cerebral small vessel disease refers to the small vessel lesion and the resulting changes in the cerebral tissue.Both the small vessels detected by cerebrovascular reserve and the lesion of cerebral small vessel disease are in the same segment,so we can take advantage of cerebrovascular reserve as means to inspect and evaluate the small vessel lesion itself.

Aim To investigate the Yiqi Yangyin Qingre Oral Liquid(YYQ) on insulin resistance in hyperglycemic fatty rats.Methods The model of hyperglycemic fatty rats was induced by intravenous injection with a low dose of streptozotocin(STZ) and a fed high fat and high caloric diet.The YYQ was given via gavage for a period of 4 weeks.The fasting blood glucose(FBG),oral glucose tolerance(OGT),serum insulin(INS),triglyceride(TG),total cholesterol(TC),free fatty acid(FFA)levels,glucose infusion rate(GIR) by euglycemic hyperinsulinemic clamp technique as well as erythrocyte insulin receptors(INSR)of rats were tested when the experiment was finished.The weight of the epididymal fat pads and the perirenal fat pads were measured.The IR,IRS-1mRNA expressions in liver tissue were measured by RT-PCR technology.Results YYQ treatment decreased the levels of FBG,TC,TG,LDL-C,FFA and increased the level of HDL-C in hyperglycemic fatty rats.As compared with the model rats,glucose tolerance was improved and body weight was reduced in hyperglycemic fatty rats treated with YYQ.Moreover,YYQ treatment upregulated IR,IRS-1mRNA expressions in liver tissue and increased insulin receptor amounts on the erythrocytes surface as well as GIR in the hyperinsulinemic euglycemic clamp experiment.Conclusions YYQ ameliorated insulin resistance in hyperglycemic fatty rats,and its mechanism might be related to increment of INSR and stimulation of insulin pathway.

Objective To investigate the effects of apolipoprotein E (ApoE) deficiency on neuromyelitis optica (NMO) model of spinal cord sections induced by NMO-IgG and complement in vitro.Methods NMO-IgG was extracted from the patients with NMO,and complementary serum from healthy people.The spinal cord sections of seven days old C57BL / 6J mice with wild type (WT) or ApoE knockout (ApoE-/-) were cultured for seven days.The spinal cords of the two genotypes were randomly divided into experimental groups (NMO-ApoE-/-group,NMO-WT group) and control groups (C-AopE-/-group,C-WT group),respectively.The experimental groups were treated with NMO-IgG and complementary serum,and the control groups only with complementary serum.Then all the sections were continued incubating for 24 h before harvested.Immunofluorescence staining and modified thick tissue film immunofluorescence were used to detect the expression of aquaporin 4 (AQP4),glial fibrillary acidic protein (GFAP),ionic calcium fibronectin (IBA1),myelin basic protein (MBP) and human neurofilament protein L (NFL) respectively.The lesion score was calculated according to the areas percentage of AQP4 and GFAP deficiency in spinal cord sections.Results Compared with the respective control groups,the expressions of AQP4,GFAP,MBP and NFL were deficient in the experimental groups (The percentages of missing area in the NMO-ApoE-/-group were 83.88％ ± 5.01％,82.44％ ± 6.11％,45.02％ ± 5.11％ and 54.65％ ± 7.66％ respectively,while the percentages of missing area in the C-ApoE-/-group were 10.44％ ± 4.07％,5.73％ ±0.82％,9.12％ ±1.41％ and 5.72％ ±0.81％,t=34.143,37.269,20.300,19.051,allP ＜0.05;The percentages of missing area in the NMO-WT group were 77.74％ ± 6.75％,75.62％ ± 5.76％,37.60％ ± 4.88％ and 46.29％ ± 4.98％,while the percentages of missing area in the C-WT group were 9.31％ ± 2.97％,5.80％ ± 0.82％,9.10％ ± 1.63％,5.80％ ± 0.81％ respectively,t =27.828,35.934,16.613,24.057,all P ＜ 0.05).While IBA1 was up-regulated and the damage scores were higher in both the NMO-ApoE-/-group and the NMO-WT group.The percentages of missing area in the NMO-ApoE-/-group and the NMO-WT group showed statistically significant difference (t =2.194,2.436,3.149,2.746,all P ＜ 0.05).The expression level of IBA1 in the NMO-WT group was higher than that in the C-WT group (19.88 ± 1.11 vs 11.18 ±0.65,t =25.270,P ＜0.05),while the expression level of IBA1 in the NMO-ApoE-/-group was higher than that in the NMO-WT group (25.81 ± 1.61 vs 19.88 ± 1.11,t =9.101,P ＜0.05).The degree of deficiency or up-regulation of above-mentioned proteins was more obvious in the NMO-ApoE-/-group than that in the NMO-WT group.Conclusions NMO-IgG extracted from NMO patients can induce NMO-like damage in isolated tissue at the presence of complement.ApoE deficiency promotes the further activation of microglia,thereby aggravates the injury of astrocyte in the model of NMO.

Objective:To evaluate the efficacy and toxicity of single-agent bendamustine in patients with indolent B-cell non-Hodgkin's lymphoma (NHL) refractory to rituximab. Methods:Between April 2010 and April 2013, 100 patients with rituximab-refrac-tory indolent B-cell NHL from 8 institutions were enrolled. Bendamustine was administered at 120 mg/m2 on days 1 and 2 every 21 days for 6-8 cycles. The primary endpoint was the overall response rate (ORR). The secondary endpoints included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety. Results:One hundred patients with a median age of 56 (rang-ing from 28 to 74) years were recruited in this clinical study. The total number of chemotherapy was 447 cycles, and the median number was 4 cycles. Ninety-three patients could be evaluated for efficacy. Fifteen patients (16.1%) had complete remission (CR), 52 (55.9%) had partial remission (PR), 22 (23.7%) had stable disease (SD), and 4 (4.3%) had progression disease (PD). The ORR and DCR were 72%and 95.7%, respectively. After a median follow-up of 26.6 months (ranging from 2 to 48.4 months), 59 patients (63.4%) had PD.The median PFS was 8.53 (95%CI:6.518-10.542) months, and PFS rate for 1 year was (40.6±5.3)%. Forty-eight patients (48%) had 3/4 grade adverse events, including leucopenia (26%), neutropenia (24%), and anemia (11%). Conclusion:Single-agent bendamustine produced a high rate of objective responses in patients with rituximab-refractory indolent B-cell NHL and could be one of the new op-tions for second-line treatment of these patients. The most common adverse event is hematologic toxicity.

Objective To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.Methods Fifty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 35-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic radical resection of colorectal cancer,were selected and divided into 2 groups (n =28 each) using a random number table method:general anesthesia group (group G) and TEAS combined with general anesthesia group (group TG).In group TG,patients received continuous TEAS at bilateral Neiguan,Hegu,Zusanli,Shangjuxu and Xiajuxu acupoints from 30 min before anesthesia induction until the end of surgery,with a frequency 2/100HZ,disperse dense waves,intensity the maximum current that could be tolerated (3-8 mA).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia in both groups.Peripheral venous blood samples were collected when entering the operating room (T1),at the end of operation (T2),and at 24 and 72 h after operation (T3,4) for determination of intestinal fatty acid binding protein (I-FABP) and diamine oxidase (DAO) in palsma using enzyme-linked immunosorbent assay.Quality of Recovery-9 (QoR9) was used to assess the postoperative quality of recovery at 24 h before surgery (T0),T3 and T4.Results The concentrations of plasma I-FABP and DAO were significantly higher at T2 and T3 than at T1 in G and TG groups (P＜0.05).Compared with the baseline at T0,QoR-9 scores were significantly decreased at T3 and T4 in G and TG groups (P＜0.05).Compared with group G,the concentrations of plasma I-FABP at T2-T4 and DAO at T2 and T3 were significantly decreased,and QoR-9 scores were increased at T3 and T4 in group TG (P＜0.05).Conclusion TEAS can attenuate intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.

Objective:To investigate the predictive values of baseline hematoma mean CT value and shape regularity (SR) for hematoma enlargement (HE) in patients with spontaneous intracerebral hemorrhage (ICH).Methods:Patients with ICH admitted to Yulin First Hospital from June 2018 to December 2021 were retrospectively included. The first head CT scan was performed within 24 h of onset, and the second head CT scan was performed within 72 h of the first scan. HE was defined as an increase in hematoma volume of at least 6 ml or 33% from the first CT. 3D Slicer software was used to reconstruct 3D images and SR was calculated. Multivariate logistic regression analysis was used to determine the independent factor for HE. Receiver operator characteristic (ROC) curve was used to evaluate the predictive value of baseline hematoma mean CT value for HE. Results:A total of 249 patients with ICH were enrolled, including 134 males (53.8%), and aged 62.2±12.1 years. The median baseline Glasgow Coma Scale score was 12, and the median time from onset to first CT scan was 3.1 h. The median baseline hematoma volume was 10.9 ml, and 58 patients (23.3%) showed HE. The baseline hematoma mean CT value in the HE group (58.5±3.2 HU vs. 60.3±3.3 HU; P<0.01) and baseline SR (0.615±0.146 vs. 0.688±0.100; P<0.001) were significantly lower in the non-HE group. Multivariate logistic regression analysis showed that the time from onset to first CT scan (odds ratio [ OR] 0.867, 95% confidence interval [ CI] 0.786-0.957; P=0.004), the baseline hematoma volume ( OR 1.050, 95% CI 1.028-1.073; P<0.001), and the baseline hematoma mean CT value ( OR 0.809, 95% CI 0.725-0.902; P<0.001) were the independent predictors of HE, while the baseline SR had no significant independent correlation with HE. ROC curve analysis showed that the area under the curve of baseline hematoma mean CT value for predicting HE was 0.652 (95% CI 0.573-0.731; P<0.001), with an optimal cutoff value of 57.97 HU. The sensitivity and specificity for predicting HE were 50% and 75.9%, respectively. Conclusion:The baseline hematoma mean CT value is an independent factor for HE in patients with ICH and has certain predictive value for HE.

Objective To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. Methods This prospective observational study included 1538 children and adolescents (aged < 18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95％ CI. Results Of the 1538 patients, CTs were obtained for 339 patients (22.04％). Forty-nine patients (3.19％) had positive CT results, 8 patients (0.52％) underwent neurosurgery, 2 patients (0.13％) died, and 1 patient (0.07％) may be missed. In this study, CHALICE was applied for 1394 children (90.70％; 95％ CI: 89.24％-92.15％), PECARN for 801 children (52.11％; 95％ CI: 49.62％-54.61％), and CATCH for 325 patients (21.15％; 95％CI: 19.10％-23.19％). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6％(74.2％-98.7％), 100％ (56.1％-100％), and 85.7％ (42.0％-99.2％), respectively; the specificities were 78.1％(75.7％-80.2％), 48.0％ (44.5％-51.5％) and 70.8％ (65.4％-75.6％); positive predictive value were 7.7％ (5.1％-11.3％), 0.9％ (0.4％-1.9％) and 6.1％ (2.5％-13.2％); and negative predictive value were 99.8％ (99.2％-100％), 99.1％ (98.1％-99.6％), and 99.6％ (97.2％-100％), respectively. Conclusions The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice.

OBJECTIVE: To enhance the safety of nasal endoscopic surgery and decrease its complications of eyes. METHOD: Three patients of chronic rhinosinusitis and nasal polyposis with lipogranulomas of the eyelids after nasal endoscopic surgery and nasal packing of petrolatum gauze were reported and analyzed, and their treatment results were presented during the last 2 years. RESULT: The medial orbital wall injury occurred in all three patients during endoscopic sinus surgery. The patients developed an ipsilateral periocular swelling, eyelid hematoma and palpebral conjunctival edema during 2 to 3 hours after surgery. Nasal packs petrolatum gauze were removed 10-24 hours after surgery. The patients were discharged from hospital when periorbital swelling and eyelid ecchymoma disappeared, and nasal cavity obstruction was improved 6 to 8 days after surgery. The swelling and nodular mass of ipsilateral eyelids (one in left upper eyelid and two in right lower eyelid) were found 12-15 days after surgery, and their eye movement and eyesight were normal. Antibiotic and corticosteroid were administered for 3 4 weeks with only improvement in eyelid swelling. These masses of eyelids were completely excised through palpebral margin 1-6 months after surgery. The histopathological examination of the surgical specimens showed lipogranuloma. No recurrence and symptom of the eyes had been observed during 4-18 months follow up. CONCLUSION The lipogranuloma of the eyelid is a rare and late complication after nasal endoscopic surgery and nasal packing with vaspetrolatum gauze. The medial orbital wall injury and bleeding during surgery, and vaseline of nasal packing permeated into the eyelid are the direct causes of this complication. The application of petrolatum gauze should be avoided when the medial orbital wall trauma is identified. The complete excision of granulomas is a best effective therapy.
Adult ; Endoscopy ; adverse effects ; Eyelid Diseases ; diagnosis ; etiology ; therapy ; Female ; Granuloma ; diagnosis ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; therapy

ObjectiveTo observe the clinical efficacy of compound Huangbai liquid fomentation on diabetic foot ulcer of Wagner grade 1-2. MethodPatients were classified into the observation group and control group， with 41 cases in either group. The observation group received routine therapy and compound Huangbai liquid fomentation， while the control group was treated by routine therapy and medical silver nanoparticles-containing dressing. Ulcer area， ulcer depth， traditional Chinese medicine （TCM） syndrome score， ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， epidermal growth factor， advanced glycation end product， high-sensitivity C-reactive protein， interleukin-6， erythrocyte sedimentation rate， and adverse events were observed before and after treatment in two groups. ResultAfter treatment， the ulcer area， ulcer depth， TCM syndrome score， vascular endothelial growth factor， epidermal growth factor， advanced glycation end product， high-sensitivity C-reactive protein， interleukin-6（IL-6）， and erythrocyte sedimentation rate were lower than those before treatment in two groups （P<0.05）， and ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， and epidermal growth factor were higher than those before treatment in two groups （P<0.05）. After treatment， the ulcer area， ulcer depth， TCM syndrome score， advanced glycation end product， high-sensitivity C-reactive protein， IL-6， and erythrocyte sedimentation rate were lower in the observation group than in the control group （P<0.05）， and ankle-brachial index， transcutaneous oxygen pressure， vascular endothelial growth factor， and epidermal growth factor were higher in the observation group than in the control group （P<0.05）. The clinical efficacy of observation group was better than that of the control group （P<0.05）. There was no significant difference in the incidence of adverse events and endpoint events between two groups. ConclusionCompound Huangbai liquid fomentation is effective for diabetic foot ulcer of Wagner grade 1-2， as it is beneficial to the healing of the ulcer. This study provides clinical evidence for the further promotion of Chinese medicine fomentation.