In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective To investigate the possible mechanism of ferroptosis induced by lipocalin2(LCN2)and microglial po-larization in intracerebral hemorrhage(ICH).Methods Forty SD rats were divided into sham operation group,ICH group,LCN2 low expression group and Liproxstatin-1 group,with 10 rats in each group.The morphological structure of the brain was observed and recorded,and the cranial nerve function(NIHSS)score was performed.Immunofluorescence staining was used to detect the expression of microglia marker protein(Iba1),and M1 and M2 microglia marker proteins(CD68 and CD206)in brain tissue.Western blot was used to detect the protein levels of LCN2,ferroptosis marker proteins[solute carrier family 7 member 11(SLC7A11)and glutathione peroxidase 4(GPX4)]in brain tissue.The contents of ferrous ion(Fe2+)and malondialdehyde(MDA)in brain tissue were detected by ELISA kits.Results Compared with the sham operation group,the expression of LCN2 protein,the intracerebral hemorrhage,the NIHSS score increased(all P＜0.05),and the expression of CD68 and CD206 in the microglia increased,the expression of ferroptosis-related proteins(SLC7A11 and GPX4)decreased,and the content of Fe2+and MDA increased in the brain tissue of the ICH group(all P＜0.05).Compared with the ICH group,the expression of LCN2 pro-tein,the intracerebral hemorrhage,the NIHSS score and the expression of CD68 in microglia significantly decreased,and the ex-pression of CD206 significantly increased,the expression of SLC7A11 and GPX4 increased,the contents of Fe2+and MDA de-creased in the brain tissue of the LCN2 low expression group(all P＜0.05).The expression of CD68 in brain tissue of Liprox-statin-1 group was significantly decreased,and the expression of CD206 was significantly increased as compared with ICH group(P＜0.05).Conclusion Down-regulation of LCN2 can promote microglial cell polarization by inhibiting ferroptosis,and im-prove nerve function injury in ICH rats.

Objective To investigate the possible mechanism of ferroptosis induced by lipocalin2(LCN2)and microglial po-larization in intracerebral hemorrhage(ICH).Methods Forty SD rats were divided into sham operation group,ICH group,LCN2 low expression group and Liproxstatin-1 group,with 10 rats in each group.The morphological structure of the brain was observed and recorded,and the cranial nerve function(NIHSS)score was performed.Immunofluorescence staining was used to detect the expression of microglia marker protein(Iba1),and M1 and M2 microglia marker proteins(CD68 and CD206)in brain tissue.Western blot was used to detect the protein levels of LCN2,ferroptosis marker proteins[solute carrier family 7 member 11(SLC7A11)and glutathione peroxidase 4(GPX4)]in brain tissue.The contents of ferrous ion(Fe2+)and malondialdehyde(MDA)in brain tissue were detected by ELISA kits.Results Compared with the sham operation group,the expression of LCN2 protein,the intracerebral hemorrhage,the NIHSS score increased(all P＜0.05),and the expression of CD68 and CD206 in the microglia increased,the expression of ferroptosis-related proteins(SLC7A11 and GPX4)decreased,and the content of Fe2+and MDA increased in the brain tissue of the ICH group(all P＜0.05).Compared with the ICH group,the expression of LCN2 pro-tein,the intracerebral hemorrhage,the NIHSS score and the expression of CD68 in microglia significantly decreased,and the ex-pression of CD206 significantly increased,the expression of SLC7A11 and GPX4 increased,the contents of Fe2+and MDA de-creased in the brain tissue of the LCN2 low expression group(all P＜0.05).The expression of CD68 in brain tissue of Liprox-statin-1 group was significantly decreased,and the expression of CD206 was significantly increased as compared with ICH group(P＜0.05).Conclusion Down-regulation of LCN2 can promote microglial cell polarization by inhibiting ferroptosis,and im-prove nerve function injury in ICH rats.

In November 23, 2023, a patient with 9 digits traumatic crush injury by machine compression was emergently admitted to the Department of Hand and Microsurgery, Sichuan Modern Hospital. Emergency procedures included amputation the distal stumps and replantation of proximal phalanges of left ring and little fingers. Wounds in both hands were temporarily covered with bone cement. On December 4, 2023, reconstruction of 5 digits were performed. Digital defects were: Type Ⅲ defects of left index and middle fingers and right thumb and index fingers and Type IV defect of right middle finger. All 5 reconstructed digits survived. Subsequent refinements yielded favourable outcomes and all donor toes were preserved completely. At the 14-month follow-up, the reconstructed digits exhibited satisfactory appearance and length without difficulties in daily life and at work.

Objective: To set up a multi-components by single maker (QAMS) method for determination of four diterpene lactones in Lianzhi Xiaoyan capsules.
Methods: Shimadzu Shim-pack C₁₈ column（250 mm×4.6 mm,5 μm）was adopted with 35 ℃. Acetonitrile-0.1% phosphoric acid aqueous solution as the mobile phase in gradient mode was used at flow rate of 1.0 mL·min^-1. The detection wavelength was set at 203 nm. Andrographolide was used as reference to calculate the relative correction factors of the other three components.
Results: The linear relationships of four components were good （r≥0.999 9） within their ranges, and their average recoveries were 100.0%-102.8% with RSDs 1.1%-2.2%. The results obtained by QAMS were close to those obtained by external standard method.
Conclusion: This rapid, precise and reproducible method can be used for the quality control of Lianzhi Xiaoyan capsules.

Objective:Through the investigation of the pathogenicity of COL4A4 heterozygous splicing mutations and the genotype-phenotype correlation in autosomal dominant Alport syndrome (ADAS), to better understand the impact of COL4A4 heterozygous splicing mutations on ADAS. Methods:The study was a case series analysis. Patients from 5 ADAS families with COL4A4 heterozygous splicing mutations detected by whole exome sequencing were recruited by three hospitals. In vivo transcriptional analysis and/or in vitro minigene splicing assay were conducted to determine the splicing patterns and assess the pathogenicity of COL4A4 heterozygous splicing mutations. Results:In the five ADAS pedigrees carrying COL4A4 heterozygous splicing mutations, four novel ADAS splicing patterns were described. In pedigree 1-4, most patients presented with continuous hematuria or/and microalbuminuria. Otherwise,the proband in pedigree 4 presented with macroalbuminuria and the proband in pedigree 1 had progressed to chronic kidney disease stage 2 at the age of 70 years old. In pedigree 5, all patients developed end-stage renal disease between 28 and 41 years old. c.735+3A>G detected in pedigree 1 and pedigree 2 and c.694-1G>C detected in pedigree 3 both led to exon 12 skipping in COL4A4, resulting in 42 nucleotides in-frame deletion (c.694_735del). c.2056+3A>G detected in pedigree 4 led to COL4A4 exon 26 skipping, which caused in-frame deletion of 69 nucleotides (c.1988_2056del). c.2716+5G>T detected in pedigree 5 led to a 360 nucleotides large in-frame deletion, including 100 bp sequence at the 3'end of exon 29,the whole sequence of exon 30 and 89 bp sequence at the 5'end of exon 31 (c.2446_2805del). Conclusions:Renal prognosis differs significantly for patients with small in-frame deletions versus large in-frame deletion splicing abnormalities. Determination of the pathogenicity and the splicing patterns of COL4A4 heterozygous splicing mutations using in vivo and in vitro transcriptional analysis may provide renal prognostic information.

Purpose: The aim of this study was to compare the effectiveness and outcomes of percutaneous ablation guided by ultrasonography (US) and computed tomography (CT) in colorectal liver oligometastases (CLOM). Methods: This study included patients with CLOM treated with percutaneous ablation from January 2008 to January 2021 in this observational study. Only lesions visualized on both CT and US images were further analyzed according to whether patients’ initial ablation treatments utilized US guidance or CT guidance. The Kaplan-Meier method was used to estimate local tumor progression (LTP)–free survival after propensity score matching (PSM). The LTP-free survival and treatment-related outcomes were compared between these two groups. Results: PSM identified 116 patients from each group, with 269 and 238 lesions in the USguided and CT-guided groups, respectively. US-guided ablation had a shorter average procedure time and lower cost than CT-guided ablation (27.54±12.06 minutes vs. 32.70±13.88 minutes, P=0.003; $2,175.13±618.17 vs. $2,455.49±710.25, P=0.002). For patients >60 years of age, the cumulative LTP rate at 1 year was lower in the US-guided group than in the CT-guided group (17.8% vs. 25.1%, P=0.038). For patients with perivascular liver lesions, the cumulative LTP rate at 1 year was lower in the US-guided group (14.4% vs. 28.2%, P=0.040). Conclusion For patients whose age is >60 years or who have perivascular liver lesions, USguided ablation is better than CT-guided ablation, with a shorter treatment time and lower costs when both ablation methods are feasible for patients.

Objective:To investigate the role of survival motor neuron ( SMN) gene knockout in mice with cisplatin-induced acute kidney injury (AKI). Methods:A mouse model (C57BL/6) of cisplatin-induced AKI was constructed. Twenty male wild type (WT) and SMN+/- mice weighing 22-24 g were randomly divided into four groups: WT mice with saline injection group (WT vehicle, n=5), SMN+/- mice with saline injection group ( SMN+/- vehicle, n=5), WT mice with cisplatin injection group (WT cisplatin, n=5) and SMN+/- mice with cisplatin injection group ( SMN+/- cisplatin, n=5). Mice were injected intraperitoneally with 20 mg/kg cisplatin or 0.9% saline. 72 hours later, the mice were sacrificed, and serum and kidney tissues were collected. The real time PCR and Western blotting were used to measure the expression levels of SMN mRNA and protein. The sarcosine oxidation and urease method were used to measure serum creatinine (Scr) and blood urea nitrogen (BUN) levels. Renal pathologic changes were observed by PAS staining. TUNEL immunofluorescence assay was used to detect the level of apoptosis. Western blotting and immunohistochemistry were used to detect the protein expression levels of apoptosis index poly (ADP-ribose) polymerase (PARP) and endoplasmic reticulum stress index CHOP. Results:Compared with WT mice, SMN mRNA and protein expression levels were lower in SMN+/- mice, and the expression level of SMN mRNA and protein was further decreased after intraperitoneal cisplatin injection (all P<0.05). Compared with WT mice with saline injection group, WT mice with cisplatin injection group had higher levels of Scr, BUN, tubular damage scores, TUNEL positive cell numbers, PARP and CHOP, while the expression levels of above indexes in the SMN+/- mice with cisplatin injection group were higher than those in the WT mice with cisplatin injection group (all P<0.05). Conclusions:SMN gene knockout can aggravate renal pathological damage and apoptosis of renal tubular epithelial cell in cisplatin-induced AKI mice. SMN may be a potential therapeutic target of AKI.

Objective:To analyze the clinical characteristics of adult Chinese patients with syncope.Methods:This is a cross-sectional survey study. Patients with preliminary diagnosis of syncope in the Emergency Department, Geriatrics and Cardiology Outpatient Department, or Syncope Unit of 37 hospitals in 19 provinces, autonomous regions and the Hong Kong Special Administrative Region from June 2018 to March 2021 were included in this study. The clinical features of these patients with syncope were analyzed.Results:A total of 4 950 consecutive patients with syncope were included in this study. The age was (56.3±16.8)years, and 2 604 cases (52.6%) were male. The most common type of syncope was neurally mediated syncope (2 345 (47.4%)), followed by cardiac syncope (1 085 (21.9%)), orthostatic hypotensive syncope (311 (6.3%)), and unexplained syncope accounted for nearly one third (1 155 (23.3%)). Predisposing syncope was more common in patients under 65 years of age(2 066(72.4%) vs. 786(27.6%),χ 2=136.5, P<0.001). Presyncope was more common in patients with neurally mediated syncope (1 972(79.0%) vs.1 908(73.9%), χ 2=17.756, P<0.001). Premonitory symptoms were more common in women(1 837(80.0%) vs. 1 863(73.0%),χ 2=33.432, P<0.001). Presyncope syndrome was more common in patients under 65 years of age (2 482(77.8%) vs. 1 218(73.4%),χ 2=17.523, P=0.001). Cyanosis was more common in ≥65 years old patients (271(18.2%) vs. 369(12.7%), χ 2=23.235, P<0.001). Urinary incontinence was more common in old patients aged ≥65 years(252(15.2%) vs. 345(10.8%), χ 2=19.313, P<0.001). Family history was more common in patients with cardiogenic syncope compared with other types of syncope (264(24.3%) vs. 754(19.5%), χ 2=11.899, P=0.001). Hypertention(1 480(30.5%)), coronary heart disease(1 057(21.4%)), atrial flutter and atrial fibrillation(359(7.2%)), second degree atrioventricular block(236(4.8%)) were common complications of syncope. The proportion of patients with coronary heart disease was significantly higher in cardiac syncope than that of other types of syncope(417(38.4%) vs. 640(16.6%), χ 2=241.376, P<0.001). Other common complications included cerebrovascular diseases (551 (11.1%)) and diabetes mellitus (632(12.8%)). Conclusions:Neurally mediated syncope is the most common syncope in adult Chinese population. Patients with predisposing conditions and premonitory conditions are younger. Presyncope is more common in women. The proportion of family history and coronary heart disease is higher in patients with cardiogenic syncope.

【Objective】 To establish a microbial limit test method for diatomite and pearlite, and verify its applicability. 【Methods】 According to the requirements of general rule 1105, Microbial Limit Test for Non Sterile Products of Pharmacopoeia of the People′s Republic of China (2020 Edition), the applicability test of microbial counting methods for three batches of perlite and diatomite was conducted before the microbial limit test of samples. The microbial growth of filter aid was analyzed and the recovery rate of each test bacterium was calculated. 【Results】 The ratio of the colony number of the test group minus the colony number of the test sample control group to the bacterial liquid control group was in the range of 0.5~2.0. 【Conclusion】 The method is accurate, reliable and can be used for microbial limit test of diatomite and perlite.