Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To investigate the genotype,mutation type,and ethnic distribution characteristics of thalassemia in the population of Hechi area,Guangxi,and to provide a reference basis for prevention and control of thalassemia and eugenic counseling in the region.Methods:Gap-polymerase chain reaction(gap-PCR)and reverse dot blot(RDB)were used for genetic testing on suspected thalassemia persons,and the results were analyzed.Results:Among 29 136 samples,a total of 17 016(58.40％)positive samples for thalassemia genes were detected,with a higher detection rate in males than in females(X2=49.917,P＜0.001).The detection rates of thalassemia genes were significant different among Zhuang,Han,Yao,Mulao,and Maonan ethnic groups(x2=546.121,P＜0.001).The α-thalassemia genotypes were mainly--SEA/αα(16.67％),-α3.7/αα(8.90％),αCSα/αα(6.00％).Additionally,four rare genotypes were detected,including--THAI/αα(47 cases),HKαα/αα(2 cases),--SEA/-α21.9(2 cases),and--THAI/αcsα(1 case).The β-thalassemia genotypes were mainly βCD17/βN(7.49％),βCD41-42/βN(6.70％),βCD71-72/βN(0.44％).108 cases of moderate and severeβ-thalassemia were detected,of which 81 cases had a history of blood transfusion,the transfusion frequency of 60 cases was more than 10 times/year,and 10 cases received bone marrow transplantation.Conclusion:Thalassemia in Hechi area is predominantly deletion type--SEA/αα,the detection rate of thalassemia in ethnic minorities is higher than that in Han population.In this area,moderate and severe β-thalassemia have certain incidence,these patients mostly need regular blood transfusion and iron removal treatment,and very few patients have received bone marrow transplantation.This study provides a certain reference basis for prevention and control of thalassemia and eugenic counseling in the region.

Based on the literature study,the thoughts and possible therapeutic mechanism in treating male infertility from the perspective of spleen and kidney by regulating intestinal flora were explored.Disturbance of intestinal flora is one of the important factors leading to the development of male infertility,and the spleen and kidney have certain similarities to intestinal flora in the physiological function and pathological changes.Moreover,tonifying the kidney and strengthening the spleen can regulate the intestinal flora by fostering the growth of beneficial bacteria,inhibiting the reproduction of pathogenic bacteria,and protecting the barrier of the intestinal mucosa.Therefore,the possible therapeutic mechanisms in treating male infertility with the prescriptions for tonifying the kidney and strengthening the spleen to regulate intestinal flora are as follows:inhibiting the expression of inflammatory factors to reduce the inflammatory reaction of testicular tissues;improving the antioxidant capacity to alleviate the damage of spermatozoa caused by oxidative stress,and improving the bad mood to alleviate the impact of psychological stress on the reproductive system.The exploration of the thoughts for treating male infertility from the perspective of spleen and kidney by regulating intestinal flora may provide a new entry point for modern Chinese medicine clinical treatment of male infertility.

By analysing the similarity between defense qi and leukocytes in terms of function， site of action， and circadian rhythm， it is proposed that in traditional Chinese medicine （TCM）， the pathogenesis of leukopenia is defense qi deficiency. By analyzing the relevant discussions on the generation and transmission of defense qi in TCM classics， it is believed that the original qi in lower jiao （焦） is the source of defense qi， while the water and grain qi in middle jiao enriches defense qi， and the upper jiao transmits and distributes defense qi to the whole body. Therefore， when treating leukopenia after chemotherapy with TCM， Guilu Erxian Gelatin （龟鹿二仙胶） and Yougui Pill （右归丸） are often used to tonify the kidney and supplement essence， and moxibustion at Guanyuan （CV 4） and Qihai （CV 6） is usually accompanied to replenish the original qi in lower jiao and enrich the source of defense qi. Guipi Decoction （归脾汤）， Buzhong Yiqi Decoction （补中益气汤）， Shenling Baizhu Powder （参苓白术散）， and Sijunzi Decoction （四君子汤） are often suggested to strengthen spleen and replenish qi， in combination with moxibustion at Zhongwan （CV 12） and Zusanli （ST 36） to transport the spleen and stomach in the middle jiao to enrich the defense qi. Modified Guizhi Decoction （桂枝汤） to harmonize nutrient and defensive aspects is often used， and moxibustion at Dazhui （GV 14） and Feishu （BL 13） or scraping is added to dredge the striae and interstice in the upper jiao and promote transmission and dissemination of the defense qi. Considering the whole process of generation and distribution of defense qi， it is suggested to choose the most appropriate treatment modality flexibly， and combine internal treatment with external treatment， in order to provide ideas for the treatment of leukopenia in tumour patients.

Objective To observe the sedative and analgesic effects of bupivacaine hydrochloride injection combined with neostigmine methylsulfate injection in critically ill patients after general anesthesia operation.Methods Acute and critical patients who were to undergo general anesthesia were randomly divided into control group and treatment group.Two groups received general anesthesia combined with epidural block anesthesia.After operation,the control group was continuously pumped 0.75％bupivacaine hydrochloride injection 45 mL through the epidural catheter,the treatment group was given 2 μg·kg-1 neostigmine methylsulfate injection on the basis of continuous pumping of bupivacaine injection through epidural catheter in the control group.Comparing the pain numerical rating scale(NRS)for 12 h,24 h,48 h,and 72 h of postoperative analgesia and the Ramsay sedation scores(Ramsay),hemodynamic index and safety in the two groups.Results Treatment group were enrolled 32 cases,2 cases dropped out,and 30 cases were finally included in the statistical analysis.Control group were enrolled 32 cases,2 cases dropped out,and 30 cases were finally included in the statistical analysis.The 12-hour Ramsay in the control group and the treatment group were(2.62±0.46)and(2.58±0.51)points;the 24-hour Ramsay were(2.32±0.45)and(2.27±0.39)points;the 48-hour Ramsay were(2.12±0.36)and(2.04±0.32)points;and the 72-hour Ramsay were(1.68±0.34)and(1.57±0.29)points,respectively;the 12-hour NRS were(1.64±0.26)and(1.53±0.28)points;the 24-hour NRS were(2.14±0.37)and(2.23±0.34)points;the 48-hour NRS were(2.57±0.39)and(2.44±0.42)points;the 72-hour NRS were(2.89±0.46)and(2.61±0.51)points,respectively.The NRS score at 72 h after operation in the treatment group was significantly lower than that in the control group(P＜0.05).The 12 h heart rate(HR)in the control group and treatment group were(75.90±6.45)and(75.42±6.24)time·min-1;24 h HR were(76.37±6.28)and(76.43±5.34)times·min-1,48 h HR(78.57±5.14)and(76.95±5.27)time·min-1;72 h HR were(76.49±4.41)and(78.17±4.64)time·min-1,respectively.The 12 h mean arterial pressure(MAP)in the control group and treatment group were(94.34±7.86)and(95.24±7.45)mmHg;24 h MAP were(95.71±7.55)and(96.56±7.29)mmHg;48 h MAP were(96.58±7.36)and(97.64±7.69)mmHg;72 h MAP were(97.63±8.15)and(96.77±8.53)mmHg,respectively the differences of the above indexes between the control group and the treatment group were not statistically significant(all P＞0.05).The extubation time of control group and treatment group were(63.42±16.34)and(59.56±17.27)h,respectively,with no statistical significance(P＞0.05).The adverse drug reactions of two groups were nausea and vomiting,use of rescue analgesics 12 h after surgery,and wound infection.The incidences of postoperative adverse drug reactions in the control group and the treatment group were 26.67％and 23.33％,respectively,with no statistical significance(P＞0.05).Conclusion Bupivacaine hydrochloride injection combined with neostigmine methylsulforte injection can significantly enhance the epidural analgesia effect in acute and critical patients undergoing general anesthesia,and the safety is better.

The overuse of antibiotics in animal husbandry has resulted in escalating animal safety con-cerns,highlighting the urgent need for a safe and effective alternative to traditional acidifiers.necessita-ting the development of safe and effective alternatives to traditional acidifiers.This study investigates the antibacterial activity and underlying mechanisms of rare-earth organic acid complexes (Re-SOA),a promising alternative to traditional acidifiers,against three common poultry and livestock pathogens:Escherichia coli,Staphylococcus aureus,and Salmonella.A series of Re-SOA were synthesized via a liq-uid-phase method.Structural characterization using infrared spectroscopy,X-ray photoelectron spectros-copy,and Raman spectroscopy confirmed successful complexation.The minimum inhibitory concentration (MIC) and minimum sterilization concentration (MBC) were determined using the Oxford cup method and agar dilution method,respectively.The results indicated a synergistic antibacterial effect of the Re-SOA complexes,demonstrating significantly enhanced antibacterial activity compared to organic acids (SOA) and rare-earth ions (Re3+) alone.The antibacterial activity of the Re-SOA complexes followed the order:Yb-SOA>Gd-SOA>La-SOA,with Yb-Ac (Ac:acetic acid) exhibiting MIC values of 0.27,0.53,and 0.53 mmol·L-1,and MBC values of 0.53,0.53,and 0.53 mmol·L-1 against the three path-ogenic bacteria,respectively.Further investigation into the cellular mechanisms of action using field e-mission scanning electron microscopy (FESEM),transmission electron microscopy (TEM),and tran-scriptome sequencing revealed that Re-SOA effectively inhibits bacterial growth by targeting key metabolic pathways,including carbohydrate metabolism,energy metabolism,amino acid metabolism,and biofilm formation.Re-SOA,as a novel antibacterial agent,exhibits high efficacy and safety.This research pro-vides a promising approach for developing novel antibacterial agents and offers a potential solution to the critical issue of antibiotic resistance in animal husbandry.

Objective To observe the sedative and analgesic effects of bupivacaine hydrochloride injection combined with neostigmine methylsulfate injection in critically ill patients after general anesthesia operation.Methods Acute and critical patients who were to undergo general anesthesia were randomly divided into control group and treatment group.Two groups received general anesthesia combined with epidural block anesthesia.After operation,the control group was continuously pumped 0.75％bupivacaine hydrochloride injection 45 mL through the epidural catheter,the treatment group was given 2 μg·kg-1 neostigmine methylsulfate injection on the basis of continuous pumping of bupivacaine injection through epidural catheter in the control group.Comparing the pain numerical rating scale(NRS)for 12 h,24 h,48 h,and 72 h of postoperative analgesia and the Ramsay sedation scores(Ramsay),hemodynamic index and safety in the two groups.Results Treatment group were enrolled 32 cases,2 cases dropped out,and 30 cases were finally included in the statistical analysis.Control group were enrolled 32 cases,2 cases dropped out,and 30 cases were finally included in the statistical analysis.The 12-hour Ramsay in the control group and the treatment group were(2.62±0.46)and(2.58±0.51)points;the 24-hour Ramsay were(2.32±0.45)and(2.27±0.39)points;the 48-hour Ramsay were(2.12±0.36)and(2.04±0.32)points;and the 72-hour Ramsay were(1.68±0.34)and(1.57±0.29)points,respectively;the 12-hour NRS were(1.64±0.26)and(1.53±0.28)points;the 24-hour NRS were(2.14±0.37)and(2.23±0.34)points;the 48-hour NRS were(2.57±0.39)and(2.44±0.42)points;the 72-hour NRS were(2.89±0.46)and(2.61±0.51)points,respectively.The NRS score at 72 h after operation in the treatment group was significantly lower than that in the control group(P＜0.05).The 12 h heart rate(HR)in the control group and treatment group were(75.90±6.45)and(75.42±6.24)time·min-1;24 h HR were(76.37±6.28)and(76.43±5.34)times·min-1,48 h HR(78.57±5.14)and(76.95±5.27)time·min-1;72 h HR were(76.49±4.41)and(78.17±4.64)time·min-1,respectively.The 12 h mean arterial pressure(MAP)in the control group and treatment group were(94.34±7.86)and(95.24±7.45)mmHg;24 h MAP were(95.71±7.55)and(96.56±7.29)mmHg;48 h MAP were(96.58±7.36)and(97.64±7.69)mmHg;72 h MAP were(97.63±8.15)and(96.77±8.53)mmHg,respectively the differences of the above indexes between the control group and the treatment group were not statistically significant(all P＞0.05).The extubation time of control group and treatment group were(63.42±16.34)and(59.56±17.27)h,respectively,with no statistical significance(P＞0.05).The adverse drug reactions of two groups were nausea and vomiting,use of rescue analgesics 12 h after surgery,and wound infection.The incidences of postoperative adverse drug reactions in the control group and the treatment group were 26.67％and 23.33％,respectively,with no statistical significance(P＞0.05).Conclusion Bupivacaine hydrochloride injection combined with neostigmine methylsulforte injection can significantly enhance the epidural analgesia effect in acute and critical patients undergoing general anesthesia,and the safety is better.

The overuse of antibiotics in animal husbandry has resulted in escalating animal safety con-cerns,highlighting the urgent need for a safe and effective alternative to traditional acidifiers.necessita-ting the development of safe and effective alternatives to traditional acidifiers.This study investigates the antibacterial activity and underlying mechanisms of rare-earth organic acid complexes (Re-SOA),a promising alternative to traditional acidifiers,against three common poultry and livestock pathogens:Escherichia coli,Staphylococcus aureus,and Salmonella.A series of Re-SOA were synthesized via a liq-uid-phase method.Structural characterization using infrared spectroscopy,X-ray photoelectron spectros-copy,and Raman spectroscopy confirmed successful complexation.The minimum inhibitory concentration (MIC) and minimum sterilization concentration (MBC) were determined using the Oxford cup method and agar dilution method,respectively.The results indicated a synergistic antibacterial effect of the Re-SOA complexes,demonstrating significantly enhanced antibacterial activity compared to organic acids (SOA) and rare-earth ions (Re3+) alone.The antibacterial activity of the Re-SOA complexes followed the order:Yb-SOA>Gd-SOA>La-SOA,with Yb-Ac (Ac:acetic acid) exhibiting MIC values of 0.27,0.53,and 0.53 mmol·L-1,and MBC values of 0.53,0.53,and 0.53 mmol·L-1 against the three path-ogenic bacteria,respectively.Further investigation into the cellular mechanisms of action using field e-mission scanning electron microscopy (FESEM),transmission electron microscopy (TEM),and tran-scriptome sequencing revealed that Re-SOA effectively inhibits bacterial growth by targeting key metabolic pathways,including carbohydrate metabolism,energy metabolism,amino acid metabolism,and biofilm formation.Re-SOA,as a novel antibacterial agent,exhibits high efficacy and safety.This research pro-vides a promising approach for developing novel antibacterial agents and offers a potential solution to the critical issue of antibiotic resistance in animal husbandry.

OBJECTIVE: To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. METHODS: Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. RESULTS: TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. CONCLUSION TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.
Humans ; Artificial Limbs ; Muscle, Skeletal ; Neurosurgical Procedures ; Plastic Surgery Procedures ; Prosthesis Implantation