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 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 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 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 explore specific magnetic resonance imaging(MRI)features of somatic symptoms in depression by comparing the differences of brain gray matter volume in depression patients with and without somatic symptoms using voxel-based morphometry(VBM).Methods A total of 52 depression patients were recruited and divided into somatic and no somatic symptoms group according to the patient health questionnaire-15 score(＞9 and≤9,respectively).Forty gender-age-matched healthy volunteers were recruited as the control group.All subjects underwent MRI scanning.Imaging data were analyzed to explore the differences in brain gray matter between groups using VBM.Results Compared with control group,gray matter volume increased in the right superior temporal gyrus,and decreased in the right inferior orbitofrontal gyrus,right inferior temporal gyrus,left inferior orbitofrontal gyrus,and left superior temporal gyrus for depressive patients with somatic symptoms(P＜0.001);gray matter volume increased in the right middle temporal gyrus,and decreased in the right superior temporal gyrus and right inferior temporal gyrus for depressive patients without somatic symptoms(P＜0.001).Only the volume in the right tongue and left cingulate gyrus increased in depressive patients with somatic symptoms compared with that in patients without somatic symptoms(P＜0.01).Conclusion VBM-MRI has demonstrated increased volume in the tongue and cingulate gyrus in the somatic symptoms of depression.

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.

OBJECTIVES: This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9,179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status. RESULTS: Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07 to 1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07 to 1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08 to 1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01 to 1.52), emotional abuse (OR, 1.28; 95% CI, 1.12 to 1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09 to 1.43) were associated with diabetes. CONCLUSIONS ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.