BACKGROUND:Studies have shown that vision recovery with thinner grafts is faster and the risk of rejection is lower.In China,there is a lack of clinical efficacy analysis of different graftthicknesses after endothelial transplantation.Therefore,determining the optimal graftthickness is crucial for improving surgical efficacy. OBJECTIVE:To evaluate the effects of different graftthickness on vision recovery and other prognostic indexes after simple Descemet's stripping endothelial keratoplasty. METHODS:A total of 72 patients(72 eyes)with corneal endothelial decompensation who received simple Descemet's stripping endothelial keratoplasty at the General Hospital of Northern Theater Command from January 2013 to February 2023 were selected.There were 32 cases(32 eyes)in the thin graftgroup(＜100 μm)and 40 cases(40 eyes)in the thick graftgroup(≥100 μm).The best corrected visual acuity,corneal endothelial cell count,corneal graft transparency,postoperative complications and graftsurvival were observed in both groups before and 1,3,6,and 12 months after surgery. RESULTS AND CONCLUSION:The visual acuity after surgery was significantly improved in both groups,and the best corrected visual acuity 3 months after surgery in the thin graftgroup was better than that in the thick graftgroup(P＜0.05).There was no significant difference in the number of corneal endothelial cells and grafttransparency between the two groups 1 year after surgery(P＞0.05).There was no significant difference in the incidence of postoperative complications such as secondary glaucoma,graftimmune rejection and graftdisplacement between the two groups(P＞0.05).There was no significant difference in the 1-year survival rate of grafts between the two groups(93.8%vs.92.3%,P＞0.05).To conclude,simple Descemet's stripping endothelial keratoplasty is a safe and effective surgical method for corneal endothelial transplantation,and its postoperative efficacy is similar to that of traditional Descemet's stripping endothelial keratoplasty,and the graftimplantation method is simpler.Thinner grafts can provide optimal corrected vision earlier and complete corneal remodeling sooner.Therefore,in the treatment of corneal endothelial decompensation,thinner grafts are preferred to improve recovery time.

ObjectiveTo explore the distribution pattern of tongue image characteristics in patients with glucolipid metabolic disorders and its main syndromes. MethodsA total of 841 patients with glucolipid metabolic disorders （disease group）， and 380 healthy subjects （control group） were included. The disease group was classified into three syndrome types： 283 cases of liver depression and spleen deficiency syndrome， 311 cases of phlegm-dampness obstruction syndrome， and 247 cases of qi stagnation and blood stasis syndrome. Tongue image data were collected using the TFDA-1 Tongue Diagnosis Instrument， and the TDAS V3.0 software was used to analyze the color， texture， and morphological features of the tongue body （TB） and tongue coating （TC） in patents with different syndromes of disease group （including lightness （L）， red-green axis （a）， yellow-blue axis （b）， luminance （Y）， difference between red signal and brightness （Cr）， difference between blue signal and brightness （Cb）， contrast （CON）， angular second moment （ASM）， entropy （ENT）， mean value （MEAN）， tongue coating area/tongue surface area （perAll）， and tongue coating area/non-coated area （perPart））. Logistic regression analysis was conducted to identify influencing factors for different syndrome types of glucolipid metabolic disorders. ResultsThe tongue body indicators TB-L， TB-Y， and TB-Cb in the disease group were significantly higher than those in the control group， while TB-a， TB-b， and TB-Cr were significantly lower. The tongue coating indicators TC-L， TC-Y， TC-Cb， perAll， and perPart in the disease group were significantly higher than those in the control group， while TC-a， TC-b， and TC-Cr were significantly lower （P＜0.05）. Comparing with the different syndromes in disease group， the TB-L and TB-Y of the liver depression and spleen deficiency syndrome， and the phlegm-damp obstruction syndrome were higher than those of the qi stagnation and blood stasis syndrome； the TB-a and TB-Cr of the phlegm-damp obstruction syndrome were lower than those of the qi stagnation and blood stasis syndrome； the perAll of the phlegm-damp obstruction syndrome was higher than that of the qi stagnation and blood stasis syndrome （P＜0.05）. In the analysis of the morphological characteristics of tongue signs， more spotted tongue in disease group compared with control group， more teeth-marked tongue in liver depression and spleen deficiency syndrome than the other two syndromes， more greasy coating in phlegm-damp obstruction syndrome， and more stasis spots of tongue in qi stagnation and blood stasis syndrome （P＜0.05）. Logistic regression analysis identified that greasy coating， spotted tongue， stasis spots of tongue， tooth-marked tongue， perAll， and TB-Cb are the influencing factors of liver depression and spleen deficiency syndrome； greasy coating， tooth-marked tongue， TC-Cb， and TC-Cr are the influencing factors of phlegm-damp obstruction syndrome； cracked tongue， stasis spots of tongue， tooth-marked tongue， and TB-Y are the influencing factors of qi stagnation and blood stasis syndrome （P＜0.05）. ConclusionCompared to healthy individuals， patients with glycolipid metabolic disorder have darker tongue color and thicker， greasy tongue coating. Glycolipid metabolic disorder patients of liver depression and spleen deficiency syndrome exhibit a reddish tongue with finer textures and more tooth marks； patients of phlegm-damp obstruction syndrome have lighter tongue coating with a coarser texture and a higher prevalence of greasy coating； patients of qi stagnation and blood stasis syndrome display lower tongue brightness with a higher prevalence of blood stasis spots.

ObjectiveTo identify the main chemical constituents of Anmeidan （AMD） and to explore the mechanism of AMD in regulating the extracellular signal-regulated kinase 1/2 （ERK1/2）/mitogen-activated protein kinase （MAPK）-interacting serine/threonine-protein kinase （MNK）/eukaryotic translation initiation factor 4E （eIF4E） signaling pathway to improve circadian rhythm disturbances in insomnia rats. MethodsThe main chemical constituents of AMD were identified using ultra-high-performance liquid chromatography-linear ion trap-electrostatic orbital trap mass spectrometry （UPLC-LTQ/Orbitrap/MS） in combination with reference standards. Sixty male Sprague-Dawley （SD） rats were randomly divided into control， model， melatonin， and AMD low-， medium-， and high-dose groups， with 10 rats in each group. Except for the control group， all rats were administered p-chlorophenylalanine via intraperitoneal injection to establish an insomnia model. The activity-rest rhythm of rats was assessed using the open field test and circadian rhythm test. Hematoxylin-eosin （HE） staining and Nissl staining were used to observe structural changes in hypothalamic neurons. Immunofluorescence， real-time quantitative polymerase chain reaction （Real-time PCR）， and Western blot analysis were employed to detect mRNA and protein expression levels of ERK1/2， MNK， and eIF4E in the hypothalamus. ResultsA total of 50 chemical components， including flavonoids， phenylpropanoids， triterpenoid saponins， alkaloids， and lignans， were identified in AMD. Compared with the control group， the model group exhibited significantly increased total distance traveled， average speed， central area residence time， and cumulative rearing time （P<0.01）， as well as prolonged cumulative activity time and total activity time in both light and dark phases （P<0.01）. Hypothalamic neurons in the model group were sparsely arranged， reduced in number， and exhibited nuclear disappearance or nucleolar rupture， with a significantly increased apoptosis index （P<0.01）. The cytoplasm appeared turbid， Nissl body staining was lighter， and the Nissl body apoptosis index was significantly increased （P<0.01）. The mRNA expression levels of ERK1/2， MNK， and eIF4E were significantly decreased （P<0.01）， along with a significant reduction in protein expression levels of ERK1/2， phosphorylated ERK1/2 （p-ERK1/2）， MNK， phosphorylated MNK （p-MNK）， eIF4E， and phosphorylated eIF4E （p-eIF4E） （P<0.01）. Compared with the model group， the total distance， average speed， central area residence time and body upright cumulative time of the AMD high-dose group were significantly reduced （P<0.01）. The total distance， average speed and body upright cumulative time of the AMD medium-dose group were significantly reduced （P<0.01）. The cumulative time of light activity and total time of activity in each dose group of AMD were significantly shortened （P<0.01）. The cumulative time of dark activity in the high-dose group of AMD was prolonged （P<0.01）. The neurons in the middle and high dose groups of AMD were closely arranged， the number of neurons increased， and the apoptosis index of hypothalamic cells decreased significantly （P<0.05， P<0.01）. The cytoplasm of the low， middle and high dose groups of AMD was clear， the color of Nissl body became darker， and the apoptosis index of Nissl body decreased significantly （P<0.01）. The expression of ERK1/2， MNK and eIF4E mRNA and protein in the hypothalamus of the middle and high dose groups of AMD increased significantly （P<0.05， P<0.01）. ConclusionAMD primarily contains 50 chemical constituents， including flavonoids， phenylpropanoids， and triterpenoid saponins. It exhibits a "synergistic enhancement" effect through multiple components and multiple pathways to improve insomnia. AMD ameliorates circadian rhythm disturbances in p-chlorophenylalanine-induced insomnia rats by upregulating ERK1/2/MNK/eIF4E signaling pathway-related proteins.

Liuhetang is one of the classic prescriptions included in the Catalogue of Ancient Classic Prescriptions （the Second Batch）. This study adopts the method of literature review to systematically sort out the ancient literature about Liuhetang and obtained a total of 127 effective data records， involving 82 ancient books （including 2 Japanese books）. The origin， medicinal composition， compatibility， original plants and their processing methods， dosage， decocting method， usage， and indications of Liuhetang were analyzed. Liuhetang is first recorded in the Formulary of the Bureau of Taiping People's Welfare Pharmacy in the Song Dynasty， consisting of Amomi Fructus， Pinelliae Rhizoma， Armeniacae Semen Amarum， Ginseng Radix et Rhizoma， Glycyrrhizae Radix et Rhizoma， red Poria， Pogostemonis Herba， Lablab Semen Album， Chaenomelis Fructus， Moslae Herba， Magnoliae Officinalis Cortex， Zingiberis Rhizoma Recens， and Jujubae Fructus. The original plants of these herbal medicines follow those in the 2020 edition of the Pharmacopoeia of the People's Republic of China. The raw materials of Amomi Fructus， Armeniacae Semen Amarum， Ginseng Radix et Rhizoma， Glycyrrhizae Radix et Rhizoma， red Poria， Pogostemonis Herba， Chaenomelis Fructus， Moslae Herba， Magnoliae Officinalis Cortex， Zingiberis Rhizoma Recens， and Jujubae Fructus are used in this prescription. Pinelliae Rhizoma， Glycyrrhizae Radix et Rhizoma， Lablab Semen Album， and Magnoliae Officinalis Cortex are processed with alum， stir-fried， processed with Zingiberis Rhizoma Recens， and processed with Zingiberis Rhizoma Recens， respectively. The recommended formula is composed of 0.79 g Amomi Fructus， 0.79 g Pinelliae Rhizoma， 0.79 g Armeniacae Semen Amarum， 0.79 g Ginseng Radix et Rhizoma， 0.79 g Glycyrrhizae Radix et Rhizoma， 1.57 g red Poria， 1.57 g Pogostemonis Herba， 1.57 g Lablab Semen Album， 1.57 g Chaenomelis Fructus， 3.15 g Moslae Herba， and 3.15 g Magnoliae Officinalis Cortex. The above medicines should be pulverized to reach 10 meshes， mixed with 450 mL water， 3 g Zingiberis Rhizoma Recens， and 3 g Jujubae Fructus， and decocted to reach a volume of 240 mL. The filtrate should be taken three times a day. In ancient times， Liuhetang was mainly used to treat cholera， vomiting， diarrhea， phlegm， dyspnea， cough， chest distension， dizziness and pain in the head， swelling in the limbs， lethargy， loss of appetite， difficult urination and dark urine caused by heat and dampness damage to the spleen and disharmony between spleen and stomach. In modern times， Liuhetang is mainly used to treat the digestive system diseases such as gastroenteritis， hepatitis， stomach pain， and diarrhea. The above research confirmed the key information of Liuhetang， providing a basis for the clinical application of this prescription.

Objective To analyze the clinical significance of subjective visual vertical (SVV) tests at different head deflection angles in assessing utricle function in patients with benign paroxysmal positional vertigo (BPPV). Methods A total of 61 BPPV patients who were treated at the Hearing Impairment and Vertigo Diagnosis and Treatment Center of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from August 2022 to May 2023 were retrospectively included, and 29 healthy adults were selected as controls. SVV tests were performed on all research subjects at different head deflection angles: upright head (0°), left head 45° (L45°), right head 45° (R45°). The test results between the two groups were compared. Results SVV absolute value at R45° in BPPV group was lower than that in the control group (P＝0.003); there was no significant difference in SVV values at 0° and L45° between the two groups. There was no statistical difference in SVV values at different head deflection angles between the control group and the left BPPV group. SVV absolute value at R45° in right BPPV group was lower than that in the control group (P＜0.001); there was no statistical difference in SVV values at 0° and L45° between the two groups. Conclusions SVV test can provide subjective information about the utricle, and SVV tests at different head deflection angles can fine-tune evaluate the function of the utricle in BPPV patients.

[摘 要] 目的：构建纳米囊泡杂化透明质酸水凝胶（ICG-NV@SeHA）并探讨其联合声动力疗法（SDT）杀伤小鼠胶质瘤GL261细胞的机制。方法：通过挤出法制备骨髓来源的间充质干细胞纳米囊泡（BMSC-NV），再将吲哚菁绿（ICG）掺入其中制备ICG-NV。在EDC存在下用ED对HA进行氨基化，合成AHA，进一步通过亲核加成反应与γ-硒代丁内酯（SBL）连接，合成SeHA。将AHA、ICG-NV和SBL溶液混合，发生氧化交联获得ICG-NV@SeHA，对其进行物理表征。用DiD标记ICG-NV和ICG-NV@SeHA后与GL261细胞共培养12 h，观察细胞内吞情况。用CCK-8法检测ICG-NV和ICG-NV@SeHA与GL261细胞和小鼠海马神经元HT22细胞的生物相容性。将GL261细胞分为PBS + 超声处理（US）、ICG + US、IVG-NV + US和ICG-NV@SeHA + US组，Calcein-AM/PI染色法和DCFH-DA荧光探针标记法分别检测联合SDT对GL261细胞杀伤作用，以及对细胞内活性氧（ROS）生成的影响；采用细胞免疫荧光实验检测对细胞表面钙网蛋白（CRT）表达的影响，酶联免疫吸附试验（ELISA）检测对细胞高迁移率族蛋白1（HMGB1）和三磷酸腺苷（ATP）释放的影响。结果：成功制备BMSC-NV，粒径约154.3 nm；ICG成功被包入囊泡中，包封率为40.6%；氨基成功连接在HA上，接枝率为32.5%。最后成功制备了ICG-NV@SeHA，透射电镜观察显示其具有疏松的多孔结构，流变结果储能模量（G’）＞损耗模量（G”），均符合水凝胶特性，且具有剪切变稀特性。细胞实验结果显示，ICG-NV可以被GL261细胞有效摄取。CCK-8实验和Calcein-AM/PI荧光染色实验结果显示，ICG-NV和ICG-NV@SeHA均具有良好的生物相容性，对GL261和HT22细胞没有明显的细胞毒作用；而ICG-NV + US和ICG-NV@SeHA + US组细胞存活率较ICG+US组显著降低（P < 0.01或P < 0.001）。ICG-NV + US和ICG-NV@SeHA + US组细胞DCFH-DA探针绿色荧光强度显著高于PBS、PBS + US和ICG + US组（P < 0.000 1或P < 0.001），反映细胞内产生大量的ROS，且细胞表面CRT表达显著增加（P < 0.000 1），上清液中HMGB1和ATP的释放也增多（P < 0.05或P < 0.01）。结论：成功制备具备优异的机械性能和可注射性的ICG-NV@SeHA，生物相容性好，联合SDT能有效杀伤GL261细胞并诱导免疫原性细胞死亡（ICD），可能成为一种有效治疗胶质瘤术后复发的新手段。

Objective To explore the effective induction scheme for differentiation of adipose-derived mesenchymal stem cell (ADMSC) to insulin producing cell (IPC). Methods Different schemes of small molecule compound were used to induce the differentiation of ADMSC. The purity of cells was analyzed by flow cytometry and the morphological changes of cells were observed under the microscope. The quality, performance and insulin related indicators of cells were detected by hematoxylin-eosin and immunohistochemical staining. The maturity and activity of cells were detected by dithizone (DTZ) and diacetylfluorescein/propidium iodide staining. The induction effect of ADMSC differentiated into IPC was analyzed. Results The purity of ADMSC reached more than 99%, and the sphere forming properties of schemes Ⅰ, Ⅱ and Ⅲ were good. Cell induction mass, the expression effects of pancreatic and duodenal homeobox 1 (PDX1), musculoaponeurotic fibrosarcoma oncogene homolog A (MAFA) and insulin and C peptide of schemes Ⅰ were both better than those of other schemes. The DTZ staining depth may be related to IPC maturity, among which the number of apoptotic cells in scheme Ⅰ was significantly less than that of scheme Ⅱ and Ⅲ. Conclusions Induction scheme Ⅰ may improve the differentiation efficiency of ADMSC to IPC and lay a certain foundation for future clinical IPC transplantation applications.

Testicular radiation injury is a structural and functional abnormality of the testes caused directly or indirectly by radiation, which disrupts spermatogenesis and compromises male fertility. The development of effective preventive and therapeutic interventions is essential because of the high prevalence of this condition in clinical settings and its profound effect on patients′ reproductive health and overall well-being. The concept of "the struggle between vital qi and pathogen" is first seen in the Treatise on Cold Pathogenic Diseases. It denotes the dynamic struggle between vital and pathogenic qi. The occurrence, development, and sequelae of all diseases reflect this ongoing conflict. In this context, this study defines the "vital qi" of the testis as its capacity to generate and preserve the essence of reproduction and to resist damage. The pathogenic qi associated with testicular radiation injury is categorized into two types: ionizing poison and retaining evil. The pathogenesis of testicular radiation damage is delineated into three stages by integrating the characteristics of vital and pathogenic qi: the injury, adhesion, and recovery phases. Based on the theoretical framework advanced by this study, the therapeutic approach for testicular radiation injury should adhere to the fundamental principle of strengthening vital qi and eliminating pathogenic factors. Although the primary focus of treatment should be on strengthening vital qi, it should also be complemented by strategies to eliminate pathogenic influences. This paper aims to provide a novel perspective and strategic approach to the traditional Chinese medicine diagnosis, prevention, and treatment of testicular radiation injury. By elucidating the process of testicular radiation injury and its corresponding treatment principles, it seeks to offer valuable insights for clinical practice.

ObjectiveBola-like short peptides exhibit novel self-assembly properties due to the formation of peptide dimers via hydrogen bonding interactions between their C-terminals. In this configuration, hydrophilic amino acids are distributed at both terminals, making these peptides behave similarly to Bola peptides. The electrostatic repulsive interactions arising from the hydrophilic amino acids at each terminal can be neutralized, thereby greatly promoting the lateral association of β-sheets. Consequently, assemblies with significantly larger widths are typically the dominant nanostructures for Bola-like peptides. To investigate the effect of hydrophilic amino acids on the self-assembly behavior of Bola-like peptides, the peptides Ac-RI₃-CONH₂ and Ac-HI₃-CONH₂ were designed and synthesized using the Bola-like peptide Ac-KI₃-CONH₂ as a template. Their self-assembly behavior was systematically examined. MethodsAtomic force microscopy (AFM) and transmission electron microscopy (TEM) were employed to characterize the morphology and size of the assemblies. The secondary structures of the assemblies were analyzed using circular dichroism (CD) and Fourier transform infrared (FTIR) spectroscopy. Small-angle neutron scattering (SANS) was used to obtain detailed structural information at a short-length scale. Based on these experimental results, the effects of hydrophilic amino acids on the self-assembly behavior of Bola-like short peptides were systematically analyzed, and the underlying formation mechanism was explored. ResultsThe aggregation process primarily involved three steps. First, peptide dimers were formed through hydrogen bonding interactions between their C-terminals. Within these dimers, the hydrophilic amino acids K, R, and H were positioned at both terminals, enabling the peptides to self-assemble in a manner similar to Bola peptides. Next, β-sheets were formed via hydrogen bonding interactions along the peptide backbone. Finally, self-assemblies were generated through the lateral association of β-sheets. The results demonstrated that both Ac-KI₃-CONH₂ and Ac-RI₃-CONH₂ could self-assemble into double-layer nanotubes with diameters of approximately 200 nm. These nanotubes were formed by the edge fusion of helical ribbons, which initially emerged from twisted ribbons. Notably, the primary assemblies of these peptides exhibited opposite chirality: nanofibers formed by Ac-KI₃-CONH₂ displayed left-handed chirality, whereas those formed by Ac-RI₃-CONH₂ exhibited right-handed chirality. This reversal in torsional direction was primarily attributed to the different abilities of K and R to form hydrogen bonds with water. In contrast, Ac-HI₃-CONH₂ formed narrower twisted ribbons with a significantly reduced width of approximately 30 nm, which was attributed to the strong steric hindrance caused by the imidazole rings. The multilayer height of these ribbons was mainly due to the unique structure of the imidazole rings, which can function as both hydrogen bond donors and acceptors, thereby promoting aggregate growth in the vertical direction. ConclusionThe final morphology of the self-assemblies resulted from a delicate balance of various non-covalent interactions. By altering the types of hydrophilic amino acid residues in Bola-like short peptides, the relative strength of non-covalent interactions that drive assembly formation can be effectively regulated, allowing precise control over the morphology and chirality of the assemblies. This study provides a simple and effective approach for constructing diverse self-assemblies and lays a theoretical foundation for the development of functional biomaterials.

ObjectiveTo explore the construction and evaluation methods of a rat model of acute myocardial infarction（AMI） with Qi and Yin deficiency syndrome established by sleep deprivation combined with coronary artery ligation. MethodsThirty-six SD rats were randomly divided into a normal group（n=6）， a myocardial infarction group（model A group， n=10）， an acute sleep deprivation+myocardial infarction group（model B group， n=10）， and a chronic sleep deprivation+myocardial infarction group（model C group， n=10） according to body weight. Rats in the normal group were not treated， rats in the model A group underwent only ligation of the left anterior descending coronary artery， rats in the model B group were sleep deprived for 96 h and then underwent ligation of the left anterior descending coronary artery， and rats in the model C group were sleep deprived for an additional 48 h each week with a 24 h rest period as one cycle for three weeks on the basis of the model B group. After coronary artery ligation in the model C group， the first week was defined as the starting point of the first sleep deprivation cycle， and indexes were tested weekly for rats in each group for 3 weeks. Electrocardiogram was used to determine the ligation of the left anterior descending coronary artery in rats， and small animal echocardiography was used to evaluate the cardiac function. The levels of serum creatine kinase（CK）， creatine kinase isoenzyme（CK-MB）， lactate dehydrogenase（LDH）， cardiac troponin T（cTnT）， interleukin-18（IL-18）， and tumor necrosis factor-α（TNF-α） were detected by biochemical assays， and hematoxylin-eosin（HE） staining was used to evaluate the pathological changes of myocardial tissue in rats. The syndrome indicators of Qi and Yin deficiency were evaluated by general state and body weight， grip strength， facial temperature， paw temperature， rectal temperature， salivary flow rate， open field test， tongue color［red（R）， green（G）， and blue（B）］ values， pulse amplitude changes， and enzyme-linked immunosorbent assay（ELISA） for the detection of expression levels of cyclic adenosine monophosphate（cAMP）， cyclic guanosine monophosphate（cGMP）， rat serum corticotropin-releasing factor（CRF）， adrenocorticotropic hormone（ACTH）， triiodothyronine（T3）， tetraiodothyronine（T4）， and corticosterone（CORT） in serum. ResultsIn terms of disease indicators， compared with the normal group， the ST segment of the electrocardiogram in each model group was significantly elevated， the echocardiographic parameters were decreased， the contents of myocardial enzymes and inflammatory factors were increased（P<0.01）， and the myocardial tissue in the infarcted area was significantly damaged. In terms of syndrome indicators， compared with the normal group， the body weight of rats in the model B and C groups decreased at each time point， the grip strength of each model group decreased， the total distance traveled and the number of entries into the center in the open field test decreased， the immobility time increased， the facial and rectal temperatures of rats in the model B and C groups increased， the salivary flow rate of each model group decreased， the tongue color was bright red or light， the tongue body was dry or smooth like a mirror， lacking of moisture sensation， the R， G and B values of the tongue surface increased， the pulse amplitude changes decreased， and the contents of T3 and T4 increased， while the expressions of cAMP， CRF， ACTH and CORT in the model B and C groups increased（P<0.05， P<0.01）. ConclusionContinuous sleep deprivation for 96 h in a multi-platform method combined with coronary artery ligation can construct a rat model of AMI with Qi and Yin deficiency syndrome， and the syndrome manifestations can be maintained for 3 weeks.