Objective: To explore the difference of radiological imaging features of delayed encephalopathy after carbon monoxide poisoning (DECMP) and acute carbon monoxide poisoning (ACMP) , and the correlation between the imaging findings and clinical prognosis of the disease. Methods: The correlation between imaging findings and clinical manifestations and prognosis of 95 patients with moderate and severe acute carbon monoxide poisoning were retrospectively analyzed. In the above 95 cases, there were 62 cases of ACMP and 33 cases of DEACMP. All patients underwent conventional CT, MRI and magnetic resonance diffusion tensor imaging (DTI) . Circular regions of interest (ROI) measurement was used for analysis of average diffusion coefficient (ADC) value and fractional anisotropy (FA) value of the MRI and DTI imaging manifestations in different brain regions. Results: The main clinical manifestation of moderate acute carbon monoxide poisoning was consciousness disorder and fatigue; Severe poisoning patients showed deep coma as the main clinical manifestations; The most prominent clinical manifestations of DEACMP were mental disorders and neurological impairment in the extrapyramidal system. A total of 95 cases with moderate or severe CO poisoning showed unilateral or bilateral cerebral cortex, bilateral basal ganglia (white ball) , cerebral white matter around bilateral ventricles or bilateral centrum semiovale, around bilateral ventricles cerebral white matter around bilateral ventricles and bilateral centrum semiovale, cerebral cortex and subcortical involvement. CT showed normal or low density shadow.MRI showed that the lesion T₁WI presented slightly low or equal signal, T₂WI and FLAIR sequences showed equal, a slightly higher or high signal; DWI sequence showed slightly higher or high signal. ADC value and FA value in different brain white matter regions of DEACMP group was significantly lower than those of ACMP group (P<0.05) , especially for those around semi oval center and lateral ventricles of the brain white matter (P<0.01) ; The ADC values increased significantly, FA value decreased significantly in the nerve nucleus (P<0.05) , especially for ADC values in globus pallidus (P<0.01) . Conclusion DTI can evaluate the brain tissue damage in patients with DEACMP more early and more accurately.

Objective We investigated the changes of the motorial network in patients suffered from brain tumors adjacent to the central sulcus occurred with reorganization of motor function using function connectivity MRI(fcMRI)technique in order to provide the new evidence for the compensational hypothesis of the reorganization caused by focal lesions.Methods Using 1.5 T MRI unit,14 patients with brain tumors in the vicinity of the central sulcus occurred with reorganization of motor function and 6 normal volunteers were examined with fcMRI technique while the subjects performed no task.By selecting seed voxels(region of interest)in the regions showing the most activation in M1 area on the activated map and cross correlating with every voxel within the brain,the fcMRI maps based on unilateral primary motor(M1)area were calculated.The location,extent and volume of the region showing significant connectivity to the several seed voxel,such as left/right M1 area in the health group and affected/unaffected M1 area in the patient group were evaluated on the fcMRI map.Results In healthy group,the extent and volume of the region showing significant connectivity to the left M1 area[(9514.17±186.92)mm3]were almost similar to those to the right M1 area [(9364.67±382.75)mm3].There showed no significant difference in motor connectivity between the two groups(P>0.05).In the tumor group,the volume of regions showing significant connectivity to the M1 area located in the affected hemisphere [(11193.14±811.29)mm3]was obviously higher than that of regions based on the seed voxel in the unaffected side[(6549.86±400.94)mm3](t=20.383,P＜0.01).The volume was significantly different among the regions showing high connectivity to the M1 of the affected side in patient group.those showing significant connectivity to the left M1 and fight M1 in health group(P＜0.01),the former was the biggest(P＜0.01).The extent of the regions showing connectivity to the affected M1 was consistent with the reorganization area of motor function revealed by fMRI.The volume of regions showing significant connectivity to M1 area of unaffected hemisphere in patient group showed significant difference compared with those showing significant connectivity to the left M1 and right M1 in health group(P＜0.01),the former was smallest(LSD,P＜0.01).especially in the affected hemisphere.It might mean the disrupted functional connectivity between the M1 area of unaffected hemisphere in patient group and motor area located in the collateral side.Conclusion The increased connectivity between the M1 area of the affected hemisphere and the other motor cortex might indicate that the reorganization in the motor pathway and the formation of the potential compensatory network second to the impairment of the normal motor pathway resulted in the functional reorganization of the motor cortex.The fcMRI technique might be a valuable approach to reveal the pathophysiological changes of nerve network caused by brain tumor.

Objective:To evaluate the effectiveness of mentorship-Leichester assessment package (LAP) model in general practice teaching.Methods:Sixty five-year Traditional Chinese Medicine (TCM) students undergoing general medicine internship from July 2020 to December 2020 were divided into study group and control group with 30 students in each group. Students in study group undertook general practice internship in Fangzhuang Community Health Service Center with the mentorship-LAP model, including group-based teaching, weekly LAP case discussion and mentor-intern individualized LAP clinical practice teaching; students in control group undertook general practice internship in other community teaching bases with the traditional clinical practice training methods. After one month, students were evaluated with LAP score sheet and the evaluation results were compared between two groups.Results:After one month of training, the scores of medical history collection, physical examination, problem solving, patient management, doctor-patient relationship, expected care and medical records in both groups increased compared with pre-training (the control group: t=4.23, 5.06, 8.94, 4.85, 3.99, 1.04, 5.13, study group: t=1.86, 2.85, 12.42, 13.61, 6.29, 4.83, 5.63, all P<0.05). The scores of medical history collection, physical examination, problem solving, patient management, doctor-patient relationship, and expected care after training in the study group were higher than those in the control group ( t=5.66, 2.83, 5.67, 8.13, 2.76, 2.52, all P<0.05). After the training, in the medical history collection items, the scores of patient-centered communication, RICE recognition, and physical-psychological-social factors in study group were higher than those in the control group ( t=5.66, 7.35 and 2.66, all P<0.05); in the problem-solving items, the scores of clinical data application, comprehensive analysis ability and personal ability limitation in study group were higher than those in the control group ( t=4.32, 3.38 and 2.26, all P<0.05); in the patient management items, the scores of overall management plans, doctor-patient collaboration, dispelling doubts, subsequent visits/follow-up, and the degree of patient understanding the management plan in the study group were higher than those in the control group ( t=3.03, 2.07, 2.43, 3.15 and 2.17, all P<0.05). Conclusion:The mentorship-LAP teaching model is helpful to improve the effectiveness of general practice internship for medicine students.

Objective : To measure the anatomical parameters of the first maxillary molars in children of different age groups and evaluate the age⁃related changes in dental crowns. Methods : A retrospective analysis was conducted on cone beam computed tomography (CBCT) images of 4⁃8 ⁃year⁃old children. NNT software was used to analyze multiple important indicators of maxillary first molar. Results : A total of 308 first maxillary molars , including 154 pediatric patients , were evaluated in this study. The thickness of the pulp apex H1 (left , P = 0. 01 ; right , P = 0. 02) and the thickness of the pulp chamber floor H3 (left and right P < 0. 01) were positively correlated with age , while the height of the pulp cavity H2 (left and right P < 0. 01) and the height of the palate tip D1 (left P = 0. 003 , right P = 0. 002) showed a negative correlation with age. There was no significant correlation between the height of the buccal tip and age (P > 0. 05) . There were significant differences in H1 and H3 between the 4⁃year⁃old and 5 ⁃year⁃old age groups between the 8 ⁃year⁃old age group ( P < 0. 05) , as well as significant differences in H2 and D1 between the 4⁃year⁃old and 5 ⁃year⁃old between the 6⁃year⁃old , 7 ⁃year⁃old and 8 ⁃year⁃old age groups (P < 0. 05) . Conclusion The age⁃related changes in the crowns of the first maxillary molars are important references for the clinical treatment , and can be accurately measured through CBCT data.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with unclear etiology and limited treatment options. The median survival time for IPF patients is approximately 2-3 years and there is no effective intervention to treat IPF other than lung transplantation. As important components of lung tissue, endothelial cells (ECs) are associated with pulmonary diseases. However, the role of endothelial dysfunction in pulmonary fibrosis (PF) is incompletely understood. Sphingosine-1-phosphate receptor 1 (S1PR1) is a G protein-coupled receptor highly expressed in lung ECs. Its expression is markedly reduced in patients with IPF. Herein, we generated an endothelial-conditional S1pr1 knockout mouse model which exhibited inflammation and fibrosis with or without bleomycin (BLM) challenge. Selective activation of S1PR1 with an S1PR1 agonist, IMMH002, exerted a potent therapeutic effect in mice with bleomycin-induced fibrosis by protecting the integrity of the endothelial barrier. These results suggest that S1PR1 might be a promising drug target for IPF therapy.

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.