Dysphasia is a fatal complication of stroke, and may result in other complications. Transcranial direct current stimulation (tDCS) is helpful for the recovery of dysphasia associated with stroke, which may involve in the polarity and cerebral plasticity. There are advantages and disadvantages of tDCS compared with repetitive transcrnial magnetic stimulation.

Objective:To observe the clinical efficacy and safety of knee-balancing Tuina(Chinese therapeutic massage)manipulation for pes anserina bursitis(PAB). Methods:A total of 64 patients with PAB were enrolled and divided into a Tuina group and a medication group by the random number table method,with 32 cases in each group.The medication group was given votalin for external use,and the Tuina group was given knee-balancing Tuina manipulation based on treatment according to structure differentiation.Both groups were treated for 7 consecutive days.The visual analog scale(VAS)score,Lyshlom score,knee joint range of motion(ROM),and total effective rate were compared between the two groups.Adverse reactions were observed in both groups. Results:During the treatment,there was 1 dropout case in the medication group.The total effective rate was 93.8%in the Tuina group and 83.9%in the medication group.The difference between the two groups was statistically significant(P<0.05).After treatment,the VAS score in both groups decreased significantly(P<0.05),and the Lyshlom score and knee joint ROM increased significantly(P<0.05).The differences in the VAS score,Lyshlom score,and knee joint ROM between the two groups were all statistically significant(P<0.05). Conclusion:The knee-balancing Tuina manipulation based on treatment according to structure differentiation can effectively relieve pain and improve knee function in PAB,and its efficacy is superior to that of external use of votalin.

Aim To study the effect of puerarin on reperfusion injury after thrombolytic therapy in acute pulmonary thromboembolism and its mechanism. Methods Thirty-two Japanese rabbits were randomly divided into sham operation group (group S),Thrombolysis-only group(group T), and Puerarin group(group Pur). Acute pulmonary thromboembolism models of rabbits were established with injection of autologous blood clots through the right heart catheters,haemodynamic monitoring was performed by introducing heart catheter through right jugular vein.The activity of plasma superoxide dismutase (SOD) and content of plasma malondialdehyde (MDA) were detected before embolization,2 h after embolization,2 h and 4 h after thrombolysis. At the end,the rabbits were sacrificed and their lung,removed for histopathologic and electron microscopic investigations. Results ①Pulmonary arterial mean pressure (PAMP) were decreased at 1 hour after thrombolysis both in group T and group Pur(P

Objective:To explore the clinical characteristics, plasma levels of hydrogen sulfide(H 2S) and the relationship between the genotype and phenotype of cardiovascular involvement in children with methylmalonic acidemia and homocystinemia. Methods:The clinical and laboratory data of 66 outpatients diagnosed with methylmalonic acidemia combined with homocystinemia in Department of Pediatrics, Peking University First Hospital from January 2014 to July 2014 were collected and analyzed respectively, and the patients were divided into 2 groups: cardiovascular involvement group (10 cases) and non-cardiovascular involvement group(56 cases). The differences in the clinical characteristics, plasma levels of H 2S and genotypes were compared between 2 groups. Results:(1) There were 45 cases of early-onset children under 1 year old, including 4 cases of cardiovascular system involvement and 41 cases of non-cardiovascular system involvement.Twenty-one cases had onset above 1 year old, including 6 cases of cardiovascular system involvement and 15 cases of non-cardiovascular system involvement. There were 44 male children, including 8 cases with cardiovascular system involvement and 36 cases without cardiovascular system involvement; 22 cases female children, including 2 cases with cardiovascular system involvement and 20 cases without cardiovascular system involvement. There was no significant difference in onset age and gender distribution between the 2 groups ( χ2=2.910, 0.368, all P>0.05). (2)In the 10 cases with cardiovascular involvement, there were 3 cases with hypertension, 2 cases with hypertension combined with pulmonary hypertension, 2 cases with mild myocardial hypertrophy, 1 case with atrial septal defect combined with pulmonary hypertension, 1 case with pulmonary hypertension, 1 case with myocardial noncompaction.Compared with the non-cardiovascular involvement group, the proportion of kidney involvement was increased and that of nervous system was decreased in cardiovascular system involvement group( χ2=20.34, 5.79, all P<0.05), the proportion of hematological system involvement between the 2 groups had no significant differences ( χ2=1.28, P>0.05). The plasma levels of hydrogen sulfide of children with cardiovascular involvement was significantly lower than that of non-cardiovascular involvement[(33.8±3.6) μmol/L vs.(39.3±5.2) μmol/L, t=-3.22, P<0.01]. (3) MMACHC gene mutation (cblC type) was identified in all 46 patients.It was found that the most common type of gene mutation was c. 80A>G in cardiovascular involvement group, while c. 609G>A was the most common type of gene mutation in non-cardiovascular involvement group. Conclusions:The clinical manifestations of children with methylmalonic acidemia and homocystinemia involving cardiovascular system are multiple and prone to multiple system involvement, especially renal involvement.A decrease in plasma hydrogen sulfide levels may be involved in the involvement of its cardiovascular system.The MMACHC gene c. 80A>G mutation is the most common genetic mutation site in children with cardiovascular involvement with methylmalonic acidemia and homocystinemia.

Inguinal incarcerated hernia in adults is a common acute abdomen in hernia and abdominal wall surgery. If not treated in time, it is easy to progress to constrictive hernia, lead to intestinal ischemic necrosis, cellulitis of tegmental tissue outside the hernia, hernia sac empyema, intestinal fistula, and even cause toxic shock, with significantly increased mortality. The types of incarceration are different and the corresponding management methods are different. Based on the proposal of the concept of musculopubic foramen hernia repair, inguinal incarcerated hernia includes incarcerated indirect hernia, incarcerated direct hernia, incarcerated femoral hernia, etc. At present, there is no uniform standard for the comprehensive treatment of different types of inguinal incarcerated hernia, and the clinical management strategies of adult inguinal incarcerated hernia still face serious challenges.

Hiatal hernia (HH) is a prevalent medical condition characterized by the protrusion of abdominal contents into the thoracic cavity through an enlarged diaphragmatic esophageal hiatus. The most common clinical manifestations of HH include acid reflux, heartburn, belching, coughing, and chest pain. Currently, there is a lack of standardized comprehensive treatment protocols for different types of HH, presenting significant challenges in their clinical management. In light of this, individualized treatment approaches should be followed by surgical practitioners when dealing with HH, in order to formulate the most appropriate clinical treatment plan tailored to each patient′s specific circumstances.

Objective To explore the feasibility of Narcotrend index (NTI) for digital monitoring of light sedation depth in patients undergoing short-term mechanical ventilation after pancreaticoduodenectomy. Methods A prospective randomized controlled trial was conducted. Patients with mechanical ventilation for 12-48 hours after pancreaticoduodenectomy admitted to department of critical care medicine of the First Affiliated Hospital of Wannan Medical College from January 2016 to December 2018 were enrolled. They were randomly divided into two groups, and NTI and Richmond agitation-sedation score (RASS) were used to guide light sedation treatment respectively. The implementation effect of light sedation, duration of mechanical ventilation, dosage of sedative drugs, occurrence of adverse events (accidental extubation, delirium, cardiovascular events) and stress response [cortisol, epinephrine, norepinephrine, C-reactive protein (CRP)] were compared between the two groups. Results A total of 87 patients were enrolled in this study, of whom 45 received NTI-guided sedation assessment and 42 received RASS-guided sedation assessment. There were no significant differences in gender, age, body mass index (BMI), liver function classification, operation time, blood loss, conversion to laparotomy and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score between the two groups. During sedation treatment, the light sedation compliance rate after light sedation, 2, 4, 6 hours and cumulative compliance period number (Dt) in NTI group were higher than those in RASS group [71.1% (32/45) vs. 50.0% (21/42), 80.0% (36/45) vs. 54.8% (23/42), 88.9% (40/45) vs. 59.5% (25/42), 83.9% (642/765) vs. 62.8% (475/756), all P < 0.05]. The dosage of dexmedetomidine in NTI group was higher than that in RASS group (μg·kg-1·h-1:0.60±0.10 vs. 0.54±0.12, P < 0.01), but more patients in RASS group receiveda larger dose of propofol to maintain sedation [ratio of use of propofol: 64.3% (27/42) vs. 37.8% (17/45), dose of propofol (mg/h): 47.82±7.31 vs. 30.83±10.35, both P < 0.05]. The sedation duration and duration of mechanical ventilation in NTI group were lower than those in RASS group (hours: 15.68±2.43 vs. 17.29±2.43, 16.27±2.42 vs. 18.25±2.04, both P < 0.01). There were no significant differences in hypertension, bradycardia, accidental extubation and delirium between the two groups during sedation treatment, but the incidence of hypotension in RASS group was higher than that in NTI group [35.7% (15/42) vs. 13.3% (6/45), P < 0.05]. Compared with RASS group, epinephrine, norepinephrine and the levels of CRP at treatment of 6 hours with light sedation and 2 hours after tracheal catheter removal in NTI group were decreased [epinephrine (pg/L): 138.35±18.60 vs. 157.50±19.91, 136.24±40.40 vs. 150.46±20.22; norepinephrine (pg/L): 347.34±45.46 vs. 393.75±49.77, 340.59±50.95 vs. 376.37±49.70; CRP (μg/L): 62.26±18.78 vs. 71.31±10.32, 53.30±14.47 vs. 64.26±14.69, all P < 0.05], and cortisol level 6 hours after treatment with light sedation was lower than that of RASS group (nmol/L: 327.03±41.04 vs. 358.12±70.01, P < 0.05). Conclusion The application of NTI monitoring to guide light sedation therapy for patients with short-term mechanical ventilation after pancreaticoduodenectomy can better achieve the goal of light sedation.

A target prediction approach to inhibit SARS-CoV-2 replication through metabolic difference analysis is presented.The approach is based on gene expression data from lung host cells,reconstructs a network model of the parts of the host cell metabolic system that are reprogrammed after viral invasion,and identifies candidate targets using single-gene knockout and cytotoxicity test.The robustness of antiviral targets against multiple currently known variants of SARS-CoV-2 is also analyzed.The results indicate that D-alanine is a key metabolite affecting SARS-CoV-2 replication and is applicable to all current SARS-CoV-2 variants.The gene regulating D-alanine(PLPBP)is the main gene target.The proposed approach is applicable to the existing viruses and host cells,providing new ideas for viral disease management.

Objective:To investigate the role and mechanism of splenic myeloid-derived suppressor cells (MDSCs) in sepsis-induced adrenal injury (SAI).Methods:Thirty male C57 mice aged 6-8 weeks were randomly divided into normal control group ( n = 5), sham operation group (Sham group, n = 5), sepsis model group [cecal ligation and perforation (CLP) group, n = 10] and sepsis+splenectomy group (CLPS group, n = 10). The sepsis model of mice was reproduced by CLP method. In Sham group, only the cecum was opened and separated, then closed, without CLP. In CLPS group, the spleen was removed before CLP. In normal control group, no challenge was given. After 24 hours, the rats were sacrificed by anesthesia, and peripheral blood, spleen, bone marrow, and bilateral adrenal glands were harvested. The pathological of adrenal gland was assessed by hematoxylin-eosin (HE) staining under optical microscope. The ratio of MDSCs in peripheral blood, spleen and bone marrow was determined by flow cytometry. The expressions of MDSCs surface antigen CD11b, Gr-1 and interleukins (IL-6, IL-1β) mRNA in adrenal tissue were measured by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). Western Blot was used to detect the expressions of mammalian rapamycin target protein (mTOR) pathway related proteins including total mTOR (T-mTOR), phosphorylation of mTOR (p-mTOR) and caspase-3. Results:The adrenal cortex and medulla of the normal control group and Sham group were intact and the structure was clear under optical microscope, while in the CLP group, the adrenal gland showed edema, cortical hemorrhage and cell edema. Compared with the CLP group, the adrenal tissue injury was significantly reduced in the CLPS group. Compared with the normal control group and Sham group, MDSCs ratio in the peripheral blood was significantly increased and significantly reduced in the spleen in the CLP group, but there was no significant difference in bone marrow, the expression levels of CD11b, Gr-1, IL-6, IL-1β mRNA and caspase-3 protein were increased significantly and p-mTOR protein expression was significantly decreased in adrenal tissue, there was no significant difference in the expression of T-mTOR protein. Compared with the CLP group, in the CLPS group, the MDSCs ratio in the peripheral blood was significantly decreased (0.143±0.011 vs. 0.324±0.023, P < 0.01), the expression levels of CD11b, Gr-1, IL-6 , IL-1β mRNA and caspase-3 protein in adrenal gland were significantly decreased [CD11b mRNA (2 -ΔΔCt): 2.90±0.56 vs. 5.74±0.13, Gr-1 mRNA (2 -ΔΔCt): 2.71±0.14 vs. 4.59±0.46, IL-6 mRNA (2 -ΔΔCt): 2.44±0.64 vs. 5.17±1.04, IL-1β mRNA (2 -ΔΔCt): 3.58±0.52 vs. 4.44±0.26, caspase-3 protein (caspase-3/GAPDH): 0.05±0.01 vs. 0.13±0.02, all P < 0.01], the p-mTOR protein expression was significantly increased (p-mTOR/GAPDH: 0.61±0.11 vs. 0.27±0.04, P < 0.01). Conclusions:The spleen is the major source of MDSCs in SAI. Splenectomy can attenuate SAI by reducing mobilization of MDSCs and activating the mTOR signaling pathway.

Humans ; Dexmedetomidine/therapeutic use* ; Hypnotics and Sedatives ; Cognitive Dysfunction/drug therapy*