Objective To investigate the relationship between white matter lesions(WML) and cognitive impairment in migraine with and without aura.Methods 56 migraine without aura patients (MwoA group),22 migraine with aura patients(MA group) and 30 normal controls were recruited.All of them were performed head MRI examination and were evaluated by operational definitions of ARWMC and Mattis Dementia Ratiing Scale(DRS),and compare among three groups,discuss the relationship between WML and cognitive impairment.Results (1) Compared with control group,the occurrence rate of WML in MA group was significantly higher(40.9％ vs 13.3％,x2=22.74,P＜0.01).The OD-ARWMC score was significantly higher in both MA and MwoA groups((0.73±l.12) vs (0.13±0.35),t=2.76,P＜0.01;(0.36±0.67) vs (0.13±0.35),t=1.75,P＜0.05).Compared with MwoA group,the occurrence rate of WML and the OD-ARWMC score of MA group was significantly higher(t=22.80,P＜0.01;t=1.79,P＜0.05).(2) During the attack period,the DRS total scale and its 5 factors (attention,initiation/perseveration,concept formation,construction and memory) were significantly lower in both MwoA and MA group(P＜0.05 or 0.01) than control group,while the DRS total scale and its two factors (attention,concept formation) of MA group were significantly lower than that of MwoA group (P＜ 0.01).During the intermission period,the concept formation and memory scale in MA group was significantly lower than control group(P＜0.05),only memory factor in MwoA group was significantly lower than control group(P＜0.05),while the initiation/perseveration factor scale of MA group was significantly lower than MwoA group(P＜0.05).(3) There Was a negative correlation between OD-ARWMC scale and the total DRS scale as well as its three factors (attention,concept formation,memory)during attack period in MA group(r=-0.584,P＜0.01;r=-0.465,P＜0.05;r=-0.558,P＜0.01;r=-0.439,P＜0.05).There was a negative correlation between OD-ARWMC scale and the total DRS scale as well as concept formation factor during attack period in MwoA group (r=-0.328,P＜ 0.05;r =-0.276,P＜ 0.05).Conclusion Migraine patients may have white matter lesions and cognitive impairment,especially in MA patients and during attack period.

BACKGROUND:The emergence of a large number of hidden blood loss during perioperative period of intertrochanteric fracture in the elderly not only increases the risk of perioperative period and complications, but also affects the postoperative recovery of joint function. At present, there is no relevant report about nutritional status and the hidden blood loss before surgery in and outside China.
OBJECTIVE:To identify the effect of nutritional status on preoperative hidden blood loss in elderly patients with intertrochanteric fracture.
METHODS:183 elderly patients with fresh and initial femoral intertrochanteric fracture were included. Laboratory serological examinations on admission and preoperation were completed. By mini nutritional assessment, patients were randomly divided into normal-nourishment group, malnourishment at risk group, and malnourishment group. The original blood volume and preoperative hidden blood loss were calculated depending on height, weight, hematocrit on admission and preoperation. According to the proportion of mean preoperative hidden blood loss on the original blood volume, patients were divided into low and high hidden blood loss groups. We compared preoperative hidden blood loss, and their proportion on the original blood volume and the preoperative incidence of high hidden blood loss, and analyzed the correlations between preoperative high hidden blood loss and preoperative nutritional status.
RESULTS AND CONCLUSION:(1) The nutritional status of elderly intertrochanteric fracture patients measured by mini nutritional assessment score was that the number of patients was 48 cases (26%) in normal-nourishment group, 64 cases (35%) in the malnourishment at risk group, and 71 cases (39%) in the malnourishment group. There were no obvious differences in the preoperative complications between any two groups (P>0.05). (2) Thirty-eight cases affected high hidden blood loss. The mean preoperative hidden blood loss was 260.43 mL. The proportion of preoperative hidden blood loss to the original blood volume was 6%. (3) The preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss were significantly higher in the malnourishment at risk group and malnourishment group than in the normal-nourishment group. Paired comparison showed significant differences (P<0.05). (4) Results confirmed that preoperative hidden blood loss, their proportion on the original blood volume and the incidence of high hidden blood loss gradual y increased with deterioration of nutritional status. The nutritional status is an important factor influencing the occurrence of preoperative hidden blood loss, and can be used as an important index for judging the high hidden blood loss and prognosis in elderly patients with intertrochanteric fracture.

Objective: To study the repeatability and consistency among different operators while different b-value DWI was used to detect mass and non-mass breast lesions. Methods: Between December 2010 and October 2017, we collected 131 female patients (one hundred and thirty-three lesions) from Zhongda Hospital Southeast University, they were diagnosed as non-cystic lesion of the mammary gland by contrast enhancement MRI (DCE-MRI),were examined with DWI and confirmed by surgical pathology. There were 94 cases of mass lesion (96 lesions) and 37 cases of non-mass lesion (37 lesions). All patients were examined with DWI before surgery,80 patients were examined with b-value of 0, 400, 800 and 1 000 s/mm², there were 51 tumor lesions and 29 non-tumor lesions;53 patients were examined with b-value of 0, 400, 800 and 1 200,1 600 s/mm²,there were 45 tumor lesions and 8 non-tumor lesions. Two radiologists with the same qualifications used double-blind reading to measure ADC values. Paired t test was used to compare the differences in measurement parameters between the two physicians. The repeatability of data between the two physicians was analyzed by intraclass correlation coefficient (ICC) and Cronbach α coefficients. The consistency of data between the two physicians was evaluated by Bland-Altman analysis. Results: In different b values (0,400,800,1 200,1 600 s/mm²), the ADC value of non-mass type breast cancer and mass type breast cancer was no statistically significance between the two operators (P>0.05).The ICC of the ADC values of the non-mass breast lesion under the different b values measured by 2 physicians were 0.72, 0.78, 0.87, 0.76, 0.74, and the repeatability was good or very good; The Cronbach α coefficients are 0.83, 0.88, 0.93, 0.86, 0.85, and the reliability is high. The ICC of the ADC values of the mass breast lesion under the different b values measured by 2 physicians were 0.88,0.95,0.97,0.93,0.91, and the repeatability was very good. the Cronbach α coefficients were 0.94,0.97,0.99,0.96,0.95, and the reliability was high. The results of the Bland-Altman image analysis showed that the ADC values of non-mass and mass lesion detected by different operators in different b values have good consistency. In different b values, there were 97.3% (36/37), 94.6% (35/37), 93.1% (27/29),8/8 and 8/8 points within the 95% consistency limit of non-mass breast lesions; there were 97.9% (94/96), 94.8% (91/96), 92.2% (47/51), 95.6% (43/45), 93.3% (42/45) within the 95% consistency limit of mass breast lesions. Conclusion The ADC values were measured under different b values, and different operators had favarable repeatability and consistency for different lesions of different types of breast cancer.

OBJECTIVETo investigate the effects of initiative and passive perioperative function exercises on hidden blood loss (HBL).

METHODSTwo hundreds and thirty elderly patients with hip fractures aging from 67 to 87 years (average age of 73.6 years) who underwent total hip replacement were included. By the intensity and the manner of perioperative function exercises, patients were divided into four groups: little initiative function exercises group (group A, n=51), little initiative and passive function exercises group (group B, n=54), normal initiative function exercises group (group C, n=65), normal initiative and passive function exercises group (group D, n=60). The true total blood loss, HBL and their proportion on the original blood volume and total blood loss was calculated depending on height, weight, intra-operative blood loss, post-operative blood loss, pre- and post-operative hematocrit, and blood transfused. According to the proportion of mean HBL on total blood loss, patients were divided into low HBL group and high HBL group. The data were analyzed by t test.

RESULTSThe mean HBL was 517 ml, 41.9% of the total blood loss. Thereinto, the mean HBL was 695 ml in group A, 49.3% of the total blood loss, the prevalence of high HBL was 66.7% (34/51); the mean HBL was 625 ml in group B, 46.9% of the total blood loss, the prevalence of high HBL was 59.3% (32/54); the mean HBL was 446 ml in group C, 38.4% of the total blood loss, the prevalence of high HBL was 30.8% (20/65); the mean HBL was 346 ml in group D, 32.3% of the total blood loss, the prevalence of high HBL was 20.0% (12/60). Mean HBL, mean HBL/total blood loss, prevalence of high HBL were lower in group C than that in group A and group B (all P<0.05); and were lower in group D than that in group C (all P<0.05). The prevalence was 57.4% (132 cases) in low HBL group, and 42.6% (98 cases) in high HBL. The proportion of little initiative function exercises patients in high HBL group was obviously higher than that in low HBL group (P<0.05).

CONCLUSIONSThe intensity and the manner of perioperative function exercises are strongly associated with the HBL in elderly patients with total hip replacement. The initiative combined with the passive function exercises could be effectively prevent and reduce the incidence of high HBL.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Blood Loss, Surgical ; Exercise Therapy ; adverse effects ; Hip Fractures ; surgery ; Humans ; Postoperative Hemorrhage

Objective:To optimize the alcohol extraction process of herbal pair puerarin-berberine.Methods:Based on the etha-nol reflux extraction,the extraction quantity of total flavonoids,total alkaloid,puerarin and berberine hydrochloride were used as the e-valuation index,and the independent variables included the drug particle,ratio of solid to liquid, ethanol concentration, reflux dura-tion and reflux times. Significance analysis was evaluated by Plackett-Burman design,and then the extraction process was optimized by Box-Behnken response surface methodology.Results:The optimal extraction conditions of drug pair puerarin-berberine were as follows:the drug particle was 80 mesh,the ratio of solid to liquid was 1:13,the ethanol concentration was 75%,the reflux time was 60 min, and the reflux times was 4. Under the above conditions, the extraction quantity of total flavonoids, alkaloid, puerarin and berberine hydrochloride was 120.34,56.99,109.63 and 39.26 mg ·ml-1, respectively.Conclusion: The extraction process of herbal pair puerarin-berberine is reasonable and feasible optimized by Plackett-Burman design and Box-Behnken response surface methodology.

Objective To study the association of NLRP3 gene polymorphism with primary hyper tension (PH) and carotid atherosclerosis (CA) in patients of Xinjiang Kazakh nationality.Methods Three hundred and fifty PH patients of Xinjiang Kazakh nationality were divided into CA group (n=150) and CA-free group (n=200) with 200 Xinjiang Kazakh nationality people undergoing physical examination served as a control group in this study.Their NLRP3 rs10754558 genotypes and alleles were detected using the Tapman probe method and their serum IL-1β level was measured by ELISA.Results The detection rate of rs10754558 genotypes and alleles was significantly higher in CA group than in control group (20.0％ vs 9.0％,43.0％ vs 34.8％,P＜0.05).No significant difference was found in NLRP3 gene types and G alleles between the two groups (P＞ 0.05).The serum IL-1β level was significantly higher in CA and CA-free groups than in control group (2.79±0.83 ng/L and 2.82±0.92 ng/L vs 2.21±0.91 ng/L,P＜0.05) and in GG gene type carriers of CA and CA-free groups than in those of control group (3.40±± 0.37 ng/L and 3.35±0.43 ng/L vs 2.21±0.90 ng/L,P＜0.05).Conclusion NLRP3 rs10754558 gene polymorphism is associated with genetic susceptibility to hypertension and carotid atherosclerosis in patients of Xinjiang Kazakh nationality.

Objective: To investigate the effects of human adipose-derived mesenchymal stem cells (ADSCs) and platelet-rich plasma (PRP) on healing of wounds with full-thickness skin defects in mice. Methods: ADSCs were isolated from the lumbar and abdominal fat donated voluntarily by a healthy woman undergoing liposuction in the Department of Plastic Surgery of Guangzhou General Hospital of Guangzhou Military Area Command, and the cells were cultured and identified. ADSCs of the second passage were used in the following experiments. The venous blood of the volunteer was taken, and PRP was obtained by secondary centrifugation. Thirty-six C57BL/6 mice were divided into simple injury group (n=12), simple ADSCs treatment group (n=12), and ADSCs+ PRP treatment group (n=12) according to the random number table. Each mouse was inflicted with a 1 cm×1 cm wound with full-thickness skin defect on the back. Immediately after injury, the wounds of mice in simple injury group were subcutaneously injected with 1 mL normal saline, the wounds of mice in simple ADSCs treatment group were subcutaneously injected with 1 mL phosphate buffer solution-blended ADSCs suspension (with concentration of 5×10⁵ /mL, the same below), and the wounds of mice in ADSCs+ PRP treatment group were subcutaneously injected with 1 mL mixture of PRP and ADSCs (1∶2 volume ratio). Three mice in each group were taken on post injury day (PID) 3, 5, 7, and 14 to observe the gross condition of wound, and the wound healing rate was calculated. On PID 3, 5, and 7, the non-healing wound tissue and 0.5 cm normal skin tissue around the wound margin were taken after gross observation. The inflammation, re-epithelialization, and angiogenesis of tissue were observed by hematoxylin and eosin staining, and the re-epithelialization rate was calculated. The collagen synthesis of tissue was observed by masson staining. Immunohistochemistry was used to observe the expression of macrophages of tissue samples collected on PID 3 and 5. Data were processed with analysis of variance of factorial design and Least-Significant Difference test. Results: (1) On PID 3, the wounds of mice in ADSCs+ PRP treatment group were with granulation tissue regeneration, redness, and swelling, and the wounds of mice in the other two groups were ruddy and with effusion. On PID 5, the wounds of mice in ADSCs+ PRP treatment group had less redness and swelling, which were dry with obvious scab, and wounds of mice in the other two groups were obviously red and swollen. On PID 7, scab formed basically on wounds of mice in the three groups. On PID 14, the wounds of mice in the three groups basically healed, and their crusts were off. On PID 3, 5, 7, and 14, the wound healing rates of mice in ADSCs+ PRP treatment group were obviously higher than those of the other two groups (P<0.05 or P<0.01). On PID 5 and 7, the wound healing rates of mice in simple ADSCs treatment group were obviously higher than those of simple injury group (P<0.01). (2) On PID 3, granulation tissue regeneration of wounds in ADSCs+ PRP treatment group was more than that in the other two groups. On PID 5, inflammatory reaction of wounds of mice was mild in ADSCs+ PRP treatment group, which was severe in the other two groups. On PID 7, the re-epithelialization process of wounds of mice was almost completed in ADSCs+ PRP treatment group, and the number of new vessels was more in ADSCs+ PRP treatment group than in the other two groups. The migration distance of regenerated epithelia around the wound edge in simple injury group and simple ADSCs treatment group was short. On PID 3, 5, and 7, the re-epithelialization rates of wounds of mice in ADSCs+ PRP treatment group were (37.6±4.5)%, (59.1±1.3)%, and (89.2±4.3)%, respectively, significantly higher than (25.7±1.5)%, (34.5±4.4)%, and (50.8±2.7)% in simple injury group and (29.1±0.8)%, (42.6±2.9)%, and (72.9±3.0)% in simple ADSCs treatment group (P<0.01). On PID 5 and 7, the re-epithelialization rates of wounds of mice in simple ADSCs treatment group were significantly higher than those in simple injury group (P<0.05 or P<0.01). (3) On PID 3 and 5, a quite large number of new collagen fibers appeared in granulation tissue of wounds of ADSCs+ PRP treatment group, while the collagen fibers in the other two groups were less. On PID 7, the granulation tissue of mice in ADSCs+ PRP treatment group decreased, and a large number of new collagen fibers appeared. The collagen fibers in wounds tissue of mice in simple ADSCs treatment group increased, while the collagen fibers deposited in wounds tissue of mice in simple injury group was still less. (4) On PID 3 and 5, the numbers of macrophages in wounds tissue of mice in simple ADSCs treatment group were 4.7±0.6 and 5.3±0.6 respectively, obviously lower than 6.3±0.6 and 7.7±0.6 in injury group (P<0.05 or P<0.01); the numbers of macrophages in wounds tissue of mice in ADSCs+ PRP treatment group were 3.0±1.1 and 2.7±0.5, significantly lower than those in the other two groups (P<0.05 or P<0.01). Conclusions Human PRP and ADSCs are involved in the early inflammation, metaphase of tissue proliferation, and re-epithelialization and shaping process of late stage of wounds with full-thickness skin defects in mice. The combination of ADSCs and PRP may be a comparatively good combination to improve the speed and quality of wound healing.

As an increasing number of emerging anti-tumor drugs are approved and marketed,the imperative for clinical safety monitoring and risk information management has grown significantly.Drug-induced neuropathy associated with these drugs exhibit characteristics such as insidious onset,rapid progression,and challenging treatment,ultimately leading to treatment failures.Therefore,a comprehensive understanding of the risk of neuropathy induced by emerging anti-tumor drugs,coupled with risk surveillance and early warning,as well as management and reporting,can significantly reduce the incidence and severity of drug-related diseases.This paper provides a review of the neuropathy caused by emerging anti-tumor drugs,introduces the pharmacovigilance system and risk information management measures in clinical usage,aiming to provide a reference for guiding the rational clinical use and minimizing the incidence of drug-induced diseases.

Objective To investigate the relationship between promotion of osteogenic differentiation of adipose-derived stem cells (ADSCs) by exosomes secreted by ADSCs and the Wnt/β-catenin signaling pathway. Methods ADSCs were extracted in the Plastic Surgery Department of the First Hospital Affiliated to China Medical University. Exosomes were extracted from ADSCs induced to differentiate into osteoblasts. The ADSCs were separated into four groups and used for measuring activity of alkaline phosphatase (ALP) by using enzyme-labeled assay, formation of calcium nodes by Alizarin red staining, and expression of β-catenin by Western blotting. Results ADSC-derived exosomes promoted differentiation of ADSCs into osteoblasts by upregulating the expression of β-catenin. Addition of Dickkopf-related protein 1 (DKK1), an inhibitor of Wnt/β-catenin pathway, inhibited expression of β-catenin which in turn resulted in reduced potential of ADSCs for osteogenic differentiation. Conclusion The osteogenic differentiation of ADSCs can be promoted by exosomes derived from ADSCs via the Wnt/β-catenin signaling pathway.

Objective:To evaluate the value of preoperative prediction of vessel invasion (VI) of locally advanced gastric cancer by machine learning model based on the venous phase enhanced CT radiomics features.Methods:A retrospective analysis of 296 patients with locally advanced gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from July 2011 to December 2020 was performed. The patients were divided into VI positive group ( n=213) and VI negative group ( n=83) based on pathological results. The data were divided into training set ( n=207) and test set ( n=89) according to the ratio of 7∶3 with stratification sampling. The clinical characteristics of patients were recorded, and the independent risk factors of gastric cancer VI were screened by multivariate logistic regression. Pyradiomics software was used to extract radiomic features from the venous phase enhanced CT images, and the minimum absolute shrinkage and selection algorithm (LASSO) was used to screen the features, obtain the optimal feature subset, and establish the radiomics signature. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic, naive Bayes (GNB), and support vector machine (SVM) models, were used to build prediction models for the radiomics signature and the screened clinical independent risk factors. The efficacy of the model in predicting gastric cancer VI was evaluated by the receiver operating characteristic curve. Results:The degree of differentiation (OR=13.651, 95%CI 7.265-25.650, P=0.003), Lauren′s classification (OR=1.349, 95%CI 1.011-1.799, P=0.042) and CA199 (OR=1.796, 95%CI 1.406-2.186, P=0.044) were independent risk factors for predicting the VI of locally advanced gastric cancer. Based on the venous phase enhanced CT images, 864 quantitative features were extracted, and 18 best constructed radiomics signature were selected by LASSO. In the training set, the area under the curve (AUC) of XGBoost, logistic, GNB and SVM models for predicting gastric cancer VI were 0.914 (95%CI 0.875-0.953), 0.897 (95%CI 0.853-0.940), 0.880 (95%CI 0.832-0.928) and 0.814 (95%CI 0.755-0.873), respectively, and in the test set were 0.870 (95%CI 0.769-0.971), 0.877 (95%CI 0.788-0.964), 0.859 (95%CI 0.755-0.961) and 0.773 (95%CI 0.647-0.898). The logistic model had the largest AUC in the test set. Conclusions:The machine learning model based on the venous phase enhanced CT radiomics features has high efficacy in predicting the VI of locally advanced gastric cancer before the operation, and the logistic model demonstrates the best diagnostic efficacy.