Objective To summarize the clinical characteristics of patients with connective tissue diseases (CTD) and autonomic neuropathy. Methods The medical records of inpatients with CTD and autonomic neuropathy from 2005 to 2015 were retrospectively analyzed including clinical manifestations, laboratory examinations, treatment and outcome. Categorical data were expressed in percentages. Kolmogorov-Smirnov test was used to examine normal distribution. Continuous data of normal distribution were expressed as x ±s deviation, while data without a normal distribution were described as median and interquartile range (P25, P75). Results Among the nine patients included in this study, all were female, and the median age was 42 years (32~50 years old). Four patients (4/9) were systemic lupus erythematosus (SLE), three patients (3/9) were primary Sj?gren's syndrome (pSS), two patients (2/9) were rheumatic arthritis (RA), and four patients were secondary Sj?gren's syndrome (SS) (two with SLE and two with RA). Five patients (5/9) had autonomic nervous dysfunction before they were diagnosed of CTD, while four patients (4/9) developed autonomic nervous dysfunction after diagnosis of CTD. The most common symptom of autonomic nervous dysfunction was postural hypotension (9 patients, 9/9), followed by hypohidrosis (4 patients, 4/9), urinary retention (2 patients, 2/9), gastrointestinal dysmotility (2 patients, 2/9) and tonic pupil (1 patient, 11%). After treatment of CTD, autonomic symptoms of three patients improved, while the others didn't. Four of the remaining 6 patients improved after receiving other assistant treatments including vasoconstrictor, pyri-dostigmine bromide, and plasma exchange. Conclusion Patients with CTD could present with autonomic neuropathy, which is mainly characterized with postural hypotension. If patients had related symptoms, clinicians should pay more attention to whether CTD exists. If treatment for CTD couldn't improve patients' condition, other assistant treatment might be considered.

Cerebral smal vessel disease (CSVD) can be divided into sporadic and hereditary CSVD. The exact pathogenesis of sporadic CSVD is unknow n. Genetic factors may also play an important role, except for environmental and vascular risk factors. As a complicated disease, sporadic CSVD has the characteristics of multigenetic susceptibility. Therefore, investigating the related genetic factors may contribute to understanding the pathogenesis of sporadic CSVD. This article review s the advances in research on the genetics of sporadic CSVD.

Vertebral artery dominance is generally considered to be a congenital vascular variation or meaningless clinical finding.Many studies have shown that the bilateral vertebral artery blood flow asymmetry caused by vertebral artery dominance is easy to result in basilar artery curvature.Some studies have shown that there are certain correlations between both the vertebral artery dominance and the basilar artery curvature and the posterior circulation stroke.

Objective To elaborate the glucose and lipid metabolism 1 year postpartum on the foundation of postpartum 6-12 weeks in patients with prior gestational abnormal glucose metabolism in Beijing area.Methods Seventy-three patients who delivered during February to December,2007,aged (32.0 ± 3.6) years,were enrolled.46 cases (63％) were diagnosed as cases of gestational diabetes mellitus (GDM) while 27 (37％) as gestational impaired glucose tolerance (GIGT).All of the patients were revisited twice by 6-12 weeks and 1 year postparaum.Body weight,waist andhip circumferences,oral glucose tolerance test(OGTT),and lipids profile were determined.Results Compared with 6-12 weeks postpartum,the body weight,waist and hip circumferences,and waist-to-hip ratio were decreased by 1 year postpartum,fasting plasma glucose was increased [(5.19 ± 0.06) vs (4.84 ± 0.57) mmol/L,P＜0.01],and 4 cases were diagnosed as cases with impaired fasting glucose (IFG; 4 vs 0).By 6-12 weeks and 1 year postpartum,postprandial plasma glucose levels were (6.84± 1.93) and (7.33 ± 1.50) mmol/L(P=0.017),and the incidences of impaired glucose tolerance(IGT) were 28.8％ and 38.4％ (P=0.167),respectively,with 6 cases of newly diagnosed IGT by 1 year postpartum.There were more cases of hypertriglyceridenia (19.2％ vs 13.7％),less cases of hypercholesterolemia(19.7％ vs 30.0％,P＜0.01),more cases with improved high-densit.y lipoprotein-cholesterol (21.9％ vs 4.1％,P＜0.01),and less cases with raised low-density lipoproteincholesterol(21.9％ vs 49.3％,P＜0.01).No difference was found in body weight,body mass index,waist circumference,hip circumference,and waist-to-hip ratio between GIGT and GDM groups.Conclusion GDM is an important cause of the increasing prevalence of diabetes in women of reproductive age.Although body weight and waist-to-hip ratio have been improved,they would still develop glucose intolerance and dyslipidemia 1 year postpartum.

Objective To investigate the effect of low platelet (PLT) count on the early fatality rate of liver transplant recipients without intraoperative PLT transfusion. Methods Clinical data of 180 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. The critical value of PLT count on postoperative 7 d to predict the early postoperative fatality rate was evaluated by the receiver operating characteristic(ROC) curve. All recipients were divided into the low PLT count group and control group according to the critical value. Relevant clinical data including perioperative PLT count, preoperative general conditions and intraoperative conditions of the recipients were included. The independent risk factors of the early fatality rate of liver transplant recipients were analyzed by Logistic regression analysis. The early prognosis of the recipients between two groups was observed and compared by the postoperative length of intensive care unit (ICU) stay, postoperative length of hospital stay, early allograft dysfunction and fatality rate on postoperative 30 d. Results The PLT count < 32×10⁹/L on 7 d after liver transplantation was an independent risk factor of the fatality rate on postoperative 30 d (P < 0.05). The postoperative length of ICU stay of the recipients in the low PLT count group was 9 (5, 14) d, significantly longer than 5 (3, 6) d in the control group (P < 0.05). In the low PLT count group, the early allograft dysfunction rate was 55.0%, significantly higher than 20.6% in the control group (P < 0.05). In the low PLT count group, the fatality rate on postoperative 30 d was 40.0%, significantly higher than 2.5% in the control group (P < 0.05). The length of hospital stay did not significantly differ between two groups (P > 0.05). Conclusions The PLT count < 32×10⁹/L on postoperative 7 d is an independent risk factor for the fatality rate on postoperative 30 d of liver transplant recipients. It can prompt the early allograft dysfunction and contribute to predict the early clinical prognosis of liver transplant recipients.

Objective:To investigate the application of the modified double-clamp surgery with the preservation of Scarpa fascia in abdominoplasty.Methods:A retrospective analysis was carried out in 26 female patients with total abdominoplasty who were admitted from March 2020 to January 2022, ranging in age from 26 to 50 years with averaged 36.9 years. The patients were divided into flap clamp group (12 cases) and Scarpa fascia clamp group (14 cases). The surgical time of abdominoplasty (excluding liposuction time), the occurrence of postoperative seroma, and postoperative incision infection were recorded in the two groups.Results:The average surgical time of the patients in the Scarpa fascia clamp group was 136 minutes, which was significantly lower than that of the flap clamp group (153 minutes) ( P<0.05). There was no postoperative seroma and incision infection in the two groups, and the postoperative incision healing grades were I/A. Conclusions:The modified double-clamp procedure with preservation of the Scarpa fascia can effectively reduce the surgical time and improve the operation efficiency.

Objective To compare the accuracy of lactate concentration and model for end-stage liver disease (MELD) to predict early mortality after liver transplantation, and to provide a convenient and timely predictive tool for clinical work. Methods A total of 121 patients who underwent Allograft liver transplantation in 2017 in our hospital, 92 males and 29 females, aged 25-78 years old, ASA physical status Ⅲ or Ⅳ, were selected to the retrospective study. Patients were divided into survival group and non-survival group, according whether survived within 30 days after the surgery. The preoperative and postoperative lactate concentrations were gotten and the preoperative and postoperative MELD scores were calculated. The preoperative lactate concentrations, postoperative lactate concentrations, preoperative MELD scores and postoperative MELD scores were compared between survival group and non-survival group, respectively. The predictive accuracy about early mortality (30 days) of lactate concentration and MELD score were compared at preoperation and postoperation through receiver operating characteristic, respectively. Results There were 109 patients (90.0％) survived and 12 patients (10.0％) non-survived within 30 days after the surgery. Compared with survival group, the preoperative lactate concentrations, postoperative lactate concentrations, preoperative MELD scores and postoperative MELD scores in the non-survival group were significantly increased (P ＜ 0.05). According to the ROC analysis, the area under the curve (AUC) of ROC of preoperative lactate concentration was 0.78 (95％ CI 0.62-0.93) with a cutoff value of 2.43 mmol/L, the AUC of preoperative MELD score was 0.70 (95％ CI 0.53-0.87) with a cutoff value of 24.50 scores. There was not statistically significant between the AUC of preoperative MELD score and lactate concentration. The AUC of postoperative lactate concentration was 0.85 (95％ CI 0.70-0.99) with a cutoff value of 9.57 mmol/L, the AUC of postoperative MELD score was 0.74 (95％ CI 0.61-0.88) with a cutoff value of 25.42 scores. The AUC of postoperative lactate concentration was statistically higher than that of MELD score (P ＜ 005). Conclusion The predictive capability of lactate concentration, especially that of postoperative lactate concentrations, was better than the predictive capability of MELD score.

Cerebral amyloid angiopathy (CAA) is a disorder characterized by amyloid deposition in the walls of leptomeningeal and cortical arteries,arterioles,and it is one of the common cerebral vascular diseases in the elderly.Cerebral amyloid angiopathy related inflammation (CAA-Ⅰ),is a recently recognized syndrome of reversible encephalopathy seen in a subset of patients with CAA.Here,we review the advances in research on the pathological mechanism,clinical features and course,investigations,diagnosis and differential diagnosis,and treatment of CAA-Ⅰ.

BACKGROUND: Some scholars have found that dermal papilla spheroid–derived exosomes could promote the development of hair follicles. However, whether adipose-derived stem cell exosomes (ADSC-Exos) have a similar effect on hair growth has not been determined yet. Thus, the purpose of this article was to detect whether ADSC-Exos could promote hair regeneration. METHODS: Adipose-derived stem cells (ADSCs) were isolated from 6-week-old C57BL/6 mice. Then, ADSC-Exos were isolated from the ADSCs. Western blotting was used to detect specific exosome markers. The particle size and distribution of the exosomes were analyzed by NanoSight dynamic light scattering. A total of 12 nude mice were randomly divided into two groups (n = 6 each): the ADSC-Exos group and the control group. For the control group, a mixture of freshly isolated dermal cells (DCs) and epidermal cells (ECs) was grafted. For the ADSC-Exos group, a mixture of DCs, ECs, and 50 lg/ml of ADSC-Exos was grafted. Gross evaluation of the hair regeneration was carried out 2–3 weeks after the transplantation, and the graft site was harvested for histology at the third week. Results: The existence of exosomes derived from ADSCs was evidenced by CD63, ALX1, and CD9 expression. Two or three weeks after the grafting, the number of regenerated hairs in the ADSC-Exos group was higher than that in the control group (p < 0.001). Histologically, the terminal hairs were remarkable in the ADSC-Exos group, whereas the hair follicles observed in the control group were comparatively immature. The ADSC-Exos group had a higher number of regenerated follicles than the control group (p < 0.001). In addition, we found that the skin tissues in the ADSC-Exos group had higher PDGF and vascular endothelial growth factor expressions and lower transforming growth factor beta 1 levels than those in the control group CONCLUSION Our results indicated that ADSC-Exos could promote in vivo hair follicle regeneration.

BACKGROUND: Some scholars have found that dermal papilla spheroid–derived exosomes could promote the development of hair follicles. However, whether adipose-derived stem cell exosomes (ADSC-Exos) have a similar effect on hair growth has not been determined yet. Thus, the purpose of this article was to detect whether ADSC-Exos could promote hair regeneration. METHODS: Adipose-derived stem cells (ADSCs) were isolated from 6-week-old C57BL/6 mice. Then, ADSC-Exos were isolated from the ADSCs. Western blotting was used to detect specific exosome markers. The particle size and distribution of the exosomes were analyzed by NanoSight dynamic light scattering. A total of 12 nude mice were randomly divided into two groups (n = 6 each): the ADSC-Exos group and the control group. For the control group, a mixture of freshly isolated dermal cells (DCs) and epidermal cells (ECs) was grafted. For the ADSC-Exos group, a mixture of DCs, ECs, and 50 lg/ml of ADSC-Exos was grafted. Gross evaluation of the hair regeneration was carried out 2–3 weeks after the transplantation, and the graft site was harvested for histology at the third week. Results: The existence of exosomes derived from ADSCs was evidenced by CD63, ALX1, and CD9 expression. Two or three weeks after the grafting, the number of regenerated hairs in the ADSC-Exos group was higher than that in the control group (p < 0.001). Histologically, the terminal hairs were remarkable in the ADSC-Exos group, whereas the hair follicles observed in the control group were comparatively immature. The ADSC-Exos group had a higher number of regenerated follicles than the control group (p < 0.001). In addition, we found that the skin tissues in the ADSC-Exos group had higher PDGF and vascular endothelial growth factor expressions and lower transforming growth factor beta 1 levels than those in the control group CONCLUSION Our results indicated that ADSC-Exos could promote in vivo hair follicle regeneration.