Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

BACKGROUND: TRIM proteins are important members of E3 ubiquitin ligases, and many studies have confirmed that TRIM family members play an important role in the development of various tumors. We found that TRIM59 expression level in non-small cell lung cancer (NSCLC) was significantly increased through second-generation sequencing. The purpose of this study was to investigate the expression of TRIM59 in NSCLC and its relationship with the clinicopathological parameters as well as the prognosis of patients. METHODS: The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets were excavated to analyze the expression of TRIM59 mRNA in NSCLC and its relationship with the prognosis of patients; The expression of TRIM59 protein in 90 tumor tissues and adjacent tissues was detected by immunohistochemical staining, and the relationship between the expression of TRIM59 protein and clinicopathological parameters and prognosis was analyzed. RESULTS: Overexpression of TRIM59 mRNA in tumor tissues predicted poor prognosis. The expression level of TRIM59 protein was significantly higher in tumor tissues than in adjacent tissues, and TRIM59 protein expression was correlated with tumor size (P=0.007), tumor differentiation (P=0.009), tumor-node-metastasis (TNM) stage (P=0.003) and lymph node metastasis (P=0.003). Multivariate Cox regression analyses showed that along with TNM stage, overexpression of TRIM59 could be considered an independent prognostic factor for NSCLC patients. CONCLUSIONS The expression of TRIM59 is closely related to the prognosis of NSCLC patients, and it is an independent risk factor for NSCLC patients.

Objective To investigate the effects of moderate-to-vigorous intensity physical activity (MVPA) in early pregnancy on the onset of gestational diabetes mellitus (GDM) in Sichuan Province. Methods A case-control study was performed on 1 508 gravidas at 8-14 gestational weeks in Sichuan Provincial Hospital for Women and Children from February to July, 2017. Baseline information during early pregnancy was collected through questionnaires. Information on time and intensity of physical activity were collected through pregnancy physical activity questionnaire. The time spent in MVPA was calculated and was categorized as active ( ≥ 3.5 h/week) or inactive MVPA (<3.5 h/week). Based on self-reported pre-pregnancy weights collected by questionnaire as well as the measured heights, body mass index (BMI) before pregnancy was calculated. After a 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, all subjects were divided into GDM (n=561) or non-GDM group (n=947), according to the GDM diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China (2014). Mann-Whitney U test and Chi-square test were used for statistical analysis. Multivariate unconditional logistic regression model was used to analyze the association between the time of MVPA in early pregnancy and GDM incidence. ResuLts The median time spent in MVPA [M(P25-P75)] in early pregnancy was 3.00 (0.50-3.12) h/week, and 345 gravidas (22.9%) were classified as active in MVPA. After the control of confounding factors such as age, gravidity and parity history, and pre-pregnancy BMI, the multivariate unconditional logistic regression analysis showed that compared with the inactive group, the risk of GDM of active MVPA gravidas was reduced by 26.1% (OR=0.739, 95%CI: 0.553-0.989, P=0.042). Among primigravidas and primiparae, the risk of GDM in active MVPA gravidas was decreased by 47.6% and 44.3% than the inactive ones, respectively (primigravidas: OR=0.524, 95%CI: 0.297-0.925, P=0.026; primiparae: OR=0.557, 95%CI: 0.357-0.868, P=0.010). ConcLusions Insufficient physical activity in early pregnancy is common in gravidas in Sichuan, China. The risk of GDM could be reduced if the frequency of MVPA during early pregnancy is no less than 3.5 h/week, especially in primigravidas and primiparae.

Objective To investigate the clinical value of C-reactive protein (CRP) combined with prothrombin time (PT) and partially activated thromboplastin time (APTY) in the diagnosis of neonatal late-onset sepsis.Methods From January 2013 to January 2018,100 neonates with sepsis admitted to our department of neonatology in Lishui Maternal and Child Health-Care Center were collected.According to the results of blood culture,neonates with positive blood culture were classified as sepsis group A (53 cases),and neonates with negative blood culture were classified as sepsis group B (47 cases).Another 50 normal newborns born at the same period were included in the control group.The CRP,PT and APTT values of the three groups were detected and compared.The receiver-operating characteristic curves (ROC) were plotted to obtain the area under ROC curve (AUC) and the sensitivity,specificity,positive predictive value and negative predictive value.Another ROC curve was plotted to obtain the area under ROC curve (AUC) and the sensitivity,specificity,positive predictive value,and negative predictive value for a new variable,CPR + PT + APTT,which was established using a binomial logistic regression method.Results The results of CPR,PT and APTT in the control group,sepsis group A and sepsis group B all increased in turn (F=10.616,6.155,5.243,P =0.000,0.000,0.000).CPR + PT + APTT had the largest AUC (0.94),the highest sensitivity (93.42％),the highest specificity (91.66％),the highest positive predictive value (92.60％),and the highest negative predictive value (78.55％) in the four indicators.Conclusion When blood culture fails to diagnose late-onset neonatal sepsis,combined detection of CPR + PT + APTT can provide some clues for its early diagnosis,which is worthy of clinical attention.

Objective: To evaluate the clinical characteristics and survival outcomes of patients with de novo grade 3 or transformed follicular lymphoma (FL). Methods: Fifty-two patients treated at Peking University Cancer Hospital between January 2009 and September 2017 were assessed, including 28 patients with FL 3A grade, 13 patients with FL 3B grade, 11 patients with transformed FL. Baseline characteristics, survival and prognostic factors were analyzed. Results: ① Twenty-six male and 26 female patients were enrolled, including 28 patients with FL 3A grade, 13 patients with FL 3B grade, 11 patients with transformed FL. ②The 3-year progression-free survival (PFS) and overall survival (OS) for the entire cohort were 56.0% and 80.6%, respectively. Patients with international prognostic index (IPI) score 0-1 demonstrated significantly better 3-year PFS (80.3% vs 20.1%; t=18.902, P<0.001) and OS (95.7% vs 57.0%; t=10.406, P<0.001) than patients with IPI score 2-3. Three-year PFS (94.1% vs 37.2% vs 25.2%; P=0.002) and OS (100.0% vs 76.0% vs 59.8%; P=0.020) were also significantly different among patients with FLIPI 1 score 0-1, 2, ≥3. FLIPI 2 score was also identified as a prognostic factor for 3-year PFS (68.4%, 0, 0; P=0.001) and OS(87.5%, 76.2%, 0; P=0.003). ③Multivariate analysis indicated a significant association of PFS (HR=3.536, P=0.015) and OS (HR=15.713, P=0.015) with IPI. FLIPI 2 was associated with OS (score 0-1, HR=0.078, P=0.007; score 2, HR=0.080, P=0.022). Conclusion De novo grade 3 or transformed FL might be a group of curable disease with current treatment strategies. IPI is still a prognostic tool in this scenario.

Objective To explore the effect of pharyngeal chili sauce and cold stimulation on swallowing function of patients with stroke coma.Methods A total of 93 patients with stroke coma were included and randomly divided into three groups.The oral nursing and glossopharyngeal massage were performed in control group (n =30).The oral nursing and cold stimulation were performed in cold stimulation group (n =32).The oral nursing and chili sauce stimulation were performed in chili sauce stimulation group (n =31).The swallowing movement,duration of tracheotomy and incidence of stroke-associated pneumonia were compared among three groups.Results Ten minutes after oral nursing,the swallowing frequency in control group,cold stimulation group and chili sauce stimulation group was (21.09 ±9.16),(34.16 ±20.43)and (49.31 ±25.17), respectively.The difference was statistically significant (F =12.962,P <0.05).The duration of tracheotomy in control group,cold stimulation group and chili sauce stimulation group was (37.60 ±13.42)d,(29.19 ±8.24)d and (22.04 ±8.23)d,respectively.The difference was statistically significant (F =12.639,P <0.05).The incidence of stroke-associated pneumonia in three groups was 43.33%,37.50% and 35.48%,respectively. there was no significant difference among three groups (χ2 =0.616,P >0.05).Conclusions Both pharyngeal chili sauce and cold stimulation can improve swallowing function of patients with stroke coma.The pharyngeal chili sauce stimulation can stimulate swallowing movement for a longer time to help the recovery of swallowing function,and can shorten the duration of tracheotomy.

Objective To study the regulatory effect of hydrogen sulfide (H2S) on endoplasmic reticulum stress in alveolar epithelial cells of rats with acute lung injury (ALI) induced by oleic acid (OA).Methods Seventy-two male Sprague Dawley (SD) rats were equally divided into control group (C group),oleic acid-induced ALI group (OA group),oleic acid-induced ALI with sodium hydrosulfide (NaHS) pretreatment group (OA + NaHS group) and sodium hydrosulfide treatment group (NaHS group).The model of acute lung injury was made by oleic acid intravenous injection in dose of 0.1 mL/kg.NaHS was injected intra-abdominally in dose of 1 ml/kg with concentration of 56 μmol/L 30 min before administration of oleic acid for pretreatment.In control groups,saline was used instead of oleic acid and NaHS in the equivalent volume.Six rats of each group were sacrificed at 2 h,4 h and 6 hours separately after modeling for observing the acute injury of lung tissue.Index of quantitative assessment of histological lung injury (IQA),wet/dry weight ratio (W/D) and H2S level of lung tissues were measured.The endoplasmic reticulum stress markers included glucose-regulated protein 78 (GRP78) and α-subunit of eukaryotic translation initiation factor-2 (elF2α) in lung tissues were measured by immunohistochemical staining and Western blot.Results At the three observation intervals,the IQA score and W/D ratio of lung tissues significantly increased in rats-after OA injected,but significantly decreased in other rats receiving both OA and NaHS.At the three intervals,the level of H2S in lung tissue significantly decreased in rats after OA injected,but significantly increased in other rats receiving both OA and NaHS.GRP78 and elF2α decreased in rats after OA injected,but increased in other rats receiving both OA and NaHS especially at 4 h and 6 h after modeling.Conclusions The findings suggested that H2S could promote the response to alveolar epithelial cell endoplasmic reticulum stress in rats with ALI resulting in attenuating the damage of lung tissue caused by oleic acid.

PURPOSE: Cathepsin K is a potent collagenase implicated in human and animal atherosclerosis-based vascular remodeling. This study examined the hypothesis that serum CatK is associated with the prevalence of coronary artery disease (CAD). MATERIALS AND METHODS: Between January 2011 and December 2012, 256 consecutive subjects were enrolled from among patients who underwent coronary angiography and percutaneous coronary intervention treatment. A total of 129 age-matched subjects served as controls. RESULTS: The subjects' serum cathepsin K and high sensitive C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol were measured. The patients with CAD had significantly higher serum cathepsin K levels compared to the controls (130.8+/-25.5 ng/mL vs. 86.9+/-25.5 ng/mL, p<0.001), and the patients with acute coronary syndrome had significantly higher serum cathepsin K levels compared to those with stable angina pectoris (137.1+/-26.9 ng/mL vs. 102.6+/-12.9 ng/mL, p<0.001). A linear regression analysis showed that overall, the cathepsin K levels were inversely correlated with the high-density lipoprotein levels (r=-0.29, p<0.01) and positively with hs-CRP levels (r=0.32, p<0.01). Multiple logistic regression analyses shows that cathepsin K levels were independent predictors of CAD (odds ratio, 1.76; 95% confidence interval, 1.12 to 1.56; p<0.01). CONCLUSION: These data indicated that elevated levels of cathepsin K are closely associated with the presence of CAD and that circulating cathepsin K serves a useful biomarker for CAD.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Cathepsin K/*blood ; Coronary Artery Disease/*blood/metabolism ; Female ; Humans ; Male ; Middle Aged

PURPOSE: Cathepsin K is a potent collagenase implicated in human and animal atherosclerosis-based vascular remodeling. This study examined the hypothesis that serum CatK is associated with the prevalence of coronary artery disease (CAD). MATERIALS AND METHODS: Between January 2011 and December 2012, 256 consecutive subjects were enrolled from among patients who underwent coronary angiography and percutaneous coronary intervention treatment. A total of 129 age-matched subjects served as controls. RESULTS: The subjects' serum cathepsin K and high sensitive C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol were measured. The patients with CAD had significantly higher serum cathepsin K levels compared to the controls (130.8+/-25.5 ng/mL vs. 86.9+/-25.5 ng/mL, p<0.001), and the patients with acute coronary syndrome had significantly higher serum cathepsin K levels compared to those with stable angina pectoris (137.1+/-26.9 ng/mL vs. 102.6+/-12.9 ng/mL, p<0.001). A linear regression analysis showed that overall, the cathepsin K levels were inversely correlated with the high-density lipoprotein levels (r=-0.29, p<0.01) and positively with hs-CRP levels (r=0.32, p<0.01). Multiple logistic regression analyses shows that cathepsin K levels were independent predictors of CAD (odds ratio, 1.76; 95% confidence interval, 1.12 to 1.56; p<0.01). CONCLUSION: These data indicated that elevated levels of cathepsin K are closely associated with the presence of CAD and that circulating cathepsin K serves a useful biomarker for CAD.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Cathepsin K/*blood ; Coronary Artery Disease/*blood/metabolism ; Female ; Humans ; Male ; Middle Aged

Objective To investigate the regulatory effect of hydrogen sulfide (H2S) on endoplasmic reticulum stress (ERS) and lipid metabolism in livers in apoE knockout (apo E-/-) mice.Methods Male C57BL/6 J mice and homozygous apoE mice were fed with a western type diet and randomly divided into four groups:C57BL/6 J control group (injected intraperitoneally with normal saline),apoE group (injected intraperitoneally with normal saline),apoE-/-+NaHS group (injected intraperitoneally with an H2S donor NaHS 56μmol · kg-1 · d-1) and apoE-/-+ DL-propargylglycine (PPG) group (injected intraperitoneally with an acystathionine-γ-lyase inhibitor PPG 30 mg ·kg-1 · d-1).After 10 weeks,all mice were sacrificed and plasma lipids were detected.Lipid deposition was determined by oil red O staining.Glucose-regulated protein78 (GRP78),Thr-981 phosphorylated double-stranded RNA-activated protein kinase like endoplasmic reticulum kinase (PERK),subunit of eukaryotic translation initiation factor-2α (elF-2α),low density lipoprotein (LDL) receptor (LDLR),sterol regulatory element binding protein-2 (SREBP-2) in the livers were detected by Western bloting.The expressions of GRP78 and SREBP-2 mRNA were analyzed by realtime polymerase chain reaction (RT-PCR).Results Compared with C57BL/6 J control group,plasma levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein (LDL),liver lipid content and expressions of GRP-78,PERK and eIF-2α were significantly increased in apoE-/-mice,but body weight did not change.Compared with apoE-/-mice,plasma LDL level was decreased,liver lipid deposition was improved,expressions of GRP-78 and PERK in livers were increased,and the ratio of p-eIF-2α/ eIF-2α was increased in apoE-/-+NaHS group,but expression levels of SREBP-2 and LDLR in liver did not change.Conclusions H2S decreases serum LDL level and liver lipid content,and up regulates GRP78 protein and mRNA expressions,promotes PERK and eIF2α phosphorylations,improves endoplasmic reticulum function,but has no effect on the expressions of SREBP-2 and LDLR in apoE-/-mice fed with a high-fat diet.