Objective To investigate the efficacy and safety of long-term intermittent treatment with topical corticosteroids in localized chronic eczema.Methods A total of 129 patients with localized chronic eczema were treated with triamcinolone acetonide and econazole nitrate cream (Pevisone (R)).Those who achieved a clinical cure within 4-week treatment were recruited into the following long-term study and classifled into 2 groups to be intermittently treated with triamcinolone acetonide and econazole nitrate cream or a moisturizing cream for 8 weeks.The cream was applied topically twice a day for 2 days every week.Patients were followed up on week 4 and 8 after the beginning of treatment and on week 12 after the discontinuation of treatment.The severity of eczema in patients was rated according to SCORAD (SCORing atopic dermatitis) score.Results The SCORAD score was significantly lower in patients treated with triamcinolone acetonide and econazole nitrate cream than in those with moisturizing cream on week 8 in the treatment and week 12 after the discontinuation (t=3.076,2.367,both P<0.05).A statistical decrease was also observed in the recurrence rate of eczema in patients treated with triamcinolone acetonide and econazole nitrate cream compared with moisturizing cream.treated patients at the 3 follow-up time points (x2=4.426,7.683,8.199,all P<0.05).The incidence of adverse events was 3.1% during the treatment with triamcinolone acetonide and econazole nitrate cream.No severe adverse reactions were observed.Conclusion Long-term intermittent treatment with topical corticosteroids is effective for the prevention of exacerbation and postponement of recurrence,of eczema.

Aim To investigate whether melatonin ( MT) can alleviate endoplasmic reticulum( ER) stress at an early stage of bleomycin( BLM)-induced lung fi-brosis in mice. Methods Adult healthy male ICR mice were divided randomly into control group, MT group, BLM group and MT + BLM group. In MT group, mice had saline treatment 30 minutes after hav-ing the intraperitoneal injection of MT (10 mg·kg-1 ) and had been intraperitoneally injected with MT once in the following every 24 hours. In BLM group, mice were intratracheally injected with a single dose of BLM (5 mg·kg-1). In MT+BLM group, mice had been intraperitoneally injected with BLM 30 minutes after having MT and had been injected with MT once in the following every 24 hours. In control group, mice re-ceived the same level of saline treatment in the same manner. All mice were dissected for collecting the tis-sue of lungs at different time points (24h, 72h) after BLM treatment. Inflammatory cell infiltration of lungs was determined by HE staining. The level of ER stress related proteins ( GRP78 , p-eIF2α, p-IRE1α) in lungs was determined using Western blot. The distribu-tion of ER stress related proteins ( GRP78 , p-IRE1α, ATF6α, p-PERK) in lungs was detected by immuno-histochemistry. Results The model of BLM-induced acute inflammation of lung fibrosis in mice had been successfully constructed. After BLM treatment, lung weight, lung weight ratio and inflammatory cell infiltra-tion were significantly increased with a significant cor-relation between time and effectiveness. After MT treatment, lung weight, lung weight ratio and inflam-matory cell infiltration were significantly reduced. The results of Western blot showed that MT pretreatment not only prevented the increase of BLM-induced GRP78 protein significantly, but also restrained the phosphorylation of eIF2α and IRE1α in mouse lungs. Immunohistochemistry also showed that MT pretreat-ment reduced the expression of GRP78 , p-IRE1α, ATF6α and p-PERK. Conclusion MT alleviates ER stress effectively at an early stage of BLM-induced lung fibrosis in mice.

Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass ＞ 5 mm,spinal stenosis ＞50％),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the arachnoid was reserved in order to reduce dural damage.Dural defects were repaired by suturing or covering with muscle.After surgery,patients were confined to bed rest to allow for drainage or puncture.Results All 15 patients were followed up for 12 to 18months (average,14.8 months).After operation,10 patients recovered fully without CSFL.Five patients developed CSFL,including 4 cases of spinal dural mater injury that healed within 4-6 days with bed rest and pressure dressing,and 1 case of cerebrospinal fluid pseudocyst that disappeared within 3 weeks with repeat puncture and aspiration treatment.No cases required secondary operations or shunt placement.All cases exhibited good neurological improvement.Conclusion During anterior surgical treatment for severe cervical OPLL,CSFL can be effectively prevented through eareful analysis of preoperative CT images,meticulous operative technique,reasonable handling of the ossified mass and positive repair of dural damage.Moreover,postoperative bed rest and drainage are effective to treat CSFL.

Objective To investigate whether increased signal intensity (ISI) can help assess the prognosis in patients with cervical spondylotic myelopathy (CSM) by means of measuring the ratio of signal intensity. Methods A retrospective study with two or more years follow-up of 57 patients with CSM underwent posterior cervical decompression were carried out from February 2000 to February 2006. 1.5T MRI was performed in all patients before surgery. T2-weighted images (T2WI) of sagittal ISI on the cervical spinal cord were obtained, For those with ISI, the values of signal intensity of the spinal cord on T2-weighted image (T2Wl) and TI-weighted image (TIWI) of sagittal view were measured at the location where there was ISI on T2WI, and the ratio of signal intensity of T2WI / T1WI (T2/T1 ratio) at the same level of the spinal cord and with similar area was calculated on the computer. Patients with ISI were subdivided into 2 groups according to T2/T1 ratio. Results ISI was not observed in 20 patients (group 1). The range of T2/T1 ratio of other 37 patients was from 1.28 to 2.80 and the median was 1.65. Nineteen patients were divided into group 2 (ratio range, 1.28-1.63), and 18 into group 3 (ratio range, 1.67-2.80). Significant differences were noted in age at surgery, duration of disease, recovery rate, pre and preoperative JOA score among three different groups.Spearman's rank correlation showed that T2/T1 ratio was positively correlated with age at surgery and duration of disease, negatively with pre- and postoperative JOA score and recovery rate. Conclusion Patients with ISI and higher T2/T1 ratio tend to have relatively severe preoperative state of illness and poor prognosis after surgical intervention. Spinal cord signal intensity change on T2-weighted MRI might be a predictor of a poor outcome in terms of functional recovery rate in patients underwent operations for multi-level CSM.

Objective To evaluate the perioperative management of blood pressure in patients with bilateral carotid artery severe stenosis underwent staging carotid endarterectomy (CEA).Methods This retrospective study included 31 patients with bilateral carotid stenosis who underwent bilateral revascularizations in our department from April 2012 to November 2015.Patients were recorded with general information,and the changes of blood pressure in preoperative,intraoperative and postoperative were observed,respectively.Regulation and control of blood pressure were performed according to individual patient's condition.Results Thirty one patients underwent a total of 62 consecutive procedures successfully.Postoperative symptoms disappeared or significantly reduced.Twenty three cases (74.2％) had high perfusion symptoms in the ipsilateral CEA,and 5 cases (16.1％) with high perfusion syndrome in the contralateral surgery.Patients were improved after strict control of blood pressure and dehydration reduced intracranial pressure.The high peffusion symptoms in patients were significantly improved or disappeared after 1 week.Doppler ultrasound was used to evaluate the carotid artery before discharge.Conclusions For patients with bilateral carotid stenosis,staging purposes CEA is safe and effective.However,perioperative blood pressure management is very important.Individual control of blood pressure can significantly reduce the risk of postoperative high perfusion and cerebral infarction.Blood pressure control is recommended after 1 week in about 85％ of preoperative blood pressure.

Objective To investigate the efficacy and safety of the resection of cervical posterior longitudinal ligament (PLL) in Bryan cervical disc arthroplasty. Methods Thirty-one patients underwent Bryan cervical disc implantation only in one level from August 2006 to January 2009 were investigated in this study. Cervical PLL was preserved in 14 patients, but not in other 17 patients. The clinical (JOA score,VAS score for neck and arm pain) and radiographic parameters (the FSU angle, ROM and diameter of the spinal cord) were compared between the two groups. Results No differences were found in terms of age, affected segment, gender, follow-up period, operation time and blood loss between the two groups. Patients underwent removal of cervical PLL were significantly superior to those underwent reservation of cervical PLL in term of clinical outcomes. There were no differences between the two groups with regard to the increase of FSU angle and ROM. However, the diameter of the spinal cord had a significant increase in patients underwent removal of cervical PLL. No severe complication was found in the two groups. Conclusion Removal of the cervical PLL is beneficial for the clinical outcomes and does not have an impact on the angle and ROM of the affected segment. The procedure is safe and feasible.

Objective:To compare the therapeutic effects of percutaneous nephrostomy and ureteral stent drainage in the treatment of infectious hydronephrosis.Methods:From June 2017 to June 2018, 92 patients with infectious hydronephrosis in the First Hospital of Jiaxing were selected.The patients' hospital number was entered into the computer and the patients were divided into group A(percutaneous nephrolithotomy and drainage treatment, 46 cases) and group B(transurethral ureteral stent drainage treatment, 46 cases) by lottery.The treatment effect and safety were compared between the two groups.Results:There were no statistically significant differences in age, male/female, duration of disease, site of renal disease, primary disease, and underlying disease between the two groups(all P>0.05). There was no statistically significant difference in the success rate of disposable catheter placement between group A and group B(97.73% vs.100.00%, χ 2=0.126, P>0.05). The efficacy of group A was significantly higher than that of group B(97.73% vs.81.40%, χ 2=4.617, P<0.05). There were no statistically significant differences in the incidence rates of bleeding, infection, drainage tube abscess and puncture abscess between the two groups(all P>0.05). Conclusion:Percutaneous nephrostomy in the treatment of infectious hydronephrosis is more effective than ureteral stent drainage.Both of two methods have high safety of treatment.Clinical treatment should be based on the specific circumstances of the patients to obtain a significant clinical effect.

Objective To investigate the association between heme oxygenase-1 (HO-1) gene rs2071746 polymorphism and long-term clinical outcome in patients with ischemic stroke.Methods Between July 2015 and June 2017,consecutive patients with acute ischemic stroke admitted to the Department of Neurology,the Third Affiliated Hospital of Soochow University were enrolled prospectively.TOAST classification was performed for all patients.Genotyping of the HO-1 gene rs2071746 polymorphism was performed using a modified multiplex ligase detection reaction technique.The patients were followed up.The primary endpoint events included ischemic stroke,vascular death,and myocardial infarction.Multivariate Cox proportional hazard regression model was used to analyze the independent influencing factors for primary endpoint events.Results A total of 1 698 patients with successful genotyping and follow-up information were enrolled.Genotyping showed that the frequency of rs2071746 A allelewas 44.91％.They were followed up for 15.21 ± 7.39 months,and 168 patients (9.89％) had primary endpoint events.The incidence of primary endpoint events in A allele carriers was significantly lower than that in non-A allele carriers (8.80％ vs.12.40％;P =0.018).Multivariate Cox proportional risk regression model showed that after adjusting for age,gender,hypertension,diabetes mellitus,smoking,alcohol consumption,and genotype,A allele was an independent protective factor for primary endpoint events in patients with acute ischemic stroke (hazard risk [HR] 0.693,95％ confidence interval [CI]0.506-0.949;P=0.022).Subgroup analysis showed that carrying the A allele was an independent protective factor for primary endpoint events in patients with large atherosclerotic stroke (HR 0.651,95％ CI 0.425-0.997;P=0.048),while rs2071746 polymorphism was not associated with long-term outcome in other etiological subtypes.Conclusion The HO-1 gene rs2071746 A allele may be a protective factor for the long-term outcome in patients with acute ischemic stroke and large atherosclerotic stroke.

ObjectiveTo investigate the epidemiological characteristics and analyze the incidence trend of SARS-CoV-2 infection in Shanghai， China， and compare with the characteristics of the infection in Jilin Province of China during the same period in 2022 and Wuhan at the beginning of 2020. MethodsInformation of new locally-transmitted confirmed SARS-CoV-2 cases， imported confirmed COVID-19 cases， local asymptomatic SARS-CoV-2 carriers and imported asymptomatic SARS-CoV-2 carriers in Shanghai from March 1 to April 18， 2022 was collected for descriptive analysis. ResultsFrom March 1 to April 18， 2022， a total of 397 933 locally-transmitted SARS-CoV-2 cases were reported in Shanghai. Of those， 27 613 were clinically confirmed cases and 21 were severe cases. Ten deaths were related to COVID-19. The pathogen is Omicron variant BA.2 of SARS-CoV-2. The number of the infected subjects increased rapidly after March 24 and lead to a disease outbreak. Severe and deceased cases had severe comorbidity and were mostly unvaccinated with SARS-CoV-2 vaccines. Asymptomatic SARS-CoV-2 carriers accounted for 93.06%， which is significantly higher than that in Jilin Province during the same period （48.07%， P<0.001）. Daily increase in the number of clinically confirmed COVID-19 cases in Shanghai in 2022 was much lower than that in Wuhan， Hubei Province， in 2020. Number of daily newly imported confirmed COVID-19 cases and imported asymptomatic SARS-CoV-2 carriers declined during this period. ConclusionThe Omicron variant in Shanghai 2022 is highly infectious and less pathogenic. Omicron variant BA.2 replicates rapidly in asymptomatic carriers， which makes the carriers the major source of infection. Full-term vaccination of inactivated SARS-CoV-2 vaccine might decrease the pathogenicity and fatality of SARS-CoV-2 variants. SARS-CoV-2 of the Omicron BA2 strain is likely transmitted through aerosols and droplets， which poses a great challenge to the control of the COVID-19 pandemic in large cities with high population density and sophisticated public transportation.

Objectve:To observe the change of functional connectivity(FC)characteristic and its correlation with cognitive flexibility in type 2 diabetes mellites(T2DM)patients with cognitive flexibility decreased.Methods:A retro-spective analysis was performed in 24 T2DM patients with cognitive flexibility decreased(T2DM+CD),34 T2DM pa-tients without cognitive flexibility decreased(T2DM-CD)and 31 healthy controls(HC).Wisconsin Card Sorting Test(WCST)and the Stroop Color Word Test(Stroop)were respectively used in three groups of subjects to assess cognitive flexibility and functional magnetic resonance imaging(fMRI)scans was used to assess the FC.The differences of cogni-tive flexibility were found between three groups of subjects.The differences of FC between the bilateral(Left and Right,L.and R.)striatum(ST)and the dorsolateral prefrontal cortex(dlPFC)were found between three groups of subjects.Further analysis was focused on the interactive effect of T2DM and cognitive flexibility on FC changes.Results:Com-pared with T2DM-CD and HC,the number of response administered,errors responses,perseverative response,and time in WCST of T2DM+CD were significantly increased,while the number of correct responses was decreased.In Stroop,the number of correct,word-color contradiction and correct word-color indifference in T2DM+CD were lower than HC.In T2DM+CD,FC between L.ST-L.dlPFC,R.ST-L.dlPFC and R.ST-R.dlPFC were decreased,and decreased FC between R.ST-R.dlPFC was associated with cognitive flexibility scale scores.There existed an interactive effect between T2DM and cognitive flexibility on FC changes.Conclusion:Decreased FC between ST and dlPFC is the neural mechanism of cognitive flexibility impairment in T2DM.