Objective To evaluate the brain function and predict the prognosis of hypoxic encephalopathy with multimodal evoked potentials. Methods Short-latency somatosensory evoked potential(SLSEP )and Brainstem auditory evoked potential( BAEP) were used to monitor 44 coma patients caused by post-cardiopulmonary resuscitation, hypotension and (or) hypoxemia, to compare simple modalities, multimodalities,and simple modalities with multimodalities according to Judson, Hall, Cant, Haupt standard. Results Simple modal and multimodal grading standards were closely related to the prognosis, the higher the grade, the poorer the prognosis . The accuracy of SLSEP (Judson standard is 84.1% )was higher than that of BAEP (Hall standard is 79.5%);and the accuracy of multimodal evoked potentials (Cant standard is 88.4%) was higher than that of the simple modality. Conclusion Multimodal evoked potentials might better indicate the degree of brain function of hypoxic encephalopathy. Cant standard might be easily carried out, which might highly show the accuracy of the prognosis, and suitably to be spread and applied in work.

Objective To determine the long-term changes in optic disc parameter and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and macular retina after acute primary angle closure.Methods Prospective clinical case-control study.A total of 26 patients (30 eyes) with acute primary angleclosure glaucoma (APACG) were in the APACG group,whose intraocular pressure were control after a single episode acute primary angle closure;30 age-and sex-matched healthy subjects (30 eyes) in the control group.All subjects underwent three dimensional optical coherence tomography (3D-OCT) examination with 3D optic disk scanning or circle optic disk scanning and 6 mm× 6 mm macular scanning.The parameters included average thickness of entire CP-RNFL,thickness of nasal,superior,temporal and inferior quadrant of CP-RNFL,disc area,disc cup area,rim area,cup/disc (C/D) area ratio,C/D horizontal diameter ratio and C/D vertical diameter ratio.The foveal retinal thickness,center retinal thickness (≤ 1 mm from the fovea),4 quadrants of macular inner-ring (＞ 1 mm but ≤3 mm from the fovea) retinal thickness,4 quadrants of macular outer-ring (＞3 mm but ≤6 mm from the fovea) retinal thickness,average thickness of macular retinal thickness and macular volume were measured and analyzed.Results The disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio and C/D vertical diameter ratio in APACG group were significantly bigger than the control group (t=3.22,4.12,3.90,3.00,3.23;P＜0.05),rim area was smaller than the control group (t=-2.63,P＜0.05).The average thickness (t=-6.68) and the thickness of superior (t =-5.90),temporal (t =-11.64) and inferior (t =-5.06) quadrants of CP-RNFL,center retinal thickness (t=-2.50),4 quadrants of macular inner-ring retinal thickness (t=-4.91,-4.88,-2.83,-3.59),nasal (t=-2.13) and superior (t=-2.49) quadrants of macular outerring retinal thickness as well as average thickness of macular retinal thickness (t=-2.65) were significantly thinner than the control group (P＜0.05),and the macular volume (t=-2.69) was significantly smaller than the control group (P＜0.05).There was no statistically difference at nasal CP-RNFL (t=-0.11),foveal retinal thickness (t=-0.59),temporal (t=-0.67) and inferior (t=-1.02) quadrants of macular outer-ring retinal thickness between two groups (P＞0.05).Conclusions In comparison with the healthy subjects,the disc area,disc cup area,C/D area ratio,C/D horizontal diameter ratio,C/D vertical diameter ratio in APACG eyes were bigger,while rim area was smaller;the CP-RNFL and macular retinal thickness were thinner except nasal CP-RNFL,fovea,temporal and inferior quadrants of macular outer-ring retinal.

Objective To analyze the clinical characteristics and risk factors of patients with confirmed venous thromboembolism (VTE) in order to improve recognition of VTE, and reduce the rate of missed diagnosis and wrong diagnosis. Methods A retrospectively review was performed for 205 patients diagnosed with VTE confirmed by CT pulmonary angiography (CTPA), radionuclide pulmonary ventilation/perfusion (V/Q) imaging, lower extremity deep vein ultrasound or venography in the First Affiliated Hospital of Bengbu Medical College from January 2009 to December 2018. The clinical manifestations, laboratory examination results, imaging results, treatment and prognosis of patients diagnosed with VTE were analyzed. The clinical possibility was assessed by pulmonary thromboembolism (PTE) simplified Wells score and deep venous thrombosis (DVT) Wells score. 130 non-VTE patients admitted in the same period were enrolled as controls, and the risk factors of VTE were screened by multivariate Logistic regression analysis. Results Among 205 VTE patients, 14 cases had incomplete data, 2 cases were complicated with other diseases deteriorated, 2 cases were excluded because of economic reasons, 10 cases abandoned treatment because of serious illness, and finally 177 cases were included in the analysis. The main clinical symptoms of VTE patients were chest tightness (36.16%), followed by chest pain (29.94%), dyspnea (29.38%) and hemoptysis (24.29%). Swelling or tenderness of unilateral/bilateral lower extremities (38.98%) and lung moist rale (20.90%) were the most common signs. ST-T changes were the main changes in electrocardiogram (ECG, 49.15%), followed by SⅠQⅢTⅢ or QⅢTⅢ changes (35.03%). Only 5.65% of the patients had plasma D-dimer less than 0.5 mg/L. 31.07% (55/177) patients had normal arterial blood gas results. Of the 177 VTE patients, 175 were diagnosed as PTE by CTPA, with bilateral/multi-lobar pulmonary artery embolism and its branches being the main type [44.57% (78/175)]. Two cases were diagnosed as PTE by V/Q imaging. Among them, 112 cases were received lower extremity deep venous ultrasound or lower extremity deep venography, 51 cases were diagnosed as lower extremity DVT, with thrombosis of popliteal and above vein as common [68.63% (35/51)]. The clinical possibility assessment showed that 67.23% (119/177) patients might have PTE (PTE simplified Wells score greater than or equal to 2), 38.98% (69/177) patients might have lower extremity DVT (DVT Wells score greater than or equal to 2). Multivariate Logistic regression analysis showed that operation less than 4 weeks [odds ratio (OR) = 5.503, 95% confidence interval (95%CI) = 1.577-19.206, P = 0.007], trauma or fracture less than 3 months (OR = 6.771, 95%CI = 1.510-30.370, P = 0.012), VTE history (OR = 0.072, 95%CI =0.009-0.549, P = 0.011) were independent risk factors for VTE occurrence. Thrombolytic therapy was administered in 13 cases while anticoagulant therapy alone was prescribed in 164 cases. 176 patients recovered, while 1 case died. Conclusions VTE clinical manifestations are not specific. Patients with risk factors should be vigilant, be strengthen with diagnostic awareness, paid attention to the evaluation of clinical possibilities. Timely thrombolytic or anticoagulant treatment after diagnosis, can improve the survival rate.

Novel antibody-drug conjugates (ADCs) are a hot spot in the research and development of new drugs for advanced solid tumors. ADCs have achieved significant efficacy in the treatment of advanced breast cancer, urothelial carcinoma, gastric cancer and other solid tumors, but their adverse reactions such as ocular toxicity, pulmonary toxicity, hematological toxicity, and liver toxicity cannot be ignored, and it is crucial to effectively deal with the adverse reactions of ADCs.

Objective To investigate the frequency and location of cerebral microbleeds in cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) to understand the imaging and clinical features of the disease.Methods Cranial magnetic resonance imaging and susceptibility-weighted imaging were assessed in seven symptomatic CADASIL patients in People's Hospital of Zhengzhou University from 2014 to 2017.Imaging features and clinical significance of these patients were analyzed retrospectively.Results The seven patients were diagnosed by Notch3 gene detection.Mutations were found in exon 11 in four cases,and in exon 4 in three cases.All the seven patients with CADASIL had cerebral microbleeds,the number of which was 108 (4-36).The number of cerebral microbleeds was found to be higher in cortico-subcortical region than in any other regions.One of CADASIL patients with cerebral microbleeds had intracerebral hemorrhage located in external capsule.The patient with intracerebral hemorrhage had hypertension and multiple cerebral microbleeds.Conclusions Cerebral microbleeds are common imaging characteristics in symptomatic CADASIL,most of which locate in cortico-subcortical region.Cerebral hemorrhage is one of the clinical manifestations of CADASIL patients.

Purpose To investigate the expression of PD-1,PD-L1,CD3 and CD8 in the immune microenvironment of non-small cell lung cancer(NSCLC)and their clinical signifi-cance.Methods The clinical data of 39 patients with NSCLC brain metastasis(BM)were collected.The expression of PD-1,PD-L1,CD3 and CD8 in the tumor and stroma of BM was detec-ted using an immunofluorescence-based tissue microenvironment analysis panel.Targeted sequencing was carried out to catalog cancer-related genes.The clinical pathological features were an-alyzed with review of relevant literature.Results Thity-nine patients with NSCLC presented with tumor-infiltrating lympho-cytes(TIL)in different degree.CD3+TIL(P=0.000 7)and CD8+TIL(P=0.0006)were more prominent in the tumor stroma,and the positive PD-L1 expression was significantly higher in the interstitial tissues of tumor(P=0.025 8).Com-pared with the whole wild-type driver gene cohort,the expres-sion of PD-L1 in the stroma of BM was significantly increased in the EGFR mutation cohort(P=0.039).Patients with high in-filtration of stroma CD8+TIL had longer median overall survival than those with low infiltration(16 months vs 6 months,P=0.032);PD-L1-positive patients(36 months)were longer sur-vival time than PD-L1-negative patients(5.5 months,P=0.056).Compared with lung primary lesions,the variant allele frequencies(VAFs)in BM generally increased,and samples with higher VAFs corresponded to higher expression of PD-1,PD-L1,CD3 and CD8.Conclusion The TIL infiltration is most prominent in the stroma of NSCLC BM.The EGFR muta-tion of a tumor might affect the immune microenvironment of me-tastases;PD-L1 expression and TIL infiltration were correlated with overall survival.