Objective To observe the expression of aquaporin 4 (AQP-4) in contused brain tissue and its relationship with brain edema following brain trauma.Methods A retrospective case control analysis was made on 42 patients with severe brain trauma admitted from January 2015 to March 2016.There were 23 males and 19 females,aged from 23 to 62 years [(35.5 ± 5.6) years].Glasgow coma score (GCS) was 3-5 points in 7 patients,6-8 points in 23 and 9-10 points in 12.Brain tissue removed from the area 1 cm near the contusion during the cranial surgery were allocated to study group (n =42),while brain tissue removed far from the contusion after internal decompression were used as control (n =8).Ultrastructure of brain tissues was observed under electron microscope.Water content of brain tissue was measured by dry-wet weight method and expression of AQP-4 was measured by immunohistochemical method at postinjury hours ＜ 6,6-12,12-24,24-72,72-96 and ＞ 96.Results Morphology and structure of brain tissue in control group were normal.Whereas in study group,the intracellular and interstitial edema were obvious and morphological structure were damaged.Water content and AQP-4 expression in control group showed no obvious increase after operation(73.55 ±0.10,0.193 ±0.016).Water content in study group increased significantly compared to control group and reached the peak value (81.28 ± 0.56) at postinjury 24-72 hours (P ＜ 0.01).AQP-4 expression in study group increased at postinjury 6 hours (0.242 ±0.023) and reached a peak at postinjury 24-72 hours (0.338 ± 0.013),with significant difference compared to control group (P ＜ 0.05).Correlation analysis showed change of brain water content was positively correlated with expression level of AQP-4 (r =0.931,P ＜ 0.01).Conclusion Expression of AQP-4 in the injured area of brain trauma is significantly increased along with the increase of water content,suggests that the upregulation of AQP-4 plays an important role in traumatic brain edema.

Objective To investigate the surgical treatment of growth hormone (GH) pituitary tumors combined with cardiomyopathy patients and its clinical effect.Methods A total of 15 patients with GH pituitary tumors combined with cardiomyopathy were enrolled and underwent surgical treatment from February 2007 to May 2015 in our hospital.Pituitary endocrinology,brain magnetic resonance imaging,echocardiography diagram were inspected before and after surgery.Serum GH level,left ventricular diastolic diameter (LVIDd),thickness of the interventricular septum (IVST),left ventricular posterior wall thickness (LVPWT),left ventricular ejection fraction (EF),and mitral valve flow spectrum ratio (E/A) were detected by noninvasive methods and compared before and after treatment.Results Through the pituitary adenomas via nasal-sphenoid sinus surgery,total removal of the tumors were noted in 9 patients,subtotal resection in 4 patients,and partial resection in two patients.GH level,LVIDd,IVST,GH,LVPWT,E/A and EF after resection of pituitary tumor were significantly improved as compared with those before resection (P＜0.05).In the long-term follow-up,the cure rate was 35.68％,and the remission rate was 76.36％.Conclusion Surgical resection of pituitary tumor with good control of growth hormone levels can significantly improve the cardiac structure and function,thereby,GH pituitary tumor patients with cardiomyopathy can obtain satisfactory therapeutic effect.

Objective To explore the role of magnetic resonance spectroscopy in evaluating the severity and prognosis of patients with brain stem injury. Methods A total of 45 patients with brain injury (the study group)and 10 healthy people(the control group)were retrospectively analyzed in Affiliated Anqing Hospital,Anhui Medical University during March 2015 to October 2016 using magnetic resonance spectroscopy.The NAA/Cr,NAA/Cho and Cho/Cr value in brain stem were analyzed. The clinical severity score (GCS) and Glasgow outcome scale (GOS)were also analyzed in our study. Results Compared with the normal group,patients in the study group had lower NAA level, NAA/Cho value but higher Cho/Cr value (P < 0.05). The severer the injury, the more obvious in NAA peak decrease. Cho peak increased and NAA/Cho ratio decreased. NAA/Cho, NAA/Cr and Cho/Cr values in the group with good prognosis were similar to those in the normal control group, but significantly different to the group with poor prognosis (P < 0.05). NAA/Cr, NAA/Cho and Cho/Cr values correlates with GOS in patients with brain stem injury. Conclusions Magnetic resonance spectroscopy can be used to measure the metabolic status of patients with brain stem injury,which is of great significance in the evaluation the severity of brain stem injury and prognosis.

Objective:To explore the clinical characteristics of poisoned patients with poisons purchase online.Methods:A retrospective case-control study was conducted on poisoned patients purchased poisons online from 1st January 2021 to 31th May 2022 in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University. The clinical data including sex, age, way of medical treatment, cause of poisoning, exposure routes, category of toxic drugs, gastric lavage, toxic detection and prognosis of patients were collected and compared with those patients obtained poisons at stores as the control group.Results:Totally 318 poisoned patients were included in this study, of which 44 (13.8%) were obtained poisons online. Compared with the patients obtained poisons at stores, the patients obtained poisons online were younger ( P<0.001), and had higher proportion of suicide intention ( P=0.006), more oral route exposure ( P=0.029), and more proportions of receiving gastric lavage before transfer to the hospital ( P=0.001). Pesticides and fertilizers with organic heterocycles were the main types of poisons in the online group, and there was no statistical difference in the distribution of poisons compared with the control group. Mixed drug poisoning was the leading cause in both online group (27.8%) and control group (38.8%) in drug overdose poisoned types, followed by dextromethorphan (16.7%) and estazolam (15.5%) in the online group. Conclusions:Young people are the main group getting poisons through the Internet. Health education should be strengthened for this group, and online shopping platforms should pay attention to the poisoning risk of potential overdose drugs or poisons transactions.

Objective:To evaluate the therapeutic effect of hemopurification on acute chlorfenapyr poisoning according to the blood concentration of chlorfenapyr and to provide experience for clinical treatment.Methods:Two patients who presented to our Emergency Department following an ingestion of chlorfenapyr and then were treated with hemopurification in 2022 were included. The concentrations of chlorfenapyr and its highly toxic metabolite tralopyril were dynamically monitored, and the clinical data of the patients were collected.Results:Case 1 was given hemoperfusion for the first time 13 hours after ingestion. During l hour hemoperfusion, the tralopyril decreased by 28.82%. The concentration increased and exceeded the pre-perfusion level after 2 hours of hemoperfusion. After three times of hemoperfusion, the concentrations of chlorfenapyr and tralopyril were still higher than those before the first time, reaching 248 ng/mL and 1 307 ng/mL respectively. The concentration of chlorfenapyr showed a downward trend after 130 h, and the tralopyril in blood reached the peak 3 164 ng/mL at 130 h and decreased to 2 707 ng/mL at 178 h. In case 2, the blood chlorfenapyr and tralopyril concentration was 392 ng/mL and 7 598 ng/mL respectively 150 hours after ingestion. The blood chlorfenapyr concentration decreased by 37.75% respectively after first hemoperfusion, and the tralopyril concentration decreased by 38.02% respectively. During 85 hours of continuous veno-venous hemodiafiltration (CVVHDF), the concentration of tralopyril was maintained at 4 234~6 410 ng/mL. Case 1 was followed up to 12 days and lost follow-up. Case 2 died and the survival time was 247 hours.Conclusions:Hemoperfusion can scavenge tralopyril, but CVVHDF has poor scavenging ability for tralopyril. And the apparent volume of distribution (Vd) of chlorfenapyr and tralopyril are large. After ingestion, chlorfenapyr spreads to various tissues quickly, and it is easy to accumulate in the adipose tissue. The chlorfenapyr in the tissue slowly is released back to the blood and stays in the blood for a long time. The peak concentration of chlorfenapyr appeared earlier than that of tralopyril. Clinicians should pay attention to the early removal of toxins from the digestive tract.