Hypertriglyceridemia （HTG） is the second leading cause of acute pancreatitis in China and can be caused by primary factors， namely gene mutations， which may lead to recurrent hypertriglyceridemic acute pancreatitis （HTG-AP） and difficulties in effective control of triglyceride. This article reports an adult Chinese male patient who experienced eight attacks of HTG-AP and was found to carry a de novo heterozygous mutation， p.K327N， of the GPD1 gene， which may cause the persistent high level of triglyceride and recurrent attacks of HTG-AP.

Objective:To analyze the characteristics of stereoelectroencephalography (SEEG) in children with drug-resistant epileptic spasms (ES), and to explore the surgical strategy of children with spastic seizure under the guidance of SEEG.Methods:The clinical data of 156 children with ES who were preoperatively evaluated in the Department of Neurosurgery Ward 3, Tsinghua University Yuquan Hospital from January 2014 to December 2021 were retrospectively reviewed.All children were evaluated in the second stage of stereotactic electrode placement after a non-invasive preoperative evaluation.The characteristics of intracranial EEG, surgical strategy and prognosis were analyzed.Results:A total of 19 eligible children were included, involving 13 boys and 6 girls.The age of first onset and surgical age of them ranged 1 month to 4 years, and 2 years to 13 years, respectively.The SEEG was divided into 3 types in children with ES at the onset.Five children were SEEG type A, presenting with the focal seizure discharges at the beginning and a gradual propagation to widespread fast-wave bursts.Ten children were SEEG type B, presenting a focal leading spike followed by diffused fast-wave bursts.Four children were SEEG type C, presenting a diffuse fast wave rhythm onset.Although some electrode discharges appeared slightly " leading", they covered more than one brain region.After focal resection or thermocoagulation, 13/19 patients did not have the onset of seizures, and 5/19 and 8/19 were graded as SEEG type A, and B, respectively.During the intermittent period of SEEG attacks in children with SEEG type A and B, a significant phenomenon of focal epileptic discharge consistent with the onset of the attack was observed, and surgical removal of these areas effectively controlled spastic seizures.Conclusions:Epileptic spasms may be triggered by a focal neocortical discharge.Intracranial EEG showed that the focal seizure onset evolves into spasm or a focal " leading spike" is a good indicator of surgical prognosis.

Objective To analyze the effects of anesthesia-induced thermoregulatory system impairment and low temperature environment of the operating room on the perioperative thermoregulation of individualized patients by constructing a computer simulation model. Methods A simple anesthesia model was proposed and then incorporated into the self-developed individualized thermoregulatory model, in which human body was represented as a cylinder with two layers of the core and the skin. The integrated model could be used to assess the effects of individualized characteristics such as age, obesity, and cardiovascular diseases on thermoregulation by modifying different physiological parameters involving sweating, shivering and cutaneous vasomotion. Simulation of the general anesthesia effects on human thermoregulation could be achieved by reducing basal metabolic rate and thresholds for vasoconstriction and shivering. Results The elderly people showed lower core temperature but higher skin temperature, compared with the young people. In a low temperature environment, an increase in fat thickness or an increase in severity degree of the left ventricular failure (LVF) might alleviate the decrease in core temperature, while an increase in wind speed or relative humidity could result in a decrease in core temperature. When the threshold setting of vasoconstriction was reduced by 0-5-3 ℃, the core temperature showed a significant decrease. Conclusions By comparing model simulations with experimental measurements, the reliability and validity of the model in predicting human transient thermal responses during varying external thermal environment was verified. The individualized characteristics of human body had an important influence on human body temperature in a low temperature environment. Moreover, the combination of individualized characteristics of human body and general anesthesia further complicated the body′s thermoregulation and posed significant challenges for clinicians.

Objective:To investigate the incidence and risk factors of polymyxin B-associated acute kidney injury (AKI) in patients with severe infections caused by extensive drug resistance Gram negative bacteria (XDR-GNB)in intensive care unit (ICU).Methods:A retrospective study of adult patients with severe infection who received polymyxin B for more than 3 days in the department of critical care medicine of Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from April 1st 2018 to January 31st 2020 were performed. AKI was diagnosed by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The baseline data, indicators during treatment period and prognostic factors were compared between AKI group and non-AKI group. Factors with statistically significant difference in univariate analysis and important clinical factors were included in the Logistic regression model to analyze the risk factors of AKI.Results:Seventy-two patients were treated with polymyxin B for more than 3 days. Forty-nine patients were finally enrolled, with 32 patients developing polymyxin B-associated AKI, and the incidence was 44.4%. The baseline data was balanced in AKI group and non-AKI group, and there was no significant difference in the prognosis [death or discharge without medial order (cases): 14 vs. 6, discharged for improvement (cases): 18 vs. 11, χ 2 = 0.329, P = 0.566]. Polymyxin B-associated AKI occurred from 1 day to 14 days after treatment, with an average of (6.8±3.8) days. Among the 32 AKI patients, 2 cases were lost to follow up after discharge, while renal function recovered in 18 cases and unrecovered in 12 cases. The prognosis of patients without recovery of renal function was significantly worse than that of patients with renal function recovery [death or discharge without medial order (cases): 12 vs. 2, discharged for improvement (cases): 0 vs. 16, P = 0.000]. Single factor analysis showed that daily dosage of polymyxin B in AKI group was higher than that in non-AKI group (mg: 151.6±23.7 vs. 132.4±30.3), numbers of patients with daily polymyxin B dose ≥ 150 mg, using vasoactive drugs, or severe hypoalbuminemia (albumin≤25 g/L) were higher than those in non-AKI group (cases: 29 vs. 10, 18 vs. 4, 9 vs. 0), with statistically significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that daily dosage of polymyxin B ≥ 150 mg and use of vasoactive drugs were independent risk factors for polymyxin B-associated AKI [odds ratio ( OR) = 37.466, 95% confidence interval (95% CI) was 2.676-524.586, P = 0.007; OR = 22.960, 95% CI was 1.710-308.235, P = 0.018]. Conclusions:Comparing with non-AKI patients, more patients with polymyxin B-associated AKI had severe hypoalbuminemia, and the probability of using vasoactive drugs and the daily dose of polymyxin B were higher than non-AKI patients. Daily dose of polymyxin B ≥ 150 mg and using vasoactive drugs were independent risk factors for polymyxin B-associated AKI.

The atmospheric particulate matter(PM) is widely regarded as one of major environmentally and unfriendly ambient air pollution, and therein PM2.5 (diameter≤2.5 μm) is most closely related to human health.Because of its smaller diameter with longer suspension duration, PM can absorb many pathogenic microorganisms, and easily enter into the deep of airway and then deposit on the bronchus and alveoli, and it brings damage to the lung tissues and the surfactant proteins.PM can give rise to oxidative stress, inflammation response, cells and DNA damage.Now, this review focuses on the characterization and composition of PM, as well as the impact of PM2.5 on the lung, surfactant proteins and human health, which helps to call for more people to pay attention to this environmental issue in order to better mitigate and prevent the damage caused by PM.

( change) in (（）, pulse change indicates the abnormal changes inside body) in the (), the Bamboo Slips of Han Dynasty in Zhangjiashan is related to the classical thought on and the theory on meridians at early era. The connotation of was explored in views of interdisciplinary perspectives, such as Chinese medicine, philology and philosophy in the ancient time. It refers to the pulse changes as mentioned in ancient medical books, indicating the abnormal changes in the body. Before the ancient medical canonization marked as sphygmology, the ancient medical scholar focused on monism. Based on the thinking mode as analogy and detecting the root from the phenomenon, it is believed that refers to the imbalance of activity inside the body, manifested with the abnormal pulse change at relevant pulse region on the body surface. Accordingly, the disorders inside the body are detected by palpation.

Objective To propose a novel stereo-electroencephalography(SEEG) quantitative measure analyzing ictal high frequency (60-90 Hz) and calculating high frequency epileptogenicity index (HFEI) to localize epileptogenic zone and evaluate epileptogenic network. Methods The clinical presurgical evaluation and SEEG data of 15 patients who were performed SEEG electrodes implantation from April 2015 to March 2016 were analyzed retrospectively. Post-implantation head CT images and 3D MRI data were fused for accurately identifying and locating each electrode contact. Ictal SEEG quantitative measure HFEI was calculated and threshold was set. The epileptogenic network was divided into focal, regional, multiple regional and bilateral ones and the results were compared with the pathological results.Results The epileptogenic network was focal for four patients, regional for four patients, multiple regional for six patients and bilateral for one patient (7/15). In terms of the pathology,two cases with hippocampal sclerosis both showed regional network. In four cases with cerebral malacia, two cases showed multiple regional network and the other two cases showed focal network. In six cases with cortical malformation, three cases showed multiple regional network, the other three cases showed focal, regional and bilateral networks respectively. Conclusions We explored a novel SEEG quantitative measure based on the high frequency power analysis,which is objective and could localize epileptogenic zone and evaluate the epileptic network.

Through analyzing the different names of “arm Taiyin”, “arm Yangming”, “Juyang”, shoulder, tooth, and ear meridian [fromZu Bi (Arm and Foot),Yin Yang, andMai Shu (Classic of Meridians)] inNei Jing (Internal Medicine), this article was to reveal the changing process of the meridian terms from arm to hand, and to analyze the co-existence of the different meridian terms and the complicated relationships between the meridians pathways and their indications. It’s believed that different academic schools were unified inLing Shu (Spiritual Pivot) and then became systemic theories.

ObjectiveTo investigate the effect of killer cell immunoglobulin-like receptor (KIR) gene in immune killing of hepatoma cells.MethodsPeripheral blood mononuclear cell (PBMC) and hepatoma cells were co-cultured with different effector-target ratios. The expression of KIR gene family in PBMC, the content to interferon-γ (IFN-γ), the morphological change of hepatoma cell and the cytotoxicity to hepatoma cell by PBMC were observed after the co-incubation with different effector-target ratios. The comparison on cytotoxicity rates was conducted using one-way analysis of variance and LSD-t test.ResultsThe expression of activating KIR gene increased after 12 h of co-culture, but decreased after 24 h of co-culture. The expression of inhibitory KIR gene decreased after 12 h of co-culture. DAP12 maintained high expression all the time. The content of IFN-γ in PBMC decreased with the increase of effector-target ratio and reached the peak at 12 h of co-culture. Hepatoma cells co-cultured with different effector-target ratios were observed with increased chromatin condensation, rising proportion of cells with hemispherical or half moon shape and marginalized nucleus, and stagnant of active cell division. The cytotoxicity rate of effector-target ratio 1∶1, 10∶1 and 50∶1 was (8±3) %, (14±4) % and (32±6) %, respectively, with 50∶1 group significantly higher than 11∶1 and 10∶1 group (LSD-t=5.97, 4.61;P<0.05).ConclusionThe activating KIR gene plays an important role in immune killing of hepatoma cells.

Humans ; In Situ Hybridization, Fluorescence ; Sarcoma, Alveolar Soft Part ; diagnosis