Objective To investigate the etiology, pathogenesis and treatment of erythromelalgia.MethodsRetrospective analysis of clinical features and respective treatment options of 8 cases of erythromelalgia patients in Ruijin Hospital.ResultsThe major clinical characteristics of EM cases included burning, sharp, tingling and/or stinging pain in toes, soles and/or dorsum of feet, increased temperature, erythema and swelling.One case reported burning pain in both fingers and feet.These symptoms were more severe during the night, walking, standing, exercising and when the individual was near a heater.Patients could relieve their pains by rest, using cold packs, walking on cold floors or immersing feet in cold water.Combined treatment, topical therapies and management of underlying disorders were necessary for erythromelalgia.ConclusionErythromelalgia is a rare cutaneous vascular disease with characteristics of recurrent redness, burning pain, and warmth of the extremities which could be induced by heat and exercise.Combined treatment, topical therapies and management of underlying disorders were necessary for erythromelalgia.

To introduce the biological properties and functions of individual blood-brain barrier components,and summarize the most widely used in vitro blood-brain barrier models,compare their strengths and weaknesses,and provide suggestions on model selection in blood-brain barrier research and new-drug research and development.

Objective To evaluate the effect of limb remote ischaemic preconditioning on pul-monary function in patients undergoing cardiac valve replacement surgery with cardiopulmonary by-pass.Methods Seventy patients,32 males and 38 females,aged 18-70 years,weighing 45-90 kg, ASA physical status Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement surgery with cardiopul-monary bypass,were divided into 2 groups using a random number table,35 in each group.Patients in group R received three cycles of right upper-limb 5 min ischemia (blood-pressure cuff inflation to≥ 200 mm Hg)and 5 min reperfusion (blood-pressure cuff deflation to 0 mm Hg)at 10 min after in-tubation.In group C,the cuff was placed around the arm but not inflated.At 10 min after intubation (T0),at 1 h after aortic declamping (T1)and at 6 h (T2),12 h (T3),24 h (T4)after surgery,arte-rial blood was sampled to conduct gas analysis,PaO2/FiO2ratio and alveolar-arterial oxygen gradient (A-aDO2)were calculated,and the dynamic lung compliance (Cd)and static lung compliance (Cs) were also recorded.The occurrence of pulmonary adverse events was recorded until discharge. Results Compared with T0,PaO2/FiO2was decreased in the two groups at T1-T4,A-aDO2was de-creased at T2-T4,Cs and Cd were increased in group C at T3,and were increased in group R at T2, T3(P<0.05).Compared with group C,the Cs and Cd at T2,T3were increased in group R.There were no significant differences between the two groups in the PaO2/FiO2,A-aDO2at T0-T4.The oc-currence of the pulmonary adverse events was decreased significantly in group R than in group C (P<0.05).The occurrence of pulmonary adverse events was declined significantly in group R than in group C (P<0.05).Conclusion Limb remote ischemic preconditioning can improve the lung compli-ance and reduce the occurrence of the pulmonary adverse events in patients undergoing cardiac valve replacement surgery.

Objective To observe the therapeutic effect of laparoscopic sleeve gastrectomy(LSG)in treating patients with obesity and polycystic ovary syndrome(PC OS).Methods In this ret-rospective analysis,clinical materials of 60 patients with obesity and PCOS by LSG were analyzed,and postoperative improvements of PCOS symptoms were observed.Results A total of 60 patients had a pre-operative mean body mass index(BMI)of(39.4±5.4)kg/m2 and an average age of(26.3±6.1)years old,and all of them successfully completed LSG.After follow-up of 12 to 18 months,50 cases(83.3％)had normalized menstrual cycles,with an average recovery time of(4.5±2.2)months af-ter surgery,and 7 cases had natural pregnancy after surgery.Before surgery,ultrasound results in 35 patients indicated polycystic ovarian morphology(PCOM),and 29 cases(82.9％)regained normal o-varian status with an average recovery duration of(6.3±2.8)months.Complicated hyperandrogene-mia was observed in 31 patients,and 29 cases(93.5％)exhibited normalization of testosterone levels within 18 months after surgery.At 18 months after surgery,the BMI was(26.47±4.70)kg/m2,the average weight loss was(32.4±7.4)％.Conclusion LSG is a safe and effective treatment for obese PCOS.

Objective To observe the therapeutic effect of laparoscopic sleeve gastrectomy(LSG)in treating patients with obesity and polycystic ovary syndrome(PC OS).Methods In this ret-rospective analysis,clinical materials of 60 patients with obesity and PCOS by LSG were analyzed,and postoperative improvements of PCOS symptoms were observed.Results A total of 60 patients had a pre-operative mean body mass index(BMI)of(39.4±5.4)kg/m2 and an average age of(26.3±6.1)years old,and all of them successfully completed LSG.After follow-up of 12 to 18 months,50 cases(83.3％)had normalized menstrual cycles,with an average recovery time of(4.5±2.2)months af-ter surgery,and 7 cases had natural pregnancy after surgery.Before surgery,ultrasound results in 35 patients indicated polycystic ovarian morphology(PCOM),and 29 cases(82.9％)regained normal o-varian status with an average recovery duration of(6.3±2.8)months.Complicated hyperandrogene-mia was observed in 31 patients,and 29 cases(93.5％)exhibited normalization of testosterone levels within 18 months after surgery.At 18 months after surgery,the BMI was(26.47±4.70)kg/m2,the average weight loss was(32.4±7.4)％.Conclusion LSG is a safe and effective treatment for obese PCOS.

Objective:To explore the effect of self-made dynamic cardiovascular three-dimensional model combined with CBL (case-based learning) teaching method in the clerkship of valvular heart disease for medical students.Methods:Sixty five-year clinical medical undergraduates from Nanjing Medical University (Batch 2016) were randomly divided into experimental group and control group. The experimental group received dynamic cardiovascular 3D model combined with CBL teaching method, while the control group received traditional model combined with CBL teaching method. After the course, the teaching effect was evaluated by examination and questionnaire. SPSS 19.0 was used for independent sample t test and chi-square test. Results:Compared with the control group, the students in experimental group had higher scores of basic theoretical knowledge [(43.10±3.51) vs. (40.87±3.19)] and clinical thinking ability [(42.20±3.15) vs. (40.20±3.81)], with significant differences ( P<0.05). Furthermore, they showed higher evaluation and satisfaction to learning initiative and enthusiasm, mastery of theoretical knowledge, clinical thinking ability, classroom learning interest, classroom activity and clarity of knowledge teaching, with significant differences ( P<0.05). Conclusion:In the teaching of valvular heart disease clerkship, the application of self-made dynamic cardiovascular three-dimensional model combined with CBL teaching method, can cultivate students' clinical diagnostic thinking ability and improve teaching quality.

Matrix protein p17 is a structural protein of human immunodeficiency virus（HIV）. It not only plays a key role in multiple stages of HIV life cycle，but also is closely associated with HIV-related lymphoma，neurocognitive impairment and breast cancer. This article reviews the role of matrix protein p17 in HIV infection and HIV-related diseases.

Objective:To explore the efficacy and safety of injection of botulinum toxin A (BTX-A) for female urethral pain syndrome (UPS).Methods:This study retrospectively included 8 women with UPS who were treated by injection of BTX-A in West China Hospital of Sichuan University from February 2021 to September 2021. The average age was (47.87±11.33) years old, the median disease duration was 3(1.0, 10.8) years. Before treatment, The visual analogue scale (VAS) was (5.38±1.92), the Pain, Urgency, Frequency score (PUF) was (10.75±5.12), and the female sexual function index (FSFI) was (14.53±11.63). 100U BTX-A was injected at the 3, 6, 9, and 12 o'clock positions of the urethral meatus, as well as at the mid-urethra and the left and right sides of the bladder neck, totaling 10 injections. The VAS, PUF score, FSFI score, and complications were recorded at 1, 3, and 6 months after treatment.Results:The VAS score decreased to (3.25±2.12), (2.88±2.23)and(2.88±2.23) at 1, 3, and 6 months, showing statistically significant differences compared to the pre-treatment scores ( P<0.05); post-treatment PUF score declined to (6.63±3.93), (6.25±4.03)and(5.13±3.31), respectively, with only the 6-month score showing a statistically significant difference compared to the pre-treatment score ( P=0.03). The FSFI score increased slightly to (14.68±11.56), (16.76±12.17) and (16.76±12.17)at 1, 3, and 6 months post-injection, respectively, with no statistically significant differences compared to the pre-treatment scores ( P>0.05). Only 1 patient had transient dysuria. Conclusion:BTX-A injection is a safe and effective treatment for UPS, and it can be used for UPS patients who are unresponsive to conservative therapy.

Objective To investigate the clinical characteristics of DCD donor-derived CRKP infection and bleeding in kidney transplantation,and to summarize the experience of diagnosis,treatment and prevention.Methods A retrospective analysis was carried out from July 2016 to December 2017 in hospital,containing clinical data of 4 cases of CRKP-infected DCD donors and 7 cases of kidney transplantation recipients.Results In the CRKP culture of 4 cases of DCD donors,1 case was positive for blood culture,1 case was positive for urine culture,1 case was positive for sputum culture,and 1 case was negative for blood,urine and sputum culture.The corresponding 7 recipients were all positive for blood culture after renal transplantation,4 cases were positive for urine culture,3 cases were positive for sputum culture,and 5 cases were positive for perirenal drainage.Of the 7 patients,4 cases had renal artery hemorrhage,1 of them was died.The average bleeding time was 17.75 days after operation (14-19 days).In 7 patients with renal transplantation,CRP increasd.And in 3 cases of deaths,CRP was stably higher than normal.Meanwhile,CRP in 4 surviving patients gradually decreased to the normal range after effective anti-infection treatment.All 7 patients were treated with carbapenems;2 patients were dead without avibactam therapy;and 5 cases were treated with avibactam and carbapenems and survived,1 case died and 1 case had good renal function recovery.Conclusion Positive CRKP in blood,urine and sputum of DCD donors can lead to CRKP infection in kidney transplant recipients.Even if the body fluids of donors are all negative,the false negative results could not be excluded.Persistent or increased high-level CRP after operation is an early warning on CRKP infection.And CRP can be used as an indicator for evaluating the effectiveness of anti CRKP therapy.The combination of avibactam and carbapenem antibiotics is an effective regimen in the treatment of DCD donor-derived CRKP.

ObjectiveTo investigate the mechanism of Xuefu Zhuyu capsules against atherosclerosis via regulating polarization of macrophages based on Notch1/jagged canonical Notch ligand 1（Jagged1）/Hes family BHLH transcription factor 1（Hes1） signaling pathway. MethodThe mouse models with atherosclerosis were prepared by feeding the mice with an ApoE^-/- high-fat diet for four weeks， and they were randomly divided into the model group， Xuefu Zhuyu capsule group， and atorvastatin group. C57BL/6 mice were fed as a normal group. The Xuefu Zhuyu capsule group was intragastrically given Xuefu Zhuyu capsules （0.728 g·kg^-1·d^-1）， and the atorvastatin group was intragastrically given atorvastatin tablet （6.07 mg·kg^-1·d^-1）. The normal group and the model group were given equal volume of the deionized water by intragastric administration， and the intervention lasted for 12 weeks. Aortic plaque morphology was observed by hematoxylin-eosin （HE） staining， and aortic plaque area and lipid deposition were observed by oil red O staining. The positive expression levels of CD86 and CD206 in aortic tissue were detected by immunohistochemistry， and serum levels of tumor necrosis factor （TNF）-α， interleukin（IL）-1β， transforming growth factor （TGF）-β₁， and IL-10 were detected by enzyme-linked immunosorbent assay （ELISA）. The relative mRNA expressions of inducible nitric oxide synthase （iNOS）， arginase-1 （Arg-1）， Notch1， Jagged1， and Hes1 in aortic tissue were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The relative protein expression of iNOS， Arg-1， Notch1， Jagged1， and Hes1 in aortic tissue was detected by Western blot. ResultCompared with the normal group， the model group had significant aortic plaque and lipid deposition， and the expression levels of pro-inflammatory cytokines TNF-α and IL-1β were increased （P<0.01）. The expression level of anti-inflammatory cytokine TGF-β₁ showed a downward trend， but the difference was not statistically significant. The mRNA and protein expressions of iNOS were increased （P<0.01）. The protein expression of Arg-1 was decreased （P<0.01）， and the mRNA expression of related pathway molecule Jagged1， as well as the protein expressions of Notch1， Jagged1， and Hes1 were increased in the model group （P<0.05， P<0.01）. Compared with those in the model group， the plaque area and lipid deposition had a decreasing trend in the Xuefu Zhuyu capsule group， and the expressions of TNF-α and IL-1β showed a downward trend. The expression of TGF-β₁ was increased （P<0.05）， and the expression of macrophage marker CD86 was decreased. The mRNA and protein expressions of iNOS were decreased （P<0.01）. The mRNA and protein expressions of Arg-1 were increased （P<0.05， P<0.01）. Furthermore， the mRNA and protein expressions of Notch1， Jagged1， and Hes1 were decreased （P<0.01）. ConclusionXuefu Zhuyu capsules can reduce aortic plaque area and lipid deposition in mice with atherosclerosis， alleviate inflammation， inhibit M1 macrophages， and promote the expression of M2 macrophages， and the mechanism may be related to the regulation of Notch1/Jagged1/Hes1 signaling pathway.