Objective: To optimize the method of simultaneous determination of four aflatoxins (B1, B2, G1 and G2) of ginger by the ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method and high-throughput method. Methods: The aflatoxins were extracted from ginger by methanol-water (80:20, V/V) solution, concentrated and dried with nitrogen. The aflatoxins were detected by UPLC-MS/MS by using Waters Acquity UPLC BEH C18 chromatographic column. The mobile phase was 0.1% formic acid water (A phase) -0.1% formic acid methanol (B phase), gradient elution, flow rate 0.35 ml/min, mass spectrometry was electrospray ion source, positive ion scanning mode, multi reaction ion monitoring were using. Results: Quantification of four aflatoxins by matrix matching standard curve. The linear was good in the range of 0.125-20.000 ng/ml, and the correlation coefficients were all greater than 0.999 0. The ginger sample detection was 0.125-0.300 μg/kg and 0.125-1.000 μg/kg, respectively. The average recoveries were 81.7%-96.0%, and the relative standard deviation (RSD) was lower than 7.53%. Conclusions This method is simple, rapid, sensitive and low limit of detection, which can meet the requirements for the detection of trace aflatoxins residues in ginger.

Purpose: Plasma osmolality, a marker of dehydration, is associated with cardiovascular mortality. We aimed to investigate whether elevated plasma osmolality is associated with case fatality within 1 year after severe acute ischemic stroke. Materials and Methods: We included severe ischemic stroke patients (defined as National Institutes of Health Stroke Scale ≥15 score) within 24 hours from symptom onset admitted to the Department of Neurology, West China Hospital between January 2017 and June 2019. Admission plasma osmolality was calculated using the equation 1.86 * (sodium+potassium)+1.15 * glucose+urea+14. Elevated plasma osmolality was defined as plasma osmolality >296 mOsm/kg, indicating a state of dehydration. Study outcomes included 3-month and 1-year case fatalities. Multivariable logistic regression was performed to determine independent associations between plasma osmolality and case fatalities at different time points. Results: A total of 265 patients with severe acute ischemic stroke were included. The mean age was 71.2±13.1 years, with 51.3% being males. Among the included patients, case fatalities were recorded for 31.7% (84/265) at 3 months and 39.6% (105/265) at 1 year. Elevated plasma osmolality (dehydration) was associated with 3-month case fatality [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.07–3.66, p=0.029], but not 1-year case fatality (OR 1.51, 95% CI 0.84–2.72, p=0.165), after full adjustment for confounding factors. Conclusion Elevated plasma osmolality was independently associated with 3-month case fatality, but not 1-year case fatality, for severe acute ischemic stroke.

Purpose: Plasma osmolality, a marker of dehydration, is associated with cardiovascular mortality. We aimed to investigate whether elevated plasma osmolality is associated with case fatality within 1 year after severe acute ischemic stroke. Materials and Methods: We included severe ischemic stroke patients (defined as National Institutes of Health Stroke Scale ≥15 score) within 24 hours from symptom onset admitted to the Department of Neurology, West China Hospital between January 2017 and June 2019. Admission plasma osmolality was calculated using the equation 1.86 * (sodium+potassium)+1.15 * glucose+urea+14. Elevated plasma osmolality was defined as plasma osmolality >296 mOsm/kg, indicating a state of dehydration. Study outcomes included 3-month and 1-year case fatalities. Multivariable logistic regression was performed to determine independent associations between plasma osmolality and case fatalities at different time points. Results: A total of 265 patients with severe acute ischemic stroke were included. The mean age was 71.2±13.1 years, with 51.3% being males. Among the included patients, case fatalities were recorded for 31.7% (84/265) at 3 months and 39.6% (105/265) at 1 year. Elevated plasma osmolality (dehydration) was associated with 3-month case fatality [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.07–3.66, p=0.029], but not 1-year case fatality (OR 1.51, 95% CI 0.84–2.72, p=0.165), after full adjustment for confounding factors. Conclusion Elevated plasma osmolality was independently associated with 3-month case fatality, but not 1-year case fatality, for severe acute ischemic stroke.

Massive brain infarction is a major type of severe ischaemic stroke, for which malignant brain oedema is a common cause for poor prognosis. Existing studies and guidelines mostly focused on the intensive care and surgical treatment for malignant brain oedema, whilst there is insufficient evidence to guide the widely applicable interventions specifically targeting malignant brain oedema. We propose that early prediction and prevention may be more feasible and beneficial in practice, than the treatment for malignant brain oedema. Future research is urgently needed to a) dynamically illustrate its natural history and explore the time window for prevention; b) investigate risk factors and early predictors, to guide the selection of high-risk patients for individualised interventions. Clinical doctors should be aware of the importance of early presentation of massive brain infarction, dynamically record changes in symptoms and sign, and provide individualised and comprehensive management, with an aim to reduce the development of malignant brain oedema, and finally reduce stroke burden.

Objective:To investgate the effect of endovascular therapy (EVT) on the requirement for decompressive craniectomy (DC) and functional outcomes in patients with large anterior circulation ischemic stroke.Methods:Patients with large anterior circulation ischemic stroke within 24 hours of onset admitted to the Department of Neurology, West China Hospital, Sichuan University between September 2017 and December 2019 were included. Outcome indicators included DC demand and poor outcome at 3 months. The latter was defined as a modified Rankin Scale score >2. Multivariate logistic regression analysis was used to determine independent factors of DC requirement and functional outcomes at 3 months. Results:A total of 381 patients with large anterior circulation ischemic stroke were enrolled, including 203 males (53.3%), and the mean age was 70.7±14.3 years. The median time from onset to admission was 4.5 hours. The median baseline National Institutes of Health Stroke Scale score was 17 and median baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was 7. Totally 139 patients (36.5%) received EVT, and 64 (16.8%) required DC; 376 patients (98.7%) completed a 3-month follow-up (5 who did not complete follow-up did not require DC, of which 2 received EVT), 312 (83.0%) had poor outcome at 3 months, and 146 (38.8%) died. Multivariate logistic regression analysis showed that EVT was an independent predictor for the requiremet of DC (odds ratio [ OR] 4.42, 95% confidence interval [ CI] 1.81-10.81; P=0.001), higher baseline ASPECTS ( OR 0.80, 95% CI 0.71-0.89; P<0.001) and successful recanalization ( OR 0.37, 95% CI 0.15-0.90; P=0.028) were independent protective factors of reducing the requirement of DC. Successful recanalization ( OR 0.09, 95% CI 0.01-0.72; P=0.023) and antiplatelet therapy ( OR 0.29, 95% CI 0.11-0.76; P=0.012) were independent predictors for reduced risk of poor outcome. In 139 patients who received EVT, 27 (19.4%) received intravenous thrombolysis, 96 (69.1%) achieved successful recanalization, 88 (63.3%) had hemorrhagic transformation, 61 (43.9%) had symptomatic hemorrhagic transformation, and 34 (24.5%) required DC; 137 (98.6%) completed a 3-month follow-up, 116 (84.7%) had poor outcome at 3 months, and 67 (48.9%) died. For patients receiving EVT, a higher baseline ASPECTS ( OR 0.72, 95% CI 0.60-0.88; P=0.001) and successful recanalization ( OR 0.35, 95% CI 0.14-0.90; P=0.029) were independent predictors of reducing the requirement of DC, while successful recanalization ( OR 0.09, 95% CI 0.01-0.71; P=0.022) was an independent predictor for reduced risk of poor outcome. Among 64 patients who required DC, 22 (34.4%) received DC. Receiving DC significantly reduced the mortality within 3 months ( OR 0.25, 95% CI 0.07-0.86; P=0.028), but had no significant effect on functional outcome at 3 months ( OR 0.35, 95% CI 0.03-4.38; P=0.412). There was no significant interaction of either EVT or successful recanalization in the effect of DC on 3-month death ( P for interaction > 0.05). Conclusions:Successful recanalization after EVT reduces requirement for DC in patients with large anterior circulation ischemic stroke and improves functional outcome at 3 months. DC can reduce the mortality in patients required DC, and have no interactive effect with EVT or successful recanalization.

Traditional Chinese Medicine (TCM) shows unique advantages in the field of adjuvant treatment of gastric cancer. The main mechanism of TCM in improving gastric cancer includes regulating cell proliferation and apoptosis, reversing cell resistance, reducing the ability of invasion and metastasis and epithelial-mesenchymal transformation, regulating immune function, inhibiting neovascularization, regulating autophagy exosome, and ferroptosis.

Severe ischemic stroke carries a high rate of disability and death. The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct, defined as severe stroke and large infarction, respectively. Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention, which includes stroke with malignant brain edema, a leading cause of death during the acute phase, and stroke with severe complications of other vital systems. Early prediction of high-risk patients with critically severe stroke would inform early prevention and treatment to interrupt the malignant course to fatal status. Selected patients with severe stroke could benefit from intravenous thrombolysis and endovascular treatment in improving functional outcome. There is insufficient evidence to inform dual antiplatelet therapy and the timing of anticoagulation initiation after severe stroke. Decompressive hemicraniectomy (DHC) <48 h improves survival in patients aged <60 years with large hemispheric infarction. Studies are ongoing to provide evidence to inform more precise prediction of malignant brain edema, optimal indications for acute reperfusion therapies and neurosurgery, and the individualized management of complications and secondary prevention. We present an evidence-based review for severe ischemic stroke, with the aims of proposing operational definitions, emphasizing the importance of early prediction and prevention of the evolution to critically severe status, summarizing specialized treatment for severe stroke, and proposing directions for future research.
Humans ; Ischemic Stroke/pathology* ; Brain Edema/surgery* ; Stroke/prevention & control* ; Brain/pathology* ; Brain Infarction/pathology* ; Treatment Outcome

Objective To investigate the value of CT calcification type of hepatic alveolar echinococcosis(HAE)for predicting its lymph node metastasis.Methods Totally 100 patients with HAE confirmed by surgical pathology were retrospectively collected,among them 50 with lymph node metastases were divided into metastasis group,while the other 50 with lymph node reactive hyperplasia into non-metastasis group.Patients'general data,as well as preoperative CT findings,including the number,location,the maximum diameter and calcification type of lesions were compared between groups.Multivariate logistic regression analysis was performed for clinical and CT features being significant different between groups to screen the independent predictors of HAE lymph node metastasis.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of CT calcification type alone and combining with other independent predictors for predicting node metastasis of HAE.Results A total of 62 groups of lymph node metastases were detected in 50 patients in metastasis group,including 39 cases with single group lymph node metastasis,10 cases with 2 groups lymph node metastasis and 1 case with 3 groups lymph node metastasis.There were significant differences of location,the maximum diameter and CT calcification type of HAE lesions within liver between groups(all P＜0.05),which were all independent predictors of HAE lymph node metastasis(all P＜0.05).The AUC of CT calcification type alone and combining with other independent predictors for predicting node metastasis of HAE was 0.757 and 0.859,respectively,which were significant different(P=0.002).Conclusion CT calcification type of HAE could effectively predict lymph node metastasis,and the predictive efficacy might be improved by combining location and maximum diameter of HAE lesions.

Objective:To investigate the value of 99Tc m-hydrazinonicotinamide (HYNIC)-prostate specific membrane antigen(PSMA) SPECT/CT imaging in biochemical recurrence of prostate cancer (PCa). Methods:From January 2018 to March 2023, 112 patients with biochemical recurrence of PCa (age (72.6±6.1) years) who underwent 99Tc m-HYNIC-PSMA SPECT/CT imaging in Henan Provincial People′s Hospital were retrospectively analyzed. According to the level of prostate specific antigen (PSA), patients were divided into 0.2 μg/L2 μg/L group. According to the Gleason score, patients were divided into Gleason score≥8 group and Gleason score <8 group. The detection rate between groups was analyzed by χ2 test, and the difference of the PSA level between groups was compared by Mann-Whitney U test. Results:PSMA imaging was positive in 77 cases and negative in 35 cases, with the detection rate of 68.8%(77/112). The detection rates of local recurrence, lymph node metastasis, bone metastasis and lung metastasis were 8.9%(10/112), 43.8%(49/112), 28.6%(32/112) and 0.9%(1/112), respectively. The detection rates of 0.2 μg/L2 μg/L groups were 44.7%(21/47), 8/12 and 90.6%(48/53), respectively ( χ2=24.44, P<0.001). The detection rates of Gleason score ≥8 group and <8 group were 76.4%(55/72) and 55.0%(22/40) ( χ2=5.47, P=0.032); the PSA level between the two groups was statistically different (3.11(0.75, 5.91) and 0.84(0.44, 2.92) μg/L; z=-2.99, P=0.003). Of the patients with PSMA positive imaging, 84.4%(65/77) changed their treatment regimen and 15.6%(12/77) continued to observe or maintain the original treatment plan. Of the patients with PSMA negative imaging, 40.0%(14/35) changed the treatment plan, 51.4%(18/35) continued to observe or maintain the original treatment plan, and 8.6%(3/35) discontinued the original treatment because no tumor metastasis was found. Conclusion:99Tc m-HYNIC-PSMA SPECT/CT imaging can provide reference for the lesion detection, treatment decision-making and follow-up observation of biochemical recurrence of PCa.

BACKGROUND:Traumatic brain injury is a condition in which the normal function of the brain is disrupted by a bump or impact to the head.It is necessary to find effective treatments and objective targets that can help doctors diagnose the injury status and restore the brain function of patients. OBJECTIVE:To explore the effect of electroacupuncture combined with low-frequency transcranial ultrasound stimulation on the electroencephalographic signals of rats with traumatic brain injury. METHODS:Forty 6-week-old SPF male Sprague-Dawley rats were randomly divided into five groups:sham group,model group,electroacupuncture group,low-frequency transcranial ultrasound stimulation group and combined group(electroacupuncture+low-frequency transcranial ultrasound stimulation),with eight rats in each group.Feeney weight-drop method was used to establish the animal model of traumatic brain injury.In the sham group,the bone window was only opened without impact.Interventions were started at 1 day after modeling.Electroacupuncture in the electroacupuncture group,low-frequency transcranial ultrasound stimulation in the low-frequency transcranial ultrasound stimulation group,and electroacupuncture+low-frequency transcranial ultrasound stimulation in the combined group were performed for days in total.The modified neurological severity scale score for assessing rats'neurological deficits was performed at 8 hours after modeling.The percentage of spontaneous alternation behavior in the Y-maze was measured at 7 days after modeling.Then,the electroencephalographic signals were collected and electroencephalographic data of α,β,θ,and δ waves were extracted by fast Fourier transform,and the value of oscillation amplitude and energy ratio were calculated in α,β,θ,and δ waves,as well as the Lempel-Ziv complexity and sample entropy. RESULTS AND CONCLUSION:Compared with the sham group,the modified neurological severity scale scores in the model group,electroacupuncture group,low-frequency transcranial ultrasound stimulation group and combined group were significantly increased at 8 hours after modeling(P<0.05).Compared with the sham group,the value of oscillation amplitude in δ wave and the value of δ energy ratio were significantly increased in the model group at 7 days after modeling,meanwhile the percentage of spontaneous alternation behavior in Y-maze,and the value of α/β energy ratio,Lempel-Ziv complexity,and sample entropy were significantly decreased(P<0.05).Compared with the model group,the value of oscillation amplitude in α and δ waves was significantly decreased in the combined group(P<0.05),while the value of α/β energy ratio was significantly increased(P<0.05)and the value of δ energy ratio was significantly decreased(P<0.05)in the electroacupuncture group,low-frequency transcranial ultrasound stimulation group and combined group.Compared with the electroacupuncture group and low-frequency transcranial ultrasound stimulation group,the value of δ energy ratio was significantly decreased in the combined group(P<0.05),while the percentage of spontaneous alternation behavior,the value of α/β energy ratio,the Lempel-Ziv complexity,and the sample entropy were significantly increased(P<0.05).To conclude,abnormal electroencephalographic signals can appear in rats with traumatic brain injury,while the electroacupuncture combined with low-frequency transcranial ultrasound stimulation can alleviate the abnormal electroencephalographic signals in rats,which suggests the electroencephalographic frequency domain value and nonlinear features can be used to assess the severity of traumatic brain injury.