Lower extremity arteriosclerosis obliterans(LEASO)is a disease characterized by the formation of atherosclerotic plaques in the lower extremity arteries,leading to arterial stenosis,occlusion,and consequent chronic limb ischemia.This article analyzes the clinical data of a patient with LEASO complicated by an iodine contrast agent allergy,along with the treatment involving intravascular ultrasound(IVUS)-guided endovascular intervention performed without contrast agent,and reviews relevant literature.The patient,a 53-year-old female,presented with coldness and numbness in the left lower extremity and pain after walking for 2 years,symptoms which had worsened over the past 2 months,with a maximum claudication distance of less than 50 meters.The lower extremity arterial CT angiography(CTA)results indicated"left iliac artery occlusion and left superficial femoral artery stenosis."After examination,the patient exhibited allergic symptoms.Upon admission,other diseases were ruled out.Given that the lower extremity symptoms severely impacted the patient's daily life and considering the potential for contrast agent allergy,the use of contrast agent was abandoned.IVUS guidance alone was employed to assess the intravascular condition for the interventional procedure.The surgical interventions chosen were drug-coated balloon angioplasty of the left superficial femoral artery and stent implantation in the left iliac artery.Postoperatively,the patient was able to walk normally,the discomfort resolved,and the treatment outcome was satisfactory.For LEASO patients with contrast agent allergy or other contraindications to contrast use,the sole use of IVUS guidance combined with invasive blood pressure monitoring to intraoperatively assess efficacy can effectively avoid contrast agent administration,providing a valuable reference for clinicians managing such cases.

OBJECTIVE To explore the relationship between white matter damage and sleepiness,decreased sleep quality,and cognitive decline in patients with OSA.METHODS There were 55 confirmed cases of OSA diagnosed by polysomnography(PSG)from January 2018 to May 2023 were selected,with 29 non-OSA controls also diagnosed by PSG.DKI scanning and Epworth sleepiness scale(ESS),Pittsburgh sleep quality index(PSQI),and Montreal cognitive assessment(MoCA)scores were performed for all subjects.Differences in kurtosis fractional anisotropy(KFA)of various brain regions were compared between the two groups to identify differential brain regions,and pairwise correlations were analyzed between KFA reduction and apnea-hypopnea index(AHI),lowest oxygen saturation(LSaO2)and various scale scores in OSA patients.RESULTS The KFA values in right external capsule,bilateral corona radiata,bilateral superior longitudinal fasciculus,corpus callosum,posterior cingulate gyrus of OSA group were lower than control group(P<0.05).For the OSA group:The correlation between ESS scores and KFA values of right posterior corona radiata,left superior longitudinal fasciculus,body of corpus callosum,splenium of corpus callosum are all negative(r=-0.287,-0.286,-0.276,-0.449,P<0.05).The correlation between PSQI scores and KFA values of right posterior corona radiata,left posterior corona radiata,splenium of corpus callosum are all negative(r=-0.390,-0.274,-0.348,P<0.05).The correlation between MoCA scores and KFA values of right posterior corona radiata,right superior longitudinal fasciculus,left anterior corona radiata,left posterior corona radiata,left superior corona radiata,left superior longitudinal fasciculus,genu of corpus callosum,body of corpus callosum,are all positive(r=0.290,0.389,0.298,0.278,0.340,0.473,0.344,0.344,P<0.05).The correlation between visuospatial and executive function scores and AHI,LSaO2,ESS scores and KFA values of right posterior corona radiata,left superior corona radiata,left superior longitudinal fasciculus and splenium of corpus callosum are all significant(r=-0.350,0.470,-0.343,0.401,0.284,0.387,0.274,P<0.05).CONCLUSION Patients with OSA exhibit damage to the white matter in certain brain regions.The damage to the corpus callosum,posterior corona radiata,and superior longitudinal fasciculus has the greatest impact on patients'sleepiness,reduced sleep quality,and cognitive impairment.In particular,the impairment in visuospatial and executive function is closely associated with white matter damage in the corona radiata and superior longitudinal fasciculus.

OBJECTIVE To explore the changes of brain white matter of the patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)with magnetic resonance diffusional kurtosis imaing(DKI).METHODS There were 38 patients with OSAHS examined by polysomnogram(PSG)from November 2017 to June 2021,and 32 non-OSAHS controls matched in gender and age who were included in this study.All the subjects were scanned by DKI.The different encephalic regions through comparing kurtosis fractional anisotropy(KFA)values of all encephalic regions between the two groups were found,and the relationship between the KFA values of the different encephalic regions in OSAHS patients and the apnea-hypopnea index(AHI),lowest saturation oxygen(LSaO2)and the percent of the total record time spent below 90%oxygen saturation(TS90%)in PSG were analyzed.RESULTS The KFA values of white matter fiber tracts in corpus callosum,bilateral corona radiata,cingulate gyrus,right superior cerebellar peduncle and inferior cerebellar peduncle of OSAHS group were obviously lower than control group(P<0.05).After controlling for age and body mass index(BMI),the partial correlation between AHI and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus in OSAHS group were also negative(r=-0.344,-0.380,-0.406,-0.53,P<0.05).The partial correlation between LSaO2 and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus,right superior cerebellar peduncle in OSAHS group were also positive(r=0.366,0.406,0.446,0.404,0.342,P<0.05).The partial correlation between TS90%and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus,right superior cerebellar peduncle and inferior cerebellar peduncle in OSAHS group were also negative(r=-0.414,-0.352,-0.355,-0.336,-0.456,-0.360,P<0.05).CONCLUSION Recurrent apnea and hypoxemia at night of OSAHS patients can cause damage to white matter fibers in parts of encephalic regions.

Objective:To explore the clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand.Methods:This study was a retrospective non-randomized controlled study. From February 2015 to February 2023, 24 patients (15 males and 9 females, aged 12-55 years) with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand, who met the inclusion criteria and were repaired with flap transplantation and tendon grafting or tendon anastomosis, were admitted to the First Affiliated Hospital of Air Force Medical University. According to different intervention time for postoperative rehabilitation treatment of patients, the patients were divided into conventional rehabilitation group and early rehabilitation group, with 12 cases in each group. Patients in early rehabilitation group received rehabilitation treatment immediately after surgery under the rehabilitation guidance of specialized rehabilitation physicians based on the characteristics of different postoperative periods. Patients in conventional rehabilitation group began rehabilitation treatment from the third week after surgery, and their rehabilitation treatment was the same as that of patients in early rehabilitation group from the second week after surgery. The patients in 2 groups were treated in the hospital until the sixth week after surgery. The occurrence of flap vascular crisis and tendon rupture were observed within 6 weeks after surgery. After 6 weeks of surgery, the manual muscle test was used to measure the pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, and grip force of the affected hand; the total action motion method was used to evaluate the finger joint range of motion of the affected hand, and the excellent and good ratio was calculated; the Carroll upper extremity function test was used to score and rate the function of the affected hand.Results:Within 6 weeks after surgery, only 1 patient in conventional rehabilitation group suffered from venous crisis, and the flap survived after the second surgical exploration and anastomosis of blood vessels; there was no occurrence of tendon rupture in patients of 2 groups. After 6 weeks of surgery, there were no statistically significant differences in pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, or grip force of the affected hand between the two groups of patients ( P>0.05); the excellent and good ratio of the finger joint range of motion of the affected hand of patients in early rehabilitation group was 11/12, which was higher than 7/12 in conventional rehabilitation group, but there was no statistically significant difference ( P>0.05); the affected hand function score of patients in early rehabilitation group was 90±6, which was significantly higher than 83±8 in conventional rehabilitation group ( t=2.41, P<0.05); the function rating of the affected hand of patients in early rehabilitation group was obviously better than that in conventional rehabilitation group ( Z=2.04, P<0.05). Conclusions:Early rehabilitation treatment for patients with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand after repair surgery can improve hand function, but it would not increase surgery related complications, which is worthy of clinical promotion and application.

Objective To establish the analytical performance specifications(APS)for routine items of biochemical inspection based on the external quality assessment(EQA)and internal quality control(IQC)data.Methods The EQA data and IQC data of routine items of biochemistry inspection in clinical laboratory center of national health commission from 2021 to 2023 were collected from the Department Clinical Laboratory of Traditional Chinese Medicine Hospital of Chengdu Pidu District.Comparing the percentage difference of the EQA data and the IQC in control imprecision[expressed as the coefficient of variation(CV)]data with the 3-level evaluation criteria derived based on biological variation(BV),the percentage pass rate of EQA data and the pass rate of CV under control were calculated,so as to achieve the quality target of APS with 80％or more as the quality control product of this level as the routine biochemical test items of the laboratory.For the inspection items that did not reach BV standard APS or were not applicable to meet the standard,the APS would be set to the WS/T 403-2012 industry standard or based on current technical level.Results TEa/allowable CV of biochemical inspection items were as follows:Potassium(K)2.4％/1.9％,Sodium(Na)4.0％/0.9％,Chloride(Cl)4.0％/0.9％,Calcium(Ca)3.4％/1.8％,Phosphate(P)9.6％/1.9％,Magnesium(Mg)3.8％/2.0％,Glucose(Glu)6.1％/2.3％,Creatinine(Crea)3.9％/2.2％,Urea(Urea)8.6％/3.3％,Total protein(TP)4.9％/2.0％,Albumin(Alb)3.3％/1.9％,Total bilirubin(TBil)6.3％/2.4％,Alanine transaminase(ALT)9.3％/2.9％,Asparpartate transaminase(AST)6.2％/2.1％,γ-glutamyl transferase activity(GGT)9.2％/2.1％,Lactate dehydrogenase(LDH)6.8％/2.2％,Alkaline phosphatase(ALP)7.2％/3.3％,Total cholesterol(TC)of 8.3％/2.6％,Triglyceride(TG)12.9％/4.9％,Amylase(AMY)5.9％/1.6％,Creatine kinase(CK)4.3％/1.6％and Uric acid(UA)2.9％/1.0％.Conclusion The APS set based on BV or current technical level can be used as a quality target for routine laboratory clinical biochemistry testing programs,and the laboratory can select the suitable APS according to the actual situation.

OBJECTIVE To observe the clinical efficacy of Yangyin Jiedu Decoction in the prevention and treatment of acute ra-diation-induced oral mucositis(RTOM).METHODS A total of 80 inpatients who were diagnosed with head and neck tumors by pathological examination and received radiotherapy in the Department of Radiotherapy,Affiliated Hospital of Nanjing University of Chi-nese Medicine from November 2021 to September 2023 were selected and randomly divided into an observation group and a control group with 40 cases in each group.The control group was given mouthwash treatment from the onset of RTOM symptoms until the symp-toms disappeared;the observation group was given Yangyin Jiedu Decoction from the first day of radiotherapy on the basis of the treat-ment of the control group until the end of radiotherapy.During the treatment,the onset time,duration and incidence of grade Ⅱ-ⅣRTOM in the two groups were observed;the pain numerical rating scale(NRS)score,Karnofsky performance status(KPS)score,body mass index(BMI)changes were evaluated;and the levels of serum inflammatory factors[C-reactive protein(CRP),interleukin 6(IL-6),interleukin 1β(IL-1β),tumor necrosis factor α(TNF-α)]were detected.RESULTS After radiotherapy,RTOM ap-peared in both groups to varying degrees.The incidence of grade Ⅱ-Ⅳ RTOM,the onset time,duration and NRS score of RTOM in the observation group were significantly better than those in the control group(P<0.05,P<0.01).After radiotherapy,the levels of se-rum CRP,IL-6,IL-1β and TNF-α in the observation group were lower than those in the control group(P<0.05,P<0.01).After radiotherapy and 1 month of follow-up,the KPS score and BMI in the observation group were higher than those in the control group(P<0.05,P<0.01).CONCLUSION Yangyin Jiedu Decoction can decrease the incidence and severity of RTOM in patients with head and neck tumors,shorten its duration,improve the quality of life of patients,downregulate the level of inflammatory cytokines,and has a preventive effect on RTOM caused by radiotherapy in patients with head and neck tumors.

Objective:To explore the brain white matter damage in patients with moderate to severe obstructive sleep apnea hypopnea syndrome(OSAHS) using diffusional kurtosis imaging(DKI), and to analyze its relationship with anxiety, depression and cognitive impairment in patients.Methods:This was a retrospective case-control study. Fifty confirmed cases (47 males and 3 females) of moderate to severe OSAHS diagnosed by polysomnography(PSG) from November 2017 to December 2022 were selected as OSAHS group(age range from 22 to 65 years old, with median age of 40 years old), and 32 healthy controls(27 males and 5 females) of non-OSAHS diagnosed by PSG were selected as control group(age range from 19 to 56 years old, with median age of 34 years old). DKI scanning, Beck Anxiety Inventory(BAI), Beck Depression Inventory-Ⅱ(BDI-Ⅱ), and Montreal cognitive assessment(MoCA) scores were performed in all subjects. Differences in kurtosis fractional anisotropy(KFA) of various brain regions were compared between the two groups to identify differential brain regions. Correlations were analyzed between KFA reduction and anxiety, depression, and cognitive impairment in OSAHS patients. To study the correlation between brain injury and anxiety, depressive mood, and cognitive dysfunction, statistical methods such as non-parametric tests for two independent samples, chi-square tests, and partial correlation analysis, were used to analyze the evaluation indicators of the two groups.Results:The KFA values in right external capsule, left anterior corona radiata, right anterior corona radiata, left posterior corona radiata, right posterior corona radiata, left superior corona radiata, right superior corona radiata, left superior longitudinal fasciculus, right superior longitudinal fasciculus, genu of corpus callosum, splenium of corpus callosum, body of corpus callosum, posterior cingulate gyrus of moderate to severe OSAHS group were all lower than those in the control group( t=-2.247, -3.028, -3.955, -4.871, -2.632, -2.594, -2.121, -2.167, -3.129, -2.015, -2.317, -2.313, -2.152, P<0.05). For the moderate to severe OSAHS group, the correlation between AHI and KFA values of right posterior corona radiata, right superior corona radiata, left anterior corona radiata, left posterior corona radiata, left superior corona radiata, left superior longitudinal fasciculus, genu of corpus callosum, body of corpus callosum, splenium of corpus callosum were all negative( r=-0.378, -0.307, -0.337, -0.343, -0.341, -0.613, -0.390, -0.384, -0.396, P<0.05). The correlation between LSO 2 and KFA values of right anterior corona radiata, right posterior corona radiata, right superior corona radiata, right superior longitudinal fasciculus, left anterior corona radiata, left posterior corona radiata, left superior corona radiata, left superior longitudinal fasciculus, genu of corpus callosum, body of corpus callosum, splenium of corpus callosum, posterior cingulate gyrus were all positive( r=0.330, 0.338, 0.425, 0.312, 0.433, 0.358, 0.410, 0.459, 0.473, 0.659, 0.489, 0.356, P<0.05). The correlation between BAI scores and KFA values of right external capsule, right anterior corona radiata, left posterior corona radiata, left superior corona radiata, body of corpus callosum, splenium of corpus callosum were all negative( r=-0.306, -0.372, -0.296, -0.346, -0.318, -0.386, P<0.05). The correlation between BDI-Ⅱ scores and KFA values of right superior corona radiata, right superior longitudinal fasciculus, left anterior corona radiata, genu of corpus callosum, body of corpus callosum, splenium of corpus callosum were all negative( r=-0.334, -0.289, -0.309, -0.310, -0.503, -0.469, P<0.05). The correlation between MoCA scores and KFA values of right posterior corona radiata, right superior longitudinal fasciculus, left anterior corona radiata, left superior corona radiata, left superior longitudinal fasciculus, genu of corpus callosum, body of corpus callosum, splenium of corpus callosum were all positive( r=0.368, 0.431, 0.324, 0.410, 0.469, 0.384, 0.369, 0.309, P<0.05). Conclusions:With the aggravation of OSAHS, the damage to some brain regions becomes more pronounced in moderate to severe OSAHS patients. These damage brain functional areas are closely related to the anxiety, depression, and cognitive impairment of patients.

OBJECTIVE: To explore the clinical characteristics and genetic etiology for a child with atypical Hemolytic uremic syndrome (aHUS) in conjunct with nephrotic level proteinuria. METHODS: A child patient who had visited the Affiliated Hospital of Qingdao University on June 25, 2020 was selected as the study subject. Clinical data of the patient was collected. Whole exome sequencing (WES) was carried out for the child, and candidate variant was verified by Sanger sequencing of the child and his parents. RESULTS: The child, an 8-month-old male, had presented mainly with edema, oliguria, hematuria, nephrotic level proteinuria, anemia, thrombocytopenia, increased creatinine and urea, hypercholesterolemia but normal complement levels. Genetic testing revealed that he has harbored compound heterozygous variants of the DGKE gene, namely c.12_18dupGAGGCGG (p.P7fs*37) and c.1042G>T (p.D348Y), which were respectively inherited from his father and mother. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variants were classified as likely pathogenic and variant of uncertain significance, respectively. By combining his clinical manifestations and results of genetic testing, the child was diagnosed with aHUS with nephrotic level proteinuria. CONCLUSION For infants and young children with aHUS in conjunct with nephrotic level proteinuria, variants of the DGKE gene should be screened. Above finding has expanded the mutational spectrum of the DGKE gene.
Infant ; Female ; Humans ; Child ; Male ; Child, Preschool ; Atypical Hemolytic Uremic Syndrome/diagnosis* ; Mutation ; Genetic Testing ; Thrombocytopenia/genetics* ; Proteinuria/genetics*

Objective:To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns.Methods:A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results:Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar ( P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups ( P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group ( t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar ( P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close ( P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group ( t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group ( t=21.78, P<0.05). Conclusions:The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect.

Humans ; Artificial Intelligence ; Lung Neoplasms/pathology* ; Mediastinum/pathology* ; Lymph Nodes/pathology* ; Neoplasm Staging ; Lymph Node Excision