Objective To investigate the structural changes during the early stage of spinal cord injury,and the relationships between these structural changes and patients' motor recovery.Methods The clinical data of 25 patients with spinal cord injury collected from 2012 October to 2014 March were analyzed retrospectively.The spinal cord injury patients were split into two groups (Good recoverers group and Poor recoverers group) according to the clinical outcome of motor recovery at 6 months follow-up,and there were 10 Good recoverers (ASIA grade:1 A,4 B,3 C,and 2 D) and 15 Poor recoverers (ASIA grade:7 A,3 B,3 C,and 2 D).The study also recruited 25 matched healthy controls.The mean age of Good recoverers,Poor recoverers and healthy controls were 37.9± 13.9,35.8± 11.5 and 36.5±9.3,respectively.Structural MRI was used to investigate the regions with brain structural changes among the three groups.Pearson correlation analysis was used to explore the relationships between these structural changes and patients' motor recovery.Results Compared to healthy controls group,both poor recoverers and good recoverers had significantly decreased cortical thickness in the bilateral primary motor cortex.Poor recoverers exhibited more serious and widespread structural damages,in addition to reduced cortical thickness in the primary motor cortex,poor recoverers also showed decreased cortical thickness in the right SMA and premotor cortex when compared to healthy controls.Compared to the healthy controls group,poor recoverers showed reduced white matter volume in the right primary motor cortex and posterior limb of the internal capsule;good recoverers showed no significant difference in white matter microstructure.Furthermore,these structural changes at the internal capsule and primary motor cortex were associated with the motor recovery rate at 6 months follow-up (r=0.75,P＜ 0.001;r=0.76,P＜ 0.001,respectively).Conclusion These findings suggest that spinal cord injury causes significant anatomical changes in the human sensorimotor system in the early phase,and these structural changes directly affect the motor recovery of spinal cord injury.Future treatment aimed at promoting neural function recovery of spinal cord injury patients should pay close attention to the injured brain.

Object To apply the technique of tissue culture to the rapid propagation of Stemona japo-nica (Bl.) Miq. and lay a foundation for the rapid propagation of its improved breeds. Methods The explants used for culture were stem segments with axillary bud of S. japonica. The media were MS basal media containing different plant hormones. Results The results of the study indicated that shoots could be induced successfully in MS medium supplement with 6-BA 3.0 mg/L and IBA 0.2 mg/L, and the better medium for bud multiplication and root inducement were MS+6-BA 3.0 mg/L+IBA 0.3 mg/L and MS+IBA 2.0 mg/L+AgNO 3 0.5 mg/L respectively. After 30 days' culture, the rate of rooting reached over 50%. The survival rate of transplanting was raised obviously by using 20 mg/L carbendazim treatment. Conclusion The primary plant regeneration system of S. japonica has been established, which makes the industrial production possible.

Objective To compare the effect of treating cricopharyngeal achalasia in stroke survivors using transnasal or transoral balloon dilatation.Methods Thirty stroke survivors with cricopharyngeal achalasia were randomly divided into a transnasal and a transoral balloon dilatation group (group N and group O),each of 15.Both groups were given routine swallowing rehabilitation training as well as the transnasal or transoral balloon dilatation.Their heart rate was monitored during the dilatation.Nasal bleeding,mucous membrane swelling and pain were also observed.Their swallowing function was evaluated using the Fujishima Ichiro swallowing efficacy score (FISE) and videofluoroscopy (VFSS) before and after the intervention.Results After the treatment,the average FISE and VFSS scores of both groups had improved significantly comnpared to before the treatment but there were no significant differences between the groups.During the treatment,the average heart rate of group O increased significantly less than that of group N.The treatment acceptance of group O was 98.2％,significantly higher than that of group N (80.1％).One case of mucosal bleeding was observed in group O,and laryngeal edema occurred significantly less often than in group N (9 cases vs.7).The average pain score was also significantly lower in group O.Conclusions Balloon dilatation facilitates swallowing among stroke survivors with cricopharyngeal achalasia.The transoral approach can help to reduce the occurrence of complications such as mucosal bleeding,laryngeal edema and pain,and has better patient acceptance.

Objective: To explore the relationship between depression and life events among junior middle school students in Shanghai, and to provide the scientific reference for the construction of psychology in the schools. Methods: A total of 3 648 junior middle school students were investigated by the Chinese version of the Kutcher Adolescent Depression Scale and Adolescent Self-Rating Life Events Check List(ASLEC) , to measure their depression and life events. χ2 test and multiple stepwise regression analysis were used to analyze the influencing factors of depression. Results: Among 3 648 junior middle school students, 846 were positive for depression, and the detection rate of depression was 23.2%. There was a statistically significant difference in the detection rate of depression among junior middle school students in different grades(χ2=143.24，P<0.01). Study pressure(r=0.54), interpersonal relationship(r=0.54), other(r=0.51), health adaptation(r=0.41), being punished(r=0.40), and loss(r=0.26) in the Adolescent Life Events Scale were positively correlated with depression (P<0.05). Multiple stepwise regression analysis showed that being punished and loss scores had negative association with depression scores(β=-0.10, -0.08). Interpersonal relationships, study pressure, health adaptation and other scores had positive predictive effects on depression scores(β=0.29, 0.26, 0.04, 0.22)(P<0.05). Conclusion There was a wide positive correlation between depression and life events in junior middle school students. Some factors of life events had certain predictive effects on depression of junior middle school students in Shanghai.

Objective:To evaluate the accuracy of lung recruitment maneuver (LRM) combined with brachial artery peak velocity variation (ΔVp) in predicting fluid responsiveness.Methods:Sixty-four patients of both sexes, aged 18-64 yr, with body mass index 19-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with New York Heart Association class Ⅰor Ⅱ, scheduled for elective open gastrointestinal surgery under general anesthesia, were enrolled in this study.LRM (positive airway pressure was maintained at 30 cmH 2O for 10 s) and volume loading test were performed in sequence after anesthesia induction.ΔVp was measured by ultrasonography at the beginning of LRM.Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) and stroke volume (SV) were recorded before LRM (T 1), during LRM (T 2), before volume expansion (T 3) and after volume expansion (T 4). The changing rate of each index before and after LRM (ΔMAP LRM, ΔHR LRM, ΔCVP LRM, ΔSV LRM) and before and after volume expansion (ΔMAP VE, ΔHR VE, ΔCVP VE, ΔSV VE) were calculated.ΔSV VE≥15% was considered to be a positive response after volume expansion, and patients were divided into response group (≥ 15%, R group) and non-response group (< 15%, NR group). Results:There were 34 cases in R group and 30 cases in NR group.Compared with NR group, MAP at T 2 and SV at T 1, 2 were significantly decreased, ΔMAP LRM, ΔMAP VE, ΔSV LRM and ΔSV VE were increased, and ΔVp was increased in group R ( P<0.05). There was a positive correlation between ΔVp and ΔSV VE ( r=0.829, P<0.05), a negative correlation between ΔSV LRM and ΔSV VE ( r=-0.876, P<0.05), and a negative correlation between ΔVp and ΔSV LRM ( r=-0.819, P<0.05). The area under the receiver operating characteristic curve of LRM combined with ΔVp was 0.808, and the cut-off value was 32.3%, the sensitivity 75.3%, and the specificity 88.2%. Conclusion:LRM combined with ΔVp (≥32.3%) can accurately predict the intraoperative fluid responsiveness in patients.

Objective To investigate the occurrence of carotid atherosclerosis in a population of permanent residents (age ≥40 years) at high risk of stroke in Xuejiadao Street,Huangdao District,Qingdao City,and to provide a scientific basis for reduction of carotid atherosclerosis in high-risk communities.Methods Using a cluster sampling method,10 007 permanent residents of age ≥40 years were enrolled in the study.Based on data from an early population screening project,1 478 subjects at high risk of carotid atherosclerosis and stroke were included for analysis.These study subjects were divided into a carotid atherosclerosis risk group and a normal group.General data were recorded,and the results of a physical examination and clinical and biochemical tests were used to analyze risk factors.Results Of 1 478 high-risk subjects aged (58.8± 9.7) years,726 had normal arteries.Of these,264 (36.36％) were males and 462 (63.64％)were females.Carotid atherosclerosis was identified in 752 cases aged (61.4± 9.5) years,with a detection rate of 50.88％.Of these,390 were males (51.86％) and 362 were females (48.14％).Univariate analysis showed that age,male sex,history of heart disease,diabetes,or hypertension,smoking,alcohol intake,waist circumference,and elevated homocysteine and low-density lipoprotein cholesterol levels were positively correlated with carotid atherosclerosis in those at high risk of stroke,while physical exercise showed a negative correlation;these results were statistically significant (P＜0.05).Multiple logistic regression analysis [OR (95％CI)] showed that age [1.621 (1.410-1.865)],male sex [0.474 (0.378-0.594)],history of heart disease [1.336 (1.085-1.645)],diabetes [1.312 (1.021-1.685)],or hypertension [1.408 (1.074-1.846)],and increased low-density lipoprotein cholesterol [1.444 (1.191-1.751)] were positively correlated with carotid atherosclerosis in those at high risk of stroke,while physical exercise [0.810 (0.690-0.950)] showed a negative correlation;these results were statistically significant (P＜0.05).Conclusion Targeting elderly men at high risk of stroke for intervention and guidance to manage hypertension,diabetes,and other chronic diseases,as well as comprehensive preventive and control measures,including reasonable physical exercise,can effectively reduce the occurrence of carotid atherosclerosis in communities.

The actor network theory, with reference to systems science, sociology and management science, offers a new perspective for research of the technology-society binary view. This theory as introduced by the authors, analyzed the constituent bodies and their relationship of the operation of the precise medical service system, and studied the translation process of the actor network. The analysis showed that the main factors affecting the operation of the precision medical service system were hospitals, patients, governments, scientific research institutions, technology-based enterprises, and universities, which were suppliers, demanders, managers, funders, and technical supporters of precision medical services. Among them, 82.72%(335/405) of clinicians believed that hospitals were the core actor that affected the operation of precision medical service system. 71.60%(290/405) of the clinicians thought that the training of medical workers was the current focus of the hospital, i. e., the mandatory access point for this actor network. Through training, the accurate medical service ability of medical workers and hospitals can be improved.

Objective: To explore the persistent viral response rate (SVR) in patients with refractory chronic hepatitis C after interferon (IFN) (peginterferon 360 μg qw) and ribavirin (PR) therapy failure. The SVR of patients with refractory chronic hepatitis C was improved by PR combined with direct antiviral agents (DAA) and proper extension of the course of therapy was applied. Methods: Seventeen cases of refractory chronic hepatitis C after IFN(peginterferon 360 μg qw) and ribavirin therapy failure were given PR combined with DAA treatment. The side effects were observed and corresponding adjustments were made on drug dosage, and SVR was recorded. Results: The 17 cases completed the whole course of treatment with PR combined with DAA for 24 weeks. All the 17 patients obtained rapid viralogical response (RVR) and SVR. After treatment, the SVR rate was 100% in patients including those with virologic relapse, retreated or previously non-responsive patients with refractory chronic hepatitis C. The adverse reaction of PR combined with DAA 24 weeks was generally mild. Conclusions The use of PR combined with DAA re-treatment in patients with refractory chronic hepatitis C can achieve SVR and shorten the treatment time. PR combined with DAA re-therapy is one of effective treatments to improve the rate of sustained viral response in patients with refractory chronic hepatitis C.

Objectives:To analyze the potential biomarkers of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer′s disease (AD) continuum.Methods:A prospective cohort study was consecutively conducted on 179 patients with AD continuum (135 presented with BPSD, 44 patients without BPSD as control) from Capital Medical University, Beijing Tiantan Hospital, the Chinese imaging biomarkers and lifestyle cohort between January 1, 2021 and December 31, 2022. Gender, age, body max index, education level, diagnosis, the apolipoprotein E epsilon4 allele (APOE ε4) carrier status, the scores of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), cerebrospinal fluid (CSF) AD-related pathological biomarkers (Aβ 42, Aβ 40, Aβ 42/40, tTau, pTau181), and blood biomarkers (white blood cell count, red blood cell count, hemoglobin, platelet, total bilirubin, albumin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting glucose, erythrocyte sedimentation rate, homocysteine, vitamin B 12, folate) were compared between the two groups by using hypothesis testing and univariate logistic regression analysis. Multivariate logistic regression analysis was used to analyze the potential biomarkers associated with BPSD in patients with AD. Results:Among the 179 patients with AD continuum in the final analysis, 77 patients were men, 102 cases were women; 35 patients were identified with mild cognitive impairment (MCI) due to AD and 144 patients with AD dementia stage, the mean age was (66.54±9.75) years. Compared with those in control group, patients with BPSD had lower cerebrospinal fluid (CSF) Aβ 40 and blood hemoglobin levels [7.08 (4.42, 15.42) vs 9.62 (6.45, 12.12) pg/L, (132.70±13.37) vs (138.80±14.38) g/L] ( U=-1.856, t=2.579, P<0.05). The levels of CSF Aβ 40 ( OR=0.030, 95% CI: 0.001-0.760) and blood hemoglobin ( OR=0.051, 95% CI: 0.004-0.670) were independently negatively associated with BPSD in patients with AD continuum (both P<0.05). Conclusion:The decreased levels of CSF Aβ 40 and blood hemoglobin could be considered as potential biomarkers in detecting BPSD in patients with AD continuum.

This article summarized the clinical experience of Professor AI Rudi in staged treatment according to pattern differentiation of systemic lupus erythematosus （SLE）. It is believed that SLE is characterized by kidney yin deficiency and heat toxin obstruction as the core disease mechanism. The staged treatment principle is to nourish yin and clear heat， invigorate blood and resolve toxins. In the early stage of heat toxins accumulation， the focus is on treating the branch and strengthen the kidneys as early as possible， recommending self-designed Liangxue Xiaofeng Powder （凉血消风散） with modifications. In the middle stage， there is yin deficiency with internal heat， which requires nourishing kidney yin and eliminating pathogenic factors. The prescription suggested is self-designed Shouwu Dihuang Decoction （首乌地黄汤）. In the late stage， there is yin impairment affecting yang， which requires a gradual consolidation of the foundation and harmonization of yin and yang， usually with Zhenwu Decoction （真武汤） and Zishen Tongguan Powder （滋肾通关散） with modifications. At the same time， the treatment emphasizes the integration of Chinese and Western medicine， and use of self-designed Ershen Dihuang Pill （二参地黄丸） after initial remission to consolidate the effect and prevent relapse. External treatment should also be given importance to， and Hongyou Ointment （红油膏） can be used to treat SLE skin lesions， reduce swelling， and relieve pain.