In 1999, the nomenclature and case definitions for neuropsychiatric lupus syndromes were published by American College of Rheumatology (ACR), and the cognition of neuropsychiatric damage of systemic lupus erythematosus (SLE) was gradually unified and standardized. Lupus headache is an intractable problem in SLE, especially in SLE patients complicated with multiple organ injury. In general, vascular headache is common in most SLE patients, and a small number of SLE patients complicated with nervous headache are found in clinic. Moreover, its pathophysiological mechanism is far from being understood. Although early diagnosis is essential for good outcomes, the diagnosis method is rather confused in the world. There still exist some limitations in the proposal of clinical classification of headache from ACR and International Headache Society (IHS), and the proposal does not mention the classification of headache related to psychiatric damage. Current therapeutic regimens are almost exclusively based on empirical evidence. Treatment approaches include symptomatic treatment, immunosuppressive, anticoagulant and anti-aggregant therapies. It provides enormous and hopeful space in research of combined therapy strategy, especially in the field of traditional Chinese medicine. The authors discussed the relationship between lupus headache and headache due to internal injury in the view of integrated traditional Chinese and Western medicine, and suggested that the treatment strategy for lupus headache should be made in argument with the headache due to internal injury. Syndrome differentiation treatment according to deficiency in the root and excess in the branch and the therapy for activating blood to dredge collaterals maybe have great advantages in treatment of the headache in SLE.

Objective To investigate the influence of different storage and time on the arterial blood gas analysis.Methods This study used a randomized controlled repeated survey design, and totals of 120 samples of arterial blood were divided into two groups by random.The blood samples of group 1 were stored in 4 ℃refrigerator, while the samples of group 2 were stored at 0℃ice box.All blood samples were tested immediately at half an hour, one hour, an hour and a half and two hours.Results pH,PaCO2 ,PaO2 ,SaO2 of the two groups had no statistically significant difference (P>0.05).But there were statistically significant differences in test results at different time points (P<0.01).With the prolonged time of samples set aside, the value of pH, PaO2 and SaO2 showed a decreasing trend, while the PaCO2 value gradually increased.Conclusions The test results of blood samples stored in 4℃refrigerator or 0℃ice box show no difference, and every arterial blood sample should accomplish the test in 30 minutes, otherwise it would affect the results of blood gas analysis.

Objective: To observe the activation of microglia and the changing rule of inflammatory cytokine as IL-6, IL-10 and nuclear factor-κB (NF-κB) in experimental rabbits after spinal cord ischemia reperfusion (SCIR) injury in order to provide theoretical basis for post-conditioning time. Methods: Rabbit SCIR injury model was established by thoracic aorta balloon occlusion. 54 New Zealand male adult white rabbits were divided into 9 groups: Sham group (the animals received balloon implantation without occlusion), SCIR-0h group (reperfusion was conducted at 0 hour of spinal cord ischemia), SCIR-1h, -2h, -3h, -8h, -24h,-48h and -72h groups. n=6 in each group. The number of normal and apoptosis neurons, the levels of Iba-1, IL-6, IL-10 and NF-κB in spinal tissue were examined and compared among different groups respectively. Results: The number of normal neuron was decreasing with the extended reperfusion time, TUNEL-positive neuron began to increasing in SCIR-8h group and the peak was reached in SCIR-24h group. The expression of Iba-1 began to elevating in SCIR-2h group and the peak was obtained in SCIR-8h group; NF-κB began to rising in SCIR-3h group and the peak was observed in SCIR-8h group; both IL-6 and IL-10 arrived the peak in SCIR-24h group. The expressions of NF-κB, IL-6 and IL-10 were positively related to Iba-1 level. Conclusion: Microglia activation had dynamic changes in experimental SCIR rabbits and the expression levels of NF-κB, IL-6 and IL-10 were positively to microglia activation; post-conditioning time at front and back to microglia activation may reduce neuron injury.

Objective:To investigate the clinical manifestations, risk factors and outcomes of patients with acute cingulate cortex (CC) infarction.Methods:Patients with acute CC infarction admitted to the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University from December 2019 to April 2022 were enrolled retrospectively. According to the location of infarction, they were divided into anterior cingulate cortex (ACC) infarction group and posterior cingulate cortex (PCC) infarction group. The clinical manifestations, stroke risk factors, imaging examination and National Institutes of Health Stroke Scale (NIHSS) score of the patients were analyzed. At one month after onset, the modified Rankin Scale was used to evaluate the short-term outcome.Results:A total of 21 patients with acute CC infarction were enrolled, including 12 males (57.14%), aged 67.14±12.36 years (range, 45-89 years). There were 16 patients (76.19%) with ACC infarction, including 13 (81.25%) unilateral CC infarction. The clinical manifestations were mainly apathy, decreased concentration, and executive dysfunction. There were 5 patients (23.81%) with PCC infarction, all with unilateral onset, mainly manifested as memory loss and visual space disorder. Among the 21 patients, 18 (85.71%) had ≥2 vascular risk factors, and 13 patients (61.90%) had ≥3 vascular risk factors, of which hypertension was most common (90.48%); 19 (90.48%) were caused by atherosclerosis, and 2 (9.52%) were caused by cardiogenic embolism. After treatment, the symptoms of both groups were improved significantly, and there was statistical difference in the NIHSS score before and after treatment ( Z=4.07, P<0.01). During the follow-up, 16 patients (76.19%) had a good outcome, 5 (23.81%) had a poor outcome and no death occurred. Conclusions:ACC and PCC infarction mainly showed different forms of cognitive impairment. If the diagnosis and treatment are timely, the overall outcome of CC infarction is good.

Objective:To examine the perioperative safety and feasibility of simultaneous off-pump coronary artery bypass grafting (OPCAB) with non-cardiac surgical procedures of moderate-to-severe severity.Methods:The perioperative results of 54 patients underwent simultaneous OPCAB with non-cardiac surgical procedures from September 2013 to January 2019 at Department of Cardiac Surgery, Peking University First Hospital were assessed retrospectively. There were 46 males and 8 females, aging (65.8±8.8) years (range: 41 to 85 years). All simultaneous non-cardiac surgical procedures, including vascular ( n=1), thoracic ( n=26), general ( n=12) and urologic surgical procedures ( n=15), were assessed to be of moderate-to-severe grade by operative severity scoring system. Perioperative results were compared between the OPCAB patients who underwent simultaneous non-cardiac surgical procedures ( n=54) and 1∶2 matched patients who underwent isolated OPCAB performed most recently by the same cardiac team with similar procedures accordingly ( n=108), using t test, Mann-Whitney U test, χ2 test or Fisher exact test. Results:All baseline factors were matched between the two groups, with no significant difference on European system for cardiac operative risk evaluation (EuroSCORE) Ⅱ (1.185(0.758)% vs. 1.215(0.905)%, Z=?0.036, P=0.972). No perioperative death was observed in the two groups. Although patients underwent simultaneous non-cardiac surgical procedures showed prolonged operation duration time ((324.9±97.1) minutes vs. (166.7±36.7) minites, t=11.564, P<0.01) and increased intraoperaive blood loss ((462.2±269.6) ml vs. (304.5±177.8) ml, t=3.866, P<0.01), primary postoperative complications, including perioperative myocardial infarction, atrial fibrillation, perioperative stroke, acute renal failure, wound infection, and bleeding reoperation did not show significant differences between the two groups (all P>0.05), while total blood transfusion volume, mechanical ventilation time and intensive care unit residence time also showed no significant differences between the two groups (all P>0.05). Conclusion:Simultaneous OPCAB with non-cardiac surgical procedures of moderate-to-severe severity in patients with operative indications are safe and feasible, and are not associated with increased postoperative risks when compared with isolated OPCAB.

Objective To investigate the clinical manifestations of nodo-paranodopathy(NPP)with anti-neurofascin 186(NF186)antibody positive.Methods The clinical data of a NPP patient with cranial nerve damage caused by anti-NF186 antibody positive was retrospectively analyzed.Results The patient was a 70-year-old male with sudden speech disorder and dysphagia one month ago.Glucocorticoid therapy was discontinued after improvement.The patient's speech,swallowing,chewing,bristling,turning and head-up movements were laborious and progressively aggravated 5 days ago.The EMG examination of the limbs was normal,and the serum and CSF anti-NF186 antibody were positive.The curative effect of glucocorticoid treatment was not obvious,and the symptoms were significantly improved after plasma exchange treatment.Conclusions Anti-NF186 antibody-positive NPP has late onset age,severe illness and accompanied with cranial nerves damage.Conventional hormone therapy is not effective,but plasma exchange therapy is effective.

Objective:To examine the perioperative safety and feasibility of simultaneous off-pump coronary artery bypass grafting (OPCAB) with non-cardiac surgical procedures of moderate-to-severe severity.Methods:The perioperative results of 54 patients underwent simultaneous OPCAB with non-cardiac surgical procedures from September 2013 to January 2019 at Department of Cardiac Surgery, Peking University First Hospital were assessed retrospectively. There were 46 males and 8 females, aging (65.8±8.8) years (range: 41 to 85 years). All simultaneous non-cardiac surgical procedures, including vascular ( n=1), thoracic ( n=26), general ( n=12) and urologic surgical procedures ( n=15), were assessed to be of moderate-to-severe grade by operative severity scoring system. Perioperative results were compared between the OPCAB patients who underwent simultaneous non-cardiac surgical procedures ( n=54) and 1∶2 matched patients who underwent isolated OPCAB performed most recently by the same cardiac team with similar procedures accordingly ( n=108), using t test, Mann-Whitney U test, χ2 test or Fisher exact test. Results:All baseline factors were matched between the two groups, with no significant difference on European system for cardiac operative risk evaluation (EuroSCORE) Ⅱ (1.185(0.758)% vs. 1.215(0.905)%, Z=?0.036, P=0.972). No perioperative death was observed in the two groups. Although patients underwent simultaneous non-cardiac surgical procedures showed prolonged operation duration time ((324.9±97.1) minutes vs. (166.7±36.7) minites, t=11.564, P<0.01) and increased intraoperaive blood loss ((462.2±269.6) ml vs. (304.5±177.8) ml, t=3.866, P<0.01), primary postoperative complications, including perioperative myocardial infarction, atrial fibrillation, perioperative stroke, acute renal failure, wound infection, and bleeding reoperation did not show significant differences between the two groups (all P>0.05), while total blood transfusion volume, mechanical ventilation time and intensive care unit residence time also showed no significant differences between the two groups (all P>0.05). Conclusion:Simultaneous OPCAB with non-cardiac surgical procedures of moderate-to-severe severity in patients with operative indications are safe and feasible, and are not associated with increased postoperative risks when compared with isolated OPCAB.

Objective To investigate the current situations and influencing factors for comprehensive geriatric assessment (CGA) of knowledge-attitude-practice (KAP) in geriatric ward nurses of a grade Ⅲ class A hospital, and to provide theoretical evidence for training and clinical practice of CGA mode. Methods 190 geriatric ward nurses from a grade Ⅲ class A hospital were selected in this study in February 2017 using convenience sampling. A self-designed geriatric ward nurses CGA questionnaire was used for the investigation. Results A total of 190 questionnaires were issued, and the valid response rate was 96.84% (184/190). The total KAP score was (74.68±7.53), with 6.0%, 90.7%, and 3.3% nurses had excellent, good, and failed scores, respectively. The univariate analyses suggested that nurses who were in the base ward had significantly higher KAP scores compared with nurses who were not (P< 0.05). Those who had received CGA education within one year had significantly higher KAP scores compared with those who had not (P<0.05). The Logistic regression analysis showed that whether in the base ward was associated with KAP in geriatric ward nurses (OR=2.212, P=0.028). Conclusions The knowledge of and cognitive attitude towards CGA are unsatisfactory in geriatric ward nurses, especially the CGA behaviors. The intensive training should be tailored for nurses according to their different characteristics. The quality assessment standard of CGA working mode should be established. Furthermore, the revisit center can be developed to improve the transfer of hospital-community-nursing home / home based on conjoined medical system. The standard CGA method which combined basic examination with detailed assessment is beneficial for elderly patients.

Objective:To investigate whether Lycopi Herba can serve as a viable alternative to Alismatis Rhizoma in the treatment of heart failure (HF) through network pharmacology and molecular docking techniques.Methods:TCMSP database was used to filter active components of Lycopi Herba and Alismatis Rhizoma. SwissTargetPrediction database was used to predict potential targets. HF-related targets were collected from databases such as GeneCards, OMIM, and DisGeNET. Venny 2.1.0 was used to draw a Venn diagram illustrating the intersection of targets between Lycopi Herba and Alismatis Rhizoma and HF. A protein-protein interaction (PPI) network was established using the String database, and key targets for the treatment of HF with Lycopi Herba and Alismatis Rhizoma were selected using Cytoscape 3.9.1 software to construct a component-intersection target network. The intersection targets were then analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways using Metascape. Molecular docking techniques were used to evaluate the affinity between active components and key targets.Results:Lycopi Herba primarily targeted pivotal proteins such as HMGCR and CYP27B1, while Alismatis Rhizoma had a broader target spectrum, including PPARA, JAK2, among others. Shared key targets between the two included HMGCR and ESR1, which were primarily involved in cholesterol synthesis and steroid hormone biosynthesis. Enrichment pathway analysis showed similarities in steroid metabolism between the two; Alismatis Rhizoma, however, was more likely to act through protein phosphorylation regulation and modulating the PI3K-Akt signaling pathway for HF treatment. A unique target for Lycopi Herba in treating HF was CHRM4, indicating its potential for blood pressure regulation and myocardial protection.Conclusions:Both Lycopi Herba and Alismatis Rhizoma exhibit certain commonalities in the treatment of HF, but Alismatis Rhizoma has a wider range of targets and signaling pathways, implying more extensive therapeutic potential. However, considering the nephrotoxicity of Alismatis Rhizoma, Lycopi Herba could be considered as an alternative treatment for HF, especially in patients with renal insufficiency or in the early stages of HF.

To explore the incidence and grade of acute gastrointestinal injury（AGI）in patients with acute stroke，and the influence of gastrointestinal disorders on the mortality of stroke. Methods A total of 103 patients were recruited. According to the National Institutes of Health Stroke Scale（NIHSS）scores，they were divided into two groups：severe stroke patients（n=52）and mild to moderate stroke patients（n=51）.The incidence of gastrointestinal complications in the two groups are calculated. AGI classification was performed according to gastrointestinal symptoms. Binary logistic analysis was used to analyze the influencing factors of gastrointestinal failure in stroke patients，and KM curve was used to evaluate the effect of AGI classification on 28-day mortality in stroke patients. Results The incidence of gastrointestinal complications was 91.3%. There was no significant difference in the incidence of gastrointestinal disorders in the mild to moderate stroke and severe stroke groups（74.5% vs 75.0%，P>0.05）；The severe stroke group showed a higher incidence of gastrointestinal failure（7.8% vs 25.0%，P<0.05）. Multivariate logistic regression analysis showed：elevated NIHSS score was a risk factor for gastrointestinal failure after stroke（P<0.05）.Combining gastrointestinal failure significantly increased the 28-day mortality of stroke patients（χ2=53.08，P<0.001）. Conclusion Gastrointestinal complications are common in patients with acute stroke. NIHSS score is positively correlated with gastrointestinal failure. And patients with gastrointestinal failure have a worse prognosis.