Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

We report a case of spinocerebellar ataxia type 8(SCA8)presenting with multisystem atrophic phenotype.The patient was a 57-year-old male with a 4-year course of illness with dizziness and ataxia as the first symptoms,followed by autonomic dysfunction and rapid eye movement sleep disorder.Neurological examination reveals autonomic dysfunction,nystagmus,dysarthria,ataxia,brain stem and cerebellar symmetrical atrophy and"hot cross bun"sign on MRI.The diagnosis of SCA8 was confirmed by the genetic testing which showed an abnormally high number of CTA/CTG repeats in the two alleles of the ATXN8OS.The patient responded well to symptomatic treatment such as ataxia and autonomic dysfunction.SCA8 is a rare movement disorder with high clinical heterogeneity.This report suggests that SCA8 can also present with autonomic dysfunction,ataxia,pontine"hot cross bun"sign and other characteristics similar to multisystem atrophy phenotype.Thus,it is necessary for clinicians to avoid misdiagnosis or missing the diagnosis of SCA8 presenting with multiple system atrophy cerebral type in clinical work.

Objective:To compare the efficacy of closed-loop target-controlled deep versus moderate neuromuscular blockade in gynecological laparoscopic surgery.Methods:This was a prospective study. Fifty American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective gynecological laparoscopic surgery in the General Hospital of Tianjin Medical University from March 2020 to March 2021, were allocated into 2 groups ( n=25 each) using a random number table method: closed-loop target-controlled moderate neuromuscular blockade group (group TOF) and closed-loop target-controlled deep neuromuscular blockade group (group PTC). Rocuronium was given by closed-loop target-controlled infusion in both groups. In group TOF, the target muscle relaxation was considered as train-of-four stimulation (TOF) of 1 or 2. In group PTC, the target muscle relaxation was considered as post-titanic count of 1 or 2. The score for operator′s satisfaction with muscle relaxation, grading, satisfaction rate, mean pneumo-peritoneum pressure, consumption of rocuronium, recovery index, recovery time to a TOF ratio 0.9 and time to extubation were recorded. The postoperative visual analogue scale score for abdominal pain and use of rescue analgesics were recorded, and the occurrence of complications such as shoulder pain, arm pain, nausea, vomiting and hypoxemia was also recorded within 48 h after surgery. Results:Compared with group TOF, the score for operator′s satisfaction with muscle relaxation, grading and satisfaction rate were significantly increased, the mean pneumo-peritoneum pressure was decreased, the total and average consumption of rocuronium was increased, the recovery time of a TOF ratio 0.9 was prolonged, and the postoperative visual analogue scale score for abdominal pain and usage rate of flurbiprofenate were decreased in group PTC ( P<0.05). There were no significant differences in the recovery index, tracheal extubation time or postoperative incidence of hypoxemia, shoulder pain, arm pain and nausea and vomiting between the two groups ( P>0.05). Conclusions:Compared with the closed-loop target-controlled moderate neuromuscular blockade, the closed-loop target-controlled deep neuromuscular blockade provides more satisfactory surgical conditions for gynecological laparoscopic surgery, decreases pneumoperitoneum pressure and reduces related complications, without increasing the development of postoperative adverse reactions.

Objective:To investigate the neuropsychological and imaging features of patients with posterior cortical atrophy (PCA).Methods:Patients of PCA, dementia with Lewy bodies (DLB), typical Alzheimer′s disease (t-AD) who were diagnosed in the Department of Neurology, Huashan Hospital, Fudan University from September 27, 2019, to September 24, 2021 were enrolled, and the normal controls who visited the Outpatient and Physical Examination Centers of Huashan Hospital, Fudan University and Rizhao People′s Hospital at the same time were enrolled, too. Neuropsychological assessments, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT data of the 4-group subjects were collected. Variance analysis was used to compare the differences in neuropsychological performance among the 4 groups, and the imaging features of PCA patients were summarized.Results:Eleven PCA patients, 17 DLB patients, 31 t-AD patients, and 11 normal controls were included in the study. The cognitive function of patients in the PCA group [Mini-Mental State Examination (MMSE) score 13.52±1.81; Montreal Cognitive Assessment (MoCA) score 7.06±1.72] was significantly impaired compared to the normal control group (MMSE score 27.85±1.75, t=-6.561, P<0.001; MoCA score 23.60±1.59, t=-7.968, P<0.001]. However, there was no statistically significant difference compared to the DLB group and the t-AD group. Patients in the PCA group exhibited more severe impairments in attention, executive function, and language compared to the DLB group (Trail Making Test A score: 298.86±16.16 vs 110.07±18.62, t=9.980, P<0.001; Trail Making Test B score: 305.51±18.89 vs 230.34±23.59, t=2.865, P=0.024; Boston Naming Test score: 8.67±1.53 vs 15.66±1.56, t=-2.682, P=0.013) and the t-AD group (148.91±12.77, t=7.071, P<0.001; 200.78±19.34, t=3.789, P=0.004; 15.15±1.05, t=-2.544, P=0.016). Scores for visuospatial function [PCA group: 1(0, 1), normal control group: 3(3, 3), Z=-4.023, P<0.001] and visual perception [PCA group: 0(0, 1), normal control group: 35(34, 36), Z=-3.704, P<0.001] were significantly lower in the PCA group compared to the normal control group. The cranial MRI findings of PCA patients showed atrophy of the parietal and occipital lobes, with less obvious atrophy of the medial temporal lobe, which can be distinguished from t-AD. 18F-fluorodeoxyglucose PET/CT of the PCA patients showed a relative reduced glucose metabolism in the bilateral parietal lobe, occipital lobe and posterior cingulate gyrus, while the 18F-florbetapir PET/CT showed deposition of amyloid protein in the bilateral frontal lobe, parietal lobe, temporal lobe, and cingulate gyrus. Conclusions:PCA patients exhibit neuropsychological characteristics of visuospatial dysfunction, along with impairments in various cognitive domains such as memory, attention, and executive functions. The typical MRI feature is parietal occipital lobe atrophy, and the PET/CT findings are consistent with metabolic changes in AD.

Objective To explore indicators of risks for preoperative adverse cardiovascular events(PACE)in elderly patients who underwent non-cardiac surgery(NCS).Methods The clinical data of elderly patients who had undergone NCS at Tianjin Medical University General Hospital from January 2022 to March 2024 were analyzed retrospectively,including gender,age,medical history,operation ways,and preoperative creatinine(Cr),hypersensitive C-reactive protein(hs-CRP),hypersensitivity cTnT(hs-cTnT),MB isoenzyme of creatine kinase(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)and D-Dimer,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib).To measure the revised cardiac risk index(RCRI),the 30-day prognosis of the patients was followed up.Patients were divided into PACE group and non-PACE group according to the occurrence of PACE,and the clinical data between the two groups were compared.Multiple Logistics regression was used to identify independent risk factors for PACE,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for PACE risk in elderly patients underwent NCS.Results A total of 112 elderly patients underwent NCS were enrolled,including 9 cases in the PACE group(incidence rate 8.03%)and 103 cases in the non-PACE group.Patients'age(years old:75.1±6.4 vs.69.4±7.2,P=0.002),preoperative incidence of coronary heart disease[44.4%(4/9)vs.28.2%(29/103),P=0.004],incidence of heart failure[22.2%(2/9)vs.6.8%(7/103),P=0.003],NT-proBNP[(ng/L):485.17(196.10,787.53)vs.98.41(73.81,160.35),P=0.001],hs-cTnT[(μg/L):0.043(0.023,0.087)vs.0.005(0.003,0.008),P=0.002],and D-Dimer[(μg/L):2 953(2 674,3 570)vs.514(260,1 010),P=0.001]levels in the PACE group were significantly higher than those in the non-PACE group,the proportion of RCRI 2-3 scores in PACE group were significantly higher than those in non-PACE group[2 scores:44.4%(4/9)vs.18.4%(19/103),3 scores:33.3%(3/9)vs.14.6%(15/103),P=0.047].As shown in multiple Logistic regression analysis,age,preoperative NT-proBNP levels and RCRI scores≥2 were independent risk factors affecting the prognosis for PACE occurrence[odds ratio(OR)and 95%confidence interval(95%CI)were 1.163(1.032-1.310),1.021(1.008-1.031)and 1.261(1.003-1.585),P values were 0.013,0.001,0.048,respectively].As shown in ROC curve analysis,age,NT-proBNP and RCRI had predictive value for the occurrence of PACE in NCS patients,the area under the curve(AUC)and 95%CI of age,NT-proBNP and RCRI were 0.795(0.675-0.915),0.908(0.838-0.979)and 0.735(0.556-0.912),with P=0.030,<0.001 and 0.020 respectively.The optimal cut-off values were:age≥69.5 years(sensitivity was 88.9%,specificity was 56.3%);NT-proBNP≥177.0 ng/L(sensitivity was 88.9%,specificity was 83.5%);RCRI≥1.5 points(sensitivity was 77.8%,specificity was 67.0%).Conclusions Age,NT-proBNP levels and RCRI have certain predictive values for the occurrence of PACE in NCS patients undergoing NCS,advanced age,higher NT-proBNP levels,and elevated RCRI scores were associated with increased PACE risk in elderly patients undergoing NCS.While age showed high sensitivity but limited specificity,combining NT-proBNP(with high diagnostic accuracy)and RCRI(with objective scoring)improved preoperative PACE risk prediction.

Objective To explore indicators of risks for preoperative adverse cardiovascular events(PACE)in elderly patients who underwent non-cardiac surgery(NCS).Methods The clinical data of elderly patients who had undergone NCS at Tianjin Medical University General Hospital from January 2022 to March 2024 were analyzed retrospectively,including gender,age,medical history,operation ways,and preoperative creatinine(Cr),hypersensitive C-reactive protein(hs-CRP),hypersensitivity cTnT(hs-cTnT),MB isoenzyme of creatine kinase(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)and D-Dimer,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib).To measure the revised cardiac risk index(RCRI),the 30-day prognosis of the patients was followed up.Patients were divided into PACE group and non-PACE group according to the occurrence of PACE,and the clinical data between the two groups were compared.Multiple Logistics regression was used to identify independent risk factors for PACE,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for PACE risk in elderly patients underwent NCS.Results A total of 112 elderly patients underwent NCS were enrolled,including 9 cases in the PACE group(incidence rate 8.03%)and 103 cases in the non-PACE group.Patients'age(years old:75.1±6.4 vs.69.4±7.2,P=0.002),preoperative incidence of coronary heart disease[44.4%(4/9)vs.28.2%(29/103),P=0.004],incidence of heart failure[22.2%(2/9)vs.6.8%(7/103),P=0.003],NT-proBNP[(ng/L):485.17(196.10,787.53)vs.98.41(73.81,160.35),P=0.001],hs-cTnT[(μg/L):0.043(0.023,0.087)vs.0.005(0.003,0.008),P=0.002],and D-Dimer[(μg/L):2 953(2 674,3 570)vs.514(260,1 010),P=0.001]levels in the PACE group were significantly higher than those in the non-PACE group,the proportion of RCRI 2-3 scores in PACE group were significantly higher than those in non-PACE group[2 scores:44.4%(4/9)vs.18.4%(19/103),3 scores:33.3%(3/9)vs.14.6%(15/103),P=0.047].As shown in multiple Logistic regression analysis,age,preoperative NT-proBNP levels and RCRI scores≥2 were independent risk factors affecting the prognosis for PACE occurrence[odds ratio(OR)and 95%confidence interval(95%CI)were 1.163(1.032-1.310),1.021(1.008-1.031)and 1.261(1.003-1.585),P values were 0.013,0.001,0.048,respectively].As shown in ROC curve analysis,age,NT-proBNP and RCRI had predictive value for the occurrence of PACE in NCS patients,the area under the curve(AUC)and 95%CI of age,NT-proBNP and RCRI were 0.795(0.675-0.915),0.908(0.838-0.979)and 0.735(0.556-0.912),with P=0.030,<0.001 and 0.020 respectively.The optimal cut-off values were:age≥69.5 years(sensitivity was 88.9%,specificity was 56.3%);NT-proBNP≥177.0 ng/L(sensitivity was 88.9%,specificity was 83.5%);RCRI≥1.5 points(sensitivity was 77.8%,specificity was 67.0%).Conclusions Age,NT-proBNP levels and RCRI have certain predictive values for the occurrence of PACE in NCS patients undergoing NCS,advanced age,higher NT-proBNP levels,and elevated RCRI scores were associated with increased PACE risk in elderly patients undergoing NCS.While age showed high sensitivity but limited specificity,combining NT-proBNP(with high diagnostic accuracy)and RCRI(with objective scoring)improved preoperative PACE risk prediction.

Objective:To explore the β-amyloid (Aβ) deposition pattern of subjects with the preclinical Alzheimer′s disease (AD), community-derived amnestic mild cognitive impairment (aMCI) and normal cognition (NC) from communities of Shanghai.Methods:According to the inclusion and exclusion criteria, 273 subjects (104 males, 169 females; age (64.2±7.6) years) were recruited from Shanghai community and memory clinics from December 2018 to July 2020. All subjects underwent MRI, 18F-AV45 PET imaging and neuropsychological scale tests and were grouped into AD, aMCI and NC groups based on clinical diagnosis. Differences in demographic information, the neuropsychological scale tests′ scores and positive rate of Aβ deposition among each group were analyzed by one-way analysis of variance or χ2 test. Aβ deposition patterns of AD and MCI groups were analyzed at voxel level, and the differences of Aβ deposition among different groups were compared. Results:Among 273 patients, the positive rates of Aβ deposition in AD, aMCI and NC groups were 84.4%(38/45), 36.4%(20/55) and 23.1%(40/173), respectively ( χ2=58.37, P<0.001). Among AD, aMCI, NC and NC (Aβ-) groups ( n=132), the education years of AD group was the lowest ((9.7±4.6) years; F=8.86, P<0.001). In addition, there were significant differences in the scores of several neuropsychological scale tests among AD, aMCI, NC groups and NC (Aβ-) group ( F values: 27.68-235.50, all P<0.001). Compared with subjects in NC(Aβ-) group, the Aβ depositions in the aMCI and AD groups were widely distributed in the whole cerebral cortex; and AD group had higher Aβ deposition in bilateral frontal, parietal, temporal, occipital lobe, cingulate gyrus and precuneus than aMCI group. Conclusions:The positive rate of Aβ deposition in the preclinical AD population from the Shanghai community is obtained. There are significant different Aβ deposition patterns in subjects at different stages of AD.

Neuropathic pain is a chronic disease that severely afflicts the life and emotional status of patients, but currently available treatments are often ineffective. Novel therapeutic targets for the alleviation of neuropathic pain are urgently needed. Rhodojaponin VI, a grayanotoxin from Rhododendron molle, showed remarkable antinociceptive efficacy in models of neuropathic pain, but its biotargets and mechanisms are unknown. Given the reversible action of rhodojaponin VI and the narrow range over which its structure can be modified, we perforwmed thermal proteome profiling of the rat dorsal root ganglion to determine the protein target of rhodojaponin VI. N-Ethylmaleimide-sensitive fusion (NSF) was confirmed as the key target of rhodojaponin VI through biological and biophysical experiments. Functional validation showed for the first time that NSF facilitated trafficking of the Cav2.2 channel to induce an increase in Ca²⁺ current intensity, whereas rhodojaponin VI reversed the effects of NSF. In conclusion, rhodojaponin VI represents a unique class of analgesic natural products targeting Cav2.2 channels via NSF.

Objective:To investigate the clinical, neuropsychological, and neuroimage characteristics in patients with corticobasal syndrome (CBS), and to elucidate the exact diagnosis of CBS patients.Methods:Twelve CBS cases admitted to the Department of Neurology, Huashan Hosiptal,Fudan University from April 2019 to July 2021 were retrospectively enrolled in this study. Those data, including clinical features (demographic data and clinical characteristics of cortical dysfunction and movement disorder), neuropsychological assessment [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales score], brain magnetic resonance imaging (MRI) and multi-mode positron emission tomography (PET)/CT, were collected and carefully reviewed. Exact diagnosis of these patients was given according to the disease diagnosis criteria.Results:Cortical dysfunction and asymmetrical movement disorders were found in all cases, with poor response to levodopa. Patients suffered from cognitive impairment (MMSE score 16.16±9.82, MoCA score 13.44±7.35). The cranial MRI demonstrated significant asymmetric atrophy of frontal and parietal lobes, especially in the pre- and post-central gyrus. Fluorodeoxyglucose PET of 12 patients showed asymmetric frontal lobe and basal ganglia (especially caudate and putamen) hypometabolism (obviously on the contralateral side of the affected limb). Tau PET was implemented in 11 patients and displayed that abnormal tau protein deposition was positive in the cortex and/or subcortex in all patients. Of the 4 cases, who completed amyloid PET, amyloid protein deposition was positive in the cortex of 2 patients. As a result, 6 patients were diagnosed as progressive supranuclear palsy, 1 patient was diagnosed as corticobasal degeneration, and 5 patients were diagnosed as Alzheimer′s disease.Conclusions:The etiology of CBS is heterogeneous. The combination of clinical manifestation, cranial MRI and multi-mode PET/CT helps the differential diagnosis of CBS.