Objective:To evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cellular immune function in the patients undergoing posterior spinal internal fixation.Methods:Ninety patients, aged 40-70 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective posterior spinal internal fixation in our hospital, were divided into 2 groups ( n=45 each) using a computer-generated table of random numbers: routine group and experiment group.Total intravenous anesthesia was used in routine group, while total intravenous anesthesia combined with TEAS was applied in experiment group.In experiment group, bilateral Zusanli and Sanyinjiao acupoints were stimulated with 2/15 Hz disperse-dense waves at the intensity that could be tolerated by patients at 30 min before induction of anesthesia, maintaining with 2/100 Hz disperse-dense waves from the end of induction until the end of operation at the same stimulation intensity before induction.Bilateral Neiguan and Taichong acupoints were stimulated for 30 min each time with 2/15Hz disperse-dense waves once a day at 1st-4th days after operation.In routine group, the electrodes were connected at the same time period, but no stimulation was given.Venous blood samples were collected before induction of anesthesia, at 1 h after surgery, and on 1st, 3rd, and 5th days after surgery, and the percentage of CD3 + , CD4 + , CD8 + T lymphocytes, CD4 + /CD8 + ratio, WBC count and percentage of neutrophils (NE%) were determined by flow cytometry, and the consumption of intraoperative anesthetics, use of postoperative analgesics, nausea and vomiting, dizziness, infection and length of hospital stay were recorded. Results:Compared with routine group, the total consumption and consumption index of remifentanil were significantly decreased, the percentage of CD3 + T lymphocytes was increased on 3rd and 5th postoperative days, the NE% was decreased on 1st postoperative day, and the incidence of dizziness was decreased ( P<0.05), and no significant change was found in the other indicators in experiment group ( P>0.05). Conclusions:Perioperative TEAS can improve postoperative cellular immune function and has a certain potential value in preventing postoperative infection in the patients undergoing posterior spinal internal fixation.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To investigate the effectiveness of CT angiography (CTA) combined with three-dimensional modeling-assisted design of superficial peroneal artery perforator flap for reconstruction of traumatic hand wound.Methods:A retrospective case series study was conducted to analyze the clinical data of 15 patients with hand injury admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2016 to December 2019. There were 11 males and 4 females, aged 19-51 years [(27.8±8.1)years]. All patients had soft tissue defect of the hand with exposed bone or tendon, and the defect area ranged from 2.0 cm×1.0 cm to 6.0 cm×4.0 cm. All patients underwent CTA of the abdominal aorta to dorsalis pedis artery before surgery. The three-dimensional models of bones, blood vessels, skin and other tissues were reconstructed by Mimics 20.0 software. The location, diameter and length of the superficial peroneal artery perforator vessels were accurately measured, and the perforator flap was designed according to the shape and size of the defect, then the resection of flap was simulated. During the operation, the superficial peroneal artery perforator flap was removed and transplanted to repair the defect according to the design. The location, diameter and length of perforator vessels were measured intraoperatively and compared with the preoperative modeling measurement. The operation time and intraoperative blood loss were recorded. The survival of the flap and healing of the donor site were observed after operation. The function of the affected limb was evaluated according to the upper limb function evaluation standard of Chinese Medical Association before and 3 months after surgery. The appearance, sensation and motion of the donor site were observed 3 months after surgery.Results:The origin and course of superficial peroneal artery perforator vessels could be clarified preoperatively based on the three-dimensional model. There was no significant difference in the location, diameter and length of perforator vessels between the pre- and intra-operative measurements ( P>0.05). All patients were followed up for 6-20 months [(12.2±3.8)months]. The operation duration was 50-125 minutes [(91.2±10.4)minutes], with blood loss of 150-450 ml [(364.1±44.7)ml]. The partial epidermal necrosis occurred in 2 patients after surgery, which gradually healed after dressing change, and other flaps survived smoothly. All donor sites could be sutured directly, and all incisions healed by first intention. According to the upper limb function evaluation standard of the Chinese Medical Association, the affected limb scored (76.4±9.7)points 3 months after surgery, higher than the preoperative score of (48.2±10.1)points ( P<0.05). The results were excellent in 8 patients, good in 6 and fair in 1, with the excellent and good rate of 93%. All patients had slight scar growth in donor sites and showed no obvious abnormalities in the sensation of foot dorsum and donor sites, with normal walking gait. Conclusion:CT angiography combined with three-dimensional modeling can accurately locate the perforating vessels, realize the individualized and precise design of the superficial peroneal artery perforator flap, and assist in the rapid and accurate flap resection, and hence promote wound healing and functional recovery of the hand.

Objective:To evaluate the accuracy of ultrasound-measured airway indicators in predicting difficult laryngoscopy.Methods:A total of 104 American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-70 yr, undergoing elective operation under general anesthesia, were selected.The airway was evaluated before induction of anesthesia, body mass index (BMI), neck circumference, mouth opening, thyromental distance and modified Mallampati classification were recorded, and mandibular condylar mobility, distance from skin to under surface of tongue, hyomental distance and distance from skin to epiglottis were measured by ultrasound.Anesthesia induction was performed after the end of measurement, and direct laryngoscopy was performed after mask pressure ventilation.Cormack-Lehane (CL) grade was recorded, and difficult laryngoscopy was defined as CL grade≥2b.The patients were divided into non-difficult laryngoscopy group (group NDL) and difficult laryngoscopy group (group DL) according to the view obtainable during laryngoscopy.The factors of which P values less than 0.05 would enter the logistic regression analysis.The accuracy of each index in predicting difficult laryngoscopy was evaluated using the area under the receiver operating characteristic curve (AUC) and 95% confidence interval (CI). The critical value was determined according to Youden index, and the sensitivity and specificity were calculated. Results:Compared with NDL group, BMI, depth of epiglottis and the incidence of modified Mallampti≥grade Ⅲ were significantly increased, and the mouth opening and thyromental distance were decreased in goup DL ( P<0.05). The AUC (95%CI) of modified Mallampti classification and the depth of epiglottis for difficult laryngoscopy prediction were 0.728 (0.619-0.836) and 0.833 (0.743-0.924), respectively.When the critical value of depth of epiglottis was 2.125 cm, the sensitivity and specificity of predicting difficult laryngoscopy were 65.71% and 89.86%, respectively. Conclusion:Ultrasound-measured depth of epiglottis can accurately predict the difficult laryngoscopy.

Objective To explore the association between BMI and the risk of developing cardiac surgery associated acute kidney injury (CS-AKI),mortality of AKI and AKI requiring renal replacement therapy (AKI-RRT) after cardiac surgery.Methods Clinical data of patients undergoing cardiac surgery from January 2011 to December 2015 in Zhongshan Hospital of Fudan University were prospectively collected.Patients were divided into four groups according to BMI classification of Chinese population.Adjustment for selection bias was further assessed using propensity score method (PSM) to evaluate the role of BMI in the development of AKI.Results A total of 8442 patients were enrolled,among which 1092 patients successfully matched through PSM.The AKI incidences were respectively 30.3％,33.3％,38.6％ and 46.8％ in four BMI groups (P ＜ 0.01) before PSM.The AKI incidences were respectively 31.9％,35.2％,42.5％ and 42.9％ in four BMI groups (P=0.016) after PSM.The risk of developing AKI increased by 19.9％ as the BMI increased per 5 kg/m2 (95％ CI:1.070-1.344,P=0.002).The hospital mortality of patient (overall,AKI,AKI-RRT) in four groups was not statistically different after PSM (P ＞ 0.05),but overweight group always had the lowest mortality.Conclusions BMI is a risk factor for AKI after cardiac surgery,and the AKI incidence increases with increasing BMI in a certain range.

Objective To investigate the effects of low-fat diet or statin intervention at early age on brain amyloid β-protein (Aβ) pathology and behaviors of middle-aged Tg2576 mice.Methods Thirty-five two-month-old Tg2576 mice were randomly divided into following 5 groups:a juvenile statin group,a juvenile low-fat diet group,a young statin group,a young low-fat group,and a blank control group (n=7);mice in the low-fat diet groups were given standard low-fat feed,and mice in the statin group were given atorvastatin at 17 mg/(kg· d) into the normal diet.The initiation times of intervention were,respectively,set to be 2-month-old in juvenile groups and 6-month-old in young groups;meanwhile,mice in the blank-control group were fed with normal diet without statin.All mice were raised to be 10-month-old and tested by Morris water maze for evaluating cognitive behaviors two weeks before execution.After peripheral blood and brains being taken,a monoclonal anti-Aβ42 antibody was employed to immunostain mice brain paraffin tissue sections for assaying tissue Aβ plaque immunoreactivity (TAPIR),and the levels of Aβ40,Aβ42,β-secretase,and γ-secretase in homogenates were detected by enzyme-linked immunosorbent assays (ELISA).Results As compared with those in the blank-control group,the average escape latencies,times of passing through hidden platforms,percentage of strong TAPIR,Aβ42 and γ-secretase level in all intervention groups showed no statistical differences (P＞0.05).As compared with those in the blank control group,Aβ42 in homogenates of young intervention groups and β-secretase level in the young statin group were significantly higher (P＜0.05).Conclusion Interventions initiated from juvenile or young,and low-fat diet intervention or statin intervention can neither improve the mice's Morris water maze testing results,nor reduce Aβs burdens in brain homogenates and Aβ40 immunopathologies in brain tissues of middle-aged mice;over early initiation of low-fat diet intervention or statin intervention might accelerate or worsen Alzheimer's disease progress.

Objective:To test the effects of natural lactobacillus bio-products on lipid metabolism and intestinal microflora.Method:A hyperlipidemia mouse model system was developed.30 hyperlipidemia mice were randomly divided into three equal groups,i.e,saline water (control treatment),lactobacillus cocktail,and simvastatin.Mice were injected daily with saline water,lactobacillus (L.plantarum,L.acidophilus and L.casei,mixture in equal volume),and simvastatin solution,respectively.Result:Significant lower total cholesterol (TC),triglyceride (TG),and low-density lipoprotein cholesterol (LDL-C) were found in the blood serum from mice treated with lactobacillus and pharmaceutical simvastatin.CFUs (colony forming unity) of lactobacillus were much higher (P ＜ 0.05),whereas CFUs of Escherichia coli and Enterococcus faecalis were much lower (P＜ 0.05 and P＜ 0.05,respectively) in mice feces of treated by lactobacillus compared to pharmaceutical simvastatin.Conclusion:Lactobacillus probiotics reduced levels of cholesterolemia,increased CFUs of lactobacillus and reduced CFUs of E.coli and E.faecalis in gut.

Objective To investigate the assessment value of multimodal CT examination for collateral circulation after cerebral ischemia. Methods Within 3 days of admission,39 patients with ischemic stroke received multimodal CT examinations,including CT scan,CT perfusion (CTP)imaging,and CT angiography (CTA). The postprocessing software of the German SIEMENS 64-slice spiral CT system was used to evaluate the state of brain tissue perfusion and the conditions of head blood vessels of the subjects. The cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP) and the score of the modified Rankin scale (mRS)in the 90 d after discharge were compared between the patients with good collateral circulation and poor collateral circulation. Results Among 39 patients, multimodal CT examination revealed that 2 patients were negative,one of them was followed up by head MR and was clinically proven as transient ischemic attack,and the other was lacunar infarction. Thirty-seven patients were positive. Multimodal CT examination found 24 patients had offending vessels occlusion and/or stenosis on the lesion sides,the collateral circulation formation in 11 of them was observed on the lesion sides;another 13 patients had poor collateral circulation on the lesion sides. The comparison of lesion sides and contralateral sides,the patients with good collateral circulation showed the CBF decreased (t= -5. 92),the MTT and TTP prolonged (t=4. 27 and 3. 17 respectively). There were significant differences (all P<0. 01). The CBV and CBF in patients with poor collateral circulation were decreased significantly (t= -14.27 and-14.82 respectively),MTT and TTP prolonged (t=7. 26 and 7. 54 respectively). There were significant differences (all P <0. 01). There were significant differences in CBF,CBV,and TTP on the lesion sides between the two groups of patients (t=3. 24,4. 11,and -2. 34,respectively;all P<0. 05). The 90 d mRS scores for patients with good collateral circulation and poor collateral circulation were 1. 3 ± 0.6 and 4. 0 ± 0. 9 respectively. There was significant difference (t = -8. 29,P <0. 01). The patients of having collateral circulation formation had good prognosis. Conclusion Multimodal CT examination has certain clinical significance for evaluation of cerebral perfusion state,understanding the establishment or patency of cerebral collateral circulation,and determining the clinical prognosis.