Objective To observe the clinical and imaging features of patients with severe cerebral venous sinus thrombosis(CVST).Methods Consecutive severe CVST patients diagnosed at the Affiliated Hospital of Northwestern University(Xi'an NO.3 Hospital)from January 2017 to July 2024 were included.Patients'demographic characteristics,clinical manifestations,risk factors,imaging characteristics,onset mode,D-dimer levels,time from onset to diagnosis,treatment strategies,and prognosis were collected and recorded.Results A total of 17 severe CVST patients were included,of which 4 cases(23.5％)were male and 13 cases(76.5％)were female,with a male-to-female ratio of 1∶3.25.The median age was 41 years(range:19-56 years).The main clinical symptoms were headache,nausea and vomiting,seizures,focal neurological deficits,psychiatric symptoms,disturbance of consciousness,and limited neck mobility.The most common clinical symptoms were headache(15/17),seizures(7/17),and focal neurological deficits(7/17),followed by disturbance of consciousness(4/17).Among the 17 patients,10 cases(58.8％)had ischemic stroke and 9 cases(52.9％)had hemorrhagic stroke.The involvement rates of transverse sinus,superior sagittal sinus,sigmoid sinus,straight sinus and inferior sagittal sinus were 94.1％,64.7％,47.1％,29.4％and 11.8％respectively,and the proportion of patients with involvement of 2 or more venous sinuses reached 88.2％.Among the 17 patients,12 cases exhibited a lack of response to standard anticoagulation therapy and underwent endovascular therapy subsequently,and one of them had new intracranial hemorrhage.Two(11.8％)patients had poor prognosis at 90 d after discharge,with one patient death and one patient with an mRS score of 3.Fifteen patients(88.2％)had a good prognosis(3 cases with an mRS score of 2,5 cases with an mRS score of 1,and 7 cases with an mRS score of 0).Conclusions Severe CVST patients often present with seizures,impaired consciousness,involvement of multiple venous sinuses,ischemic stroke,and hemorrhagic stroke.Early identification,and active anticoagulation or endovascular therapy are crucial to improve the prognosis and reduce the disability and mortality rates of this disease.

OBJECTIVE: To investigate the possible mechanism and fracture stability of subtypes of type B Hangman's fracture by using imaging observation. METHODS: Patients with type B Hangman's fractures admitted to multiple centers between January 2008 and October 2023 were selected as the research objects. The clinical data and imaging data of patients who met the selection criteria were extracted. The patients' age, gender, cause of fracture, disease duration, visual analogue scale (VAS) score of neck pain, neck disability index (NDI), and American Spinal Injury Association (ASIA) classification of spinal cord function were collected. Based on the imaging data, the anatomical structure of the contralateral superior articular process fracture, the relationship between the superior articular process fracture line and the position of the odontoid process, the associated posterior vertebral wall fracture and its classification, the incidence of vertebral arch floating and C _{2, 3} instability were observed. The superior articular fracture angle (SAFA), superior articular fracture displacement distance (SAFD), and C ₂ vertebral body rotation (VBRA) were measured. According to the anatomical structure of the contralateral superior articular process fracture, the patients were divided into a pedicle fracture group (POA group), a inferior articular process fracture group (IAP group), and a laminar fracture group (CSL group). The baseline data and imaging indexes were analyzed between groups, and the imaging anatomical characteristics of each subtype of fracture were observed to explore its possible mechanism and fracture stability. RESULTS: A total of 86 cases of type B Hangman's fractures were collected. There were 67 males and 19 females. The mean age was 51.0 years (range, 21-78 years). There were 48 cases of pedicle fracture (POA group), 25 cases of inferior articular process fracture (IAP group), and 13 cases of laminar fracture (CSL group). There was no significant difference in age, gender, cause of fracture, disease duration, VAS score of neck pain, and NDI between groups ( P>0.05). However, the incidence of spinal cord injury in POA group was the highest ( P<0.05). The incidences of superior articular process fracture line posterior to the odontoid process and posterior vertebral wall fracture in POA group were the highest ( P<0.05). The incidences of vertebral arch floating and C _{2, 3} instability in IAP group were the highest ( P<0.05). There were significant differences in SAFA and VBRA between groups ( P<0.05). There was no significant difference in SAFD between groups ( P>0.05). The differences in the incidences of fracture displacement>3 mm and VBRA>5° between groups were significant ( P<0.05). There were 78 cases of unstable Hangman's fracture, including 2 cases of simple C _2、3 instability, 22 cases of simple axis rotation and displacement instability, 8 cases of simple vertebral arch floating instability, and the rest of the patients had two or more types of instability. CONCLUSION The mechanism of different subtypes of type B Hangman's fracture may be that the lateral mass of the rotation of the atlas applied the overextension compression force to the unilateral superior articular process of the axis vertebra, and the contralateral pedicle, inferior articular process and lamina fractures were caused by direct violence or/and rotational violence to different degrees. The decomposition of this type of fracture into C _{2, 3} intervertebral, axis vertebra body displacement and rotation and vertebral arch floating instability is beneficial to the treatment and surgical approach selection.
Humans ; Spinal Fractures/surgery* ; Male ; Female ; Cervical Vertebrae/diagnostic imaging* ; Middle Aged ; Adult ; Tomography, X-Ray Computed ; Aged ; Odontoid Process/injuries* ; Fracture Fixation, Internal/methods* ; Young Adult

Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

Objective To observe the clinical and imaging features of patients with severe cerebral venous sinus thrombosis(CVST).Methods Consecutive severe CVST patients diagnosed at the Affiliated Hospital of Northwestern University(Xi'an NO.3 Hospital)from January 2017 to July 2024 were included.Patients'demographic characteristics,clinical manifestations,risk factors,imaging characteristics,onset mode,D-dimer levels,time from onset to diagnosis,treatment strategies,and prognosis were collected and recorded.Results A total of 17 severe CVST patients were included,of which 4 cases(23.5％)were male and 13 cases(76.5％)were female,with a male-to-female ratio of 1∶3.25.The median age was 41 years(range:19-56 years).The main clinical symptoms were headache,nausea and vomiting,seizures,focal neurological deficits,psychiatric symptoms,disturbance of consciousness,and limited neck mobility.The most common clinical symptoms were headache(15/17),seizures(7/17),and focal neurological deficits(7/17),followed by disturbance of consciousness(4/17).Among the 17 patients,10 cases(58.8％)had ischemic stroke and 9 cases(52.9％)had hemorrhagic stroke.The involvement rates of transverse sinus,superior sagittal sinus,sigmoid sinus,straight sinus and inferior sagittal sinus were 94.1％,64.7％,47.1％,29.4％and 11.8％respectively,and the proportion of patients with involvement of 2 or more venous sinuses reached 88.2％.Among the 17 patients,12 cases exhibited a lack of response to standard anticoagulation therapy and underwent endovascular therapy subsequently,and one of them had new intracranial hemorrhage.Two(11.8％)patients had poor prognosis at 90 d after discharge,with one patient death and one patient with an mRS score of 3.Fifteen patients(88.2％)had a good prognosis(3 cases with an mRS score of 2,5 cases with an mRS score of 1,and 7 cases with an mRS score of 0).Conclusions Severe CVST patients often present with seizures,impaired consciousness,involvement of multiple venous sinuses,ischemic stroke,and hemorrhagic stroke.Early identification,and active anticoagulation or endovascular therapy are crucial to improve the prognosis and reduce the disability and mortality rates of this disease.

Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective To establish the method for the simultaneous determination of hypoxanthine, inosine, guanosine and adenosine in Dilong formula granules by HPLC and compare the fingerprints of Dilong formula granules from different manufacturers by HPLC chromatogram. Methods The contents of hypoxanthine, inosine, guanosine and adenosine were determined by Thermo Acclaim^TM120C₁₈ column (4.6 mm×250 mm 5 μm). The mobile phase was acetonitrile-water. Gradient elution with flow rate of 0.6 ml/min was used. Column temperature was 25 ℃. Detection wavelength was 254 nm. 10 batches of samples were tested. The HPLC chromatogram were compared and analyzed by using the similarity Evaluation system of chromatographic fingerprint of traditional Chinese Medicine (version 2012.130723). Results The linear ranges for the detection of hypoxanthine, inosine, guanosine and adenosine showed good linear relationships within their own ranges (r≥0.999 9). The average recoveries were 99.20%~102.98% with RSD of 0.26 %~0.71%. The contents of 4 components in 10 batches of samples were 0.740 0~4.457 4 mg/g, 2.132 3~7.805 0 mg/g, 0.325 4~1.596 1 mg/g, 0.537 2~2.222 9 mg/g respectively. The similarity between HPLC chromatogram and control fingerprints of Dilong formula granules from different manufacturers was greater than 0.91. Conclusion The method could be used to determine the contents of hypoxanthine, inosine, guanosine and adenosine in Dilong formula granule. HPLC fingerprints could be used to evaluation the quality in Dilong formula granule. The similarity of HPLC fingerprints from different manufacturer production of Dilong formula granule is high, but 4 contents in composition are difference.

Objective To establish the Good Agricultural Practice（GAP）for standard operation procedure of Shanghai Pheretima. Methods According to the comprehensive technical requirements of GAP standardized production of Chinese herbal medicine, the key technologies of standardized cultivation and processing were studied in Sangxin Town, Chongming District, Shanghai. Results The production area environment, variety characteristics, breeding technology, pest control, harvesting and processing, packaging, storage and transportation, quality monitoring and other technical links of Shanghai Pheretima were clearly defined and standardized. Conclusion This study provides practical basis for the standardization and modernization quality management of Shanghai Pheretima.

OBJECTIVE： To study the effects of resveratrol （Res） on cognitive function and SIRT1/NF-κB signaling pathway in neonatal rats with hypoxic-ischemic brain injury. METHODS： SD neonatal rats were randomly divided into sham operation group （normal saline）， model group （normal saline）， Res low-dose and high-dose groups （30， 60 mg/kg）， with 12 rats in each group. Except that sham operation group received sham operation， hypoxic-ischemic brain injury model was established by Rice method in other groups. After modeling， the rats were given relevant medicine intraperitoneally each day， for consecutive 6 weeks. Water maze test was used to analyze spatial learning and memory function of rats in each group. The escape latency after 1， 3 and 6 weeks of administration and the times of crossing platform after 6 weeks of administration were recorded. TTC staining was used to detect cerebral infraction area of rats after 6 weeks of medication. Western blot was used to detect the expression of Bcl-2， Bax， Caspase-3， SIRT1， SIRT1/NF-κB pathway related protein SIRT1 and p-NF-κB in hippocampal CA1 region. RESULTS： Compared with sham operation group， escape latency of rats was prolonged significantly in model group after 1， 3， 6 weeks of medication （P＜0.05）， the times of crossing platform was decreased significantly after 6 weeks of medication （P＜0.05）； the area of cerebral infarction was increased significantly （P＜0.05）； the protein expression of Bax， Caspase-3 and p-NF-κB in hippocampus CA1 region were increased significantly， while the protein expression of Bcl-2 and SIRT1 were decreased significantly （P＜0.05）. Compared with model group， the escape latency of Res low-dose and high-dose groups were shortened significantly after 1， 3， 6 weeks of medication （P＜0.05）， while the times of crossing platform was increased significantly after 6 weeks of medication （P＜0.05）； the area of cerebral infarction was decreased significantly （P＜0.05）， and the protein expression of Bax， Caspase-3 and p-NF-κB protein in hippocampal CA1 area were decreased significantly， while the protein expression of Bcl-2 and SIRT1 were increased significantly （P＜0.05）. The improvement of above indexes in high-dose group were significantly better than low-dose group （P＜0.05）. CONCLUSIONS： Res can improve cognitive dysfunction in neonatal rats with hypoxic-ischemic brain injury， which is related with SIRT1/NF-κB signaling pathway.

Objective To explore the application value of the pulse index continuous cardiac output monitoring technology (PICCO) in treating severe craniocerebral injury complicating neurogenic pulmonary edema(NPE).Methods Fifty-two cases of severe craniocerebral injury complicating NPE in the intensive care medicine department of this hospital were divided into the observation group and control group,26 cases in each group.The control group adopted the routine neurological treatment measures and guided the fluid infusion by monitoring the central venous pressure(CVP),while on the basis of the control group,the treatment group monitored the hemodynamics by PICCO and guided the fluid management according to the cardiac index(CI),extravascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),global end diastolic volume index(GEDVI) and intrathoracic blood volume index(ITBVI).The clinical curative effects,hemodynamic indexes,intracranial pressure(ICP),average daily infusion volume,mechanical ventilation time,hospital stay and GOS prognosis evaluation were compared between the two groups.Results The improvement of the heart rate(HR),mean arterial pressure (MAP),oxygenation index(PaO2/FiO2),ICP and other indicators in the observation group was more obvious than that in the control group(P＜0.05);the CVP rise in the control group was more obvious(P＜0.05);CI,EVLWI,PVPI,GEDVI and ITBVI in the observation group were improved and stabilized;the daily average infusion amount,mechanical ventilation time and hospital stay in the observation group were less than those in the control group(P＜0.05);but the good prognosis rate and mortality rate had no significant difference between the two groups(P＞0.05).Conclusion PICCO can better conduct the liquid management,improves the clinical symptoms,shortens the mechanical ventilation time and hospitalization stay,but the results show no significant improvement in prognosis and mortality.