCPN can be determined using the SRT and the BLT, while determining the second NP and vestibular function as well as performing an audiological evaluation can be used to assist in identifying the affected side. The efficacy rates immediately and 1 week after treatment with the barbecue maneuver were higher in patients with pAG-DCPN than in patients with pG-DCPN. Conclusions pAG-DCPN was more compatible with the characteristics of cupulolithiasis, and pG-DCPN was more likely to be associated with a light cupula rather than canalolithiasis. pAG-DCPN was more likely to be accompanied by a disease associated with atherosclerosis, while pG-DCPN was often accompanied by autoimmune-related diseases and a history of migraine. The associations between pAG-DCPN, pG-DCPN, and the above-mentioned diseases need to be clarified further. The canalith-repositioning maneuver was effective in patients with pAG-DCPN and ineffective in patients with pG-DCPN, but most cases of pGDCPN are self-limiting.

Objectives:To examine the prognosis factors for readmission after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients in the Chinese population.Methods:A total of 1 129 AAA patients who underwent EVAR at Department of Vascular Surgery, Zhongshan Hospital, Fudan University, from January 2010 to December 2017 were enrolled. There were 948 males and 181 females, with an age of (71.2±9.6) years (range: 18 to 93 years). Comorbidities included primary hypertension found in 630 patients, diabetes mellitus in 129 patients and coronary heart disease in 163 patients. A total of 214 patients had a history of smoking, and 11 patients had a history of previous aortic intervention.Clinical data including baseline information, laboratory examinations and follow-up data before December 31, 2019 were retrospectively collected. The primary end point was readmission. Cox regression analysis was used to analyze the prognosis factors for the end point.Results:All patients completed at least one follow-up with a follow-up time of 22.7(42.6) months (range: 1 to 120 months). The readmission rate of 1 year post-operation was 4.52% (51/1 129). The overall readmission rate was 11.34% (128/1 129) during the whole follow-up duration. The main reasons of readmission included endoleak in 60 patients with readmission, iliac limb occlusion in 25 patients and distal iliac aneurysm in 12 patients. Age ( HR=0.972, 95 %CI: 0.956 to 0.987, P<0.01) and elevated pre-operative fibrinogen level ( HR=2.213, 95 %CI: 1.185 to 4.134, P=0.013) were found to be the prognosis factors for the survival time free from aortic-related readmission in univariate Cox regression analysis. Elevated pre-operative fibrinogen level ( HR=2.542, 95 %CI: 1.353 to 4.776, P=0.004) was found to be the prognosis factor for the survival time free from aortic-related readmission in multivariate Cox regression analysis. Conclusions:The most common reason for readmission was endoleak, followed by iliac limb occlusion and distal iliac aneurysm. Elevated pre-operative fibri nogen level was the risk factor for the survival time free from aortic-related readmission, though further researches were warranted for exploring the underlying mechanism.

Objectives:To examine the prognosis factors for readmission after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients in the Chinese population.Methods:A total of 1 129 AAA patients who underwent EVAR at Department of Vascular Surgery, Zhongshan Hospital, Fudan University, from January 2010 to December 2017 were enrolled. There were 948 males and 181 females, with an age of (71.2±9.6) years (range: 18 to 93 years). Comorbidities included primary hypertension found in 630 patients, diabetes mellitus in 129 patients and coronary heart disease in 163 patients. A total of 214 patients had a history of smoking, and 11 patients had a history of previous aortic intervention.Clinical data including baseline information, laboratory examinations and follow-up data before December 31, 2019 were retrospectively collected. The primary end point was readmission. Cox regression analysis was used to analyze the prognosis factors for the end point.Results:All patients completed at least one follow-up with a follow-up time of 22.7(42.6) months (range: 1 to 120 months). The readmission rate of 1 year post-operation was 4.52% (51/1 129). The overall readmission rate was 11.34% (128/1 129) during the whole follow-up duration. The main reasons of readmission included endoleak in 60 patients with readmission, iliac limb occlusion in 25 patients and distal iliac aneurysm in 12 patients. Age ( HR=0.972, 95 %CI: 0.956 to 0.987, P<0.01) and elevated pre-operative fibrinogen level ( HR=2.213, 95 %CI: 1.185 to 4.134, P=0.013) were found to be the prognosis factors for the survival time free from aortic-related readmission in univariate Cox regression analysis. Elevated pre-operative fibrinogen level ( HR=2.542, 95 %CI: 1.353 to 4.776, P=0.004) was found to be the prognosis factor for the survival time free from aortic-related readmission in multivariate Cox regression analysis. Conclusions:The most common reason for readmission was endoleak, followed by iliac limb occlusion and distal iliac aneurysm. Elevated pre-operative fibri nogen level was the risk factor for the survival time free from aortic-related readmission, though further researches were warranted for exploring the underlying mechanism.

Objective:To explore the relationship between carotid atherosclerosis (CAS) and bone metabolism marker osteocalcin (OC) in patients with type 2 diabetes (T2DM).Methods:A total of 100 patients with T2DM admitted to Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University) from January 2018 to August 2018 were selected as study subjects, and the carotid intima-media thickness (IMT) was detected.The patients were divided into CAS group and normal carotid IMT group (NC group), with 50 cases in each group.The levels of OC, fasting plasma glucose(FPG), fasting insulin(FINS), glycosylated hemoglobin(HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein(HDL-C), low density lipoprotein (LDL-C), insulin resistance index (HOMA-IR) were compared between the two groups.Results:The OC level of the CAS group[(11.86±4.46)ng/mL] was significantly lower than that of the NC group[(23.94±4.52)ng/mL] ( t=-9.640, P=0.001). The LDL-C level of the CAS group[(2.89±0.82)mmol/L] was significantly higher than that of the NC group[(2.55±1.16)mmol/L]( t=2.03, P=0.049). Pearson correlation analysis showed that IMT was positively correlated with age, LDL-C, HbA1c ( r=0.285, 0.190, 0.173; P=0.000, 0.020, 0.035), and negatively correlated with OC ( r=-0.603, P=0.000). Conclusion:CAS in patients with T2DM is closely related to OC, and the reduction of OC levels may be a risk factor for CAS in T2DM patients.

Objective To analyze the MRI features of hydrosalpinx and to investigate its clinical value.Methods MRI and ultrasound manifestations in 40 patients with hydrosalpinx in 53 fallopian tubes confirmed by operative and pathological findings were analyzed retrospectively,and these findings were also compared with the results of aparoscopy and pathology.Results Among 53 fallopian tubes with hydrosalpinx,bilateral tubes in 13 patients and 27 unilateral tubes in other patients were found.The tubes were botuliform in 32, retort-shaped in 1 6,pouch-shaped in 5.Incomplete separation of the lumen were found in 1 9.In 9 patients with acute salpingitis,1 5 tubes were found with empyema and expansion.In other 31 patients with chronic salpingitis,38 tubes were with hydrops and expansion,14 of whom were with hematocele.The sensibilities of MRI and ultrasound diagnosis for hydrosalpinx were 94.3%(50/53)and 88.7%(47/53)with no statistical differences(P >0.05),however the specificitis were 90.6%(48/53)and 77.6%(41/53)with obvious statistical differences(P <0.05).Conclusion The locating and qualitative diagnosis of MRI for hydrosalpinx is superior to ultrasound.MRI can discriminate the quality of cyst fluid and thus can definitely diagnose the hydrosalpinx caused by acute or chronic salpingitis.