BACKGROUND: Inflammation plays a critical role in severe cerebral venous thrombosis (CVT) pathogenesis, but the benefits of anti-inflammatory therapies remain unclear. This study aimed to investigate the association between steroid therapy combined with anticoagulation and the prognosis of acute/subacute severe CVT patients. METHODS: A prospective cohort study enrolled patients with acute/subacute severe CVT at Xuanwu Hospital (July 2020-January 2024). Patients were allocated into steroid and non-steroid groups based on the treatment they received. Functional outcomes (modified Rankin scale [mRS]) were evaluated at admission, discharge, and 6 months after discharge. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), cerebrospinal fluid (CSF) IL-6, and intracranial pressure were measured at admission and discharge in the steroid group. Fundoscopic Frisén grades were assessed at admission and 6 months after discharge. Univariate and multivariate logistic regression were used to evaluat associations between steroid use and favorable outcomes (mRS ≤2) at the 6-month follow-up. Paired tests assessed changes in hs-CRP and other variables before and after treatment, and Spearman's correlations were used to analyze relationships between these changes and functional improvements. RESULTS: A total of 107 and 58 patients in the steroid and non-steroid groups, respectively, were included in the analysis. Compared with the non-steroid group, the steroid group had a higher likelihood of achieving an mRS score of 0-2 (93.5% vs . 82.5%, odds ratio [OR] = 2.98, P  = 0.037) at the 6-month follow-up. After adjusting for confounding factors, the result remained consistent. Pulsed steroid therapy did not increase mortality during hospitalization or follow-up, nor did it lead to severe steroid-related complications (all P  >0.05). Patients in the steroid group showed a significant reduction in serum hs-CRP, IL-6, CSF IL-6, and intracranial pressure at discharge compared to at admission, as well as a significant reduction in the fundoscopic Frisén grade at the 6-month follow-up compare to at admission (all P  <0.001). A reduction in serum inflammatory marker levels during hospitalization positively correlated with improvements in functional outcomes ( P  <0.05). CONCLUSION: Short-term steroid use may be an effective and safe adjuvant therapy for acute/subacute severe CVT when used alongside standard anticoagulant treatments, which are likely due to suppression of the inflammatory response. However, these findings require further validation in randomized controlled trials. TRAIL REGISTRATION ClinicalTrials.gov , NCT05990894.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Anticoagulants/therapeutic use* ; C-Reactive Protein/metabolism* ; Interleukin-6/metabolism* ; Intracranial Thrombosis/drug therapy* ; Prospective Studies ; Steroids/therapeutic use* ; Venous Thrombosis/drug therapy*

Objective:To construct an evaluation index system for the perioperative medical service efficiency.Methods:From September to November 2023, this study conducted literature search and research group discussions to select initial indicators for evaluating the efficiency of perioperative medical services guided by value-based healthcare; 2-round Delphi methods were used to construct an evaluation index system for perioperative medical service efficiency, and the weights of the indicators were determined using the analytic hierarchy process.Results:The expert motivation for both rounds of Delphi method was 100.00%, the expert authority coefficient was 0.94, and the Kendall coordination scores were 0.56 and 0.75, respectively. The final established evaluation index system for perioperative medical service efficiency included 2 primary indexes, 9 secondary indexes, and 41 tertiary indexes. The first level indexes included medical quality and medical cost, with relative weights of 66.67% and 33.33%, respectively. Among them, medical quality included 7 secondary indexes: medical management, medical safety, service mode, information construction, patient outcomes, service efficiency, and satisfaction; Medical costs include 2 secondary indiexes: patient costs and medical institution costs.Conclusions:The evaluation index system for the efficiency of perioperative medical services reflected the connotation of value-based healthcare and could comprehensively and objectively evaluate the efficiency of perioperative medical services.

Objective:To explore the protective role and possible mechanism of neural stem cells combined with edaravone in cortical neurons after oxygen-glucose deprivation/reperfusion (OGD-R).Methods:(1) Neural stem cells from brain tissues of SD fetal rats aged 14-16 d were cultured in vitro, and identified with Nestin, glial fibrillary acidic protein (GFAP), and microtubule-associated protein 2 (MAP2) immunofluorescent staining. Expressions of neuron-specific nuclear protein (NeuN) and β-Tubulin were detected by immunofluorescent staining in primary cortical neurons from SD rats born within 24 h. (2) Primary cortical neurons were divided into normal group (normal culture), OGD-R model group (re-oxygenated culture for 24 h after hypoxia for 1.5 h), OGD-R+neural stem cells group (re-oxygenated co-culture with cortical neurons and neural stem cells for 24 h after hypoxia for 1.5 h), OGD-R+edaravone group (re-oxygenated culture for 24 h after hypoxia for 1.5 h; 100 μmol/L edaravone before hypoxia), OGD-R+neural stem cells+edaravone group (re-oxygenated co-culture with cortical neurons and neural stem cells for 24 h after hypoxia for 1.5 h; 100 μmol/L edaravone before hypoxia); 24 h after each treatment, neuron proliferation in each group was detected by cell counting Kit 8 (CCK8), apoptosis rate was detected by flow cytometry, contents of interleukin-1β (IL-1β), and tumor necrosis factor α (TNF-α) in neuronal supernatant were detected by enzyme-linked immunosorbent assay (ELISA), and real-time quantitative fluorescent polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the mRNA and protein expressions of Notch1, Hes1 and Hes5, respectively. Results:(1) Immunofluorescent staining results showed that neural stem cells were positive for Nestin, GFAP and MAP2, and cortical neurons were positive for NeuN and β-Tubulin; all of them were successfully identified. (2) Compared with normal group, OGD-R model group, OGD-R+neural stem cell group and OGD-R+edaravone group had decreased neuron viability, increased apoptosis, increased supernatant IL-1β and TNF-α contents, and increased Notch1 mRNA and protein expressions, with significant differences ( P<0.05). Compared with OGD-R model group, OGD-R+neural stem cells+edaravone group had increased neuron viability, decreased apoptosis, decreased supernatant IL-1β and TNF-α contents, and decreased mRNA and protein expressions of Hes1 and Hes5, with significant differences ( P<0.05). Compared with the OGD-R model group, OGD-R+edaravone group and OGD-R+neural stem cell+edaravone group had significantly decreased Notch1 mRNA and protein expressions ( P<0.05). Conclusion:Combination of edaravone and neural stem cell therapy can reverse the neuronal damage caused by OGD-R, whose mechanism may be by inhibiting the expressions of inflammatory factors and key signaling molecules in Notch signaling pathway, such as Notch1, Hes1, and Hes5.

Objective:To investigate the correlation between the levels of serum secreted frizzled-related protein 5 (SFRP5), sputum CXC chemokine receptor 2(CXCR2), chemokine receptor 1 (CCR1) and airway inflammation in children with acute asthma.Methods:A total of 53 cases of acute asthma (acute group), 50 cases of asthma at remission stage (stable group) and 50 cases of healthy children (control group) in our hospital from January 2017 to January 2020 were enrolled.The expression levels of serum SFRP5, CXCR2 and CCR1, as well as pulmonary function indicators (FEV1/FVC, FEV1%), fractional exhaled nitric oxide(FeNO), and airway inflammation-related cytokines[interleukin(IL-13), vascular endothelial growth factor(VEGF)] were detected, respectively.Results:The levels of serum SFRP5 was the lowest in acute group, followed by stable group, which was the highest in control group, with statistic difference ( P<0.05). The mRNA expression levels of CXCR2 and CCR1 were the highest in acute group, followed by stable group, which were the lowest in control group, with statistic difference ( P<0.05). The predicted values of FEV1/FVC and FEV1% in acute group were significantly lower than those in stable group and control group, while FeNO in acute group was significantly higher than those in stable group and control group ( P<0.05). The predicted values of FEV1/FVC and FEV1% in stable group were significantly lower than those in control group, and FeNO was significantly higher than that in control group( P<0.05). The values of FEV1/FVC and FEV1% were the lowest in acute group, followed by stable group, which were the highest in control group ( P<0.05). The values of serum IL-13 and VEGF were the highest in acute group, followed by stable group, which were the lowest in control group, with statistic difference( P<0.05). Correlation analysis showed that the level of serum SFRP5 was positively correlated with lung function index FEV1/FVC and FEV1% to the predicted value( P<0.05), and negatively correlated with the levels of inflammatory index IL-13 and FeNO ( P<0.05). The levels of sputum CXCR2 and CCR1 were negatively correlated with lung function index FEV1/FVC and FEV1% to predicted value( P<0.05), and positively correlated with inflammatory index IL-13, VEGF and FeNO( P<0.05). Conclusion:Serum SFPR5 is decreased, and septum mRNA expression levels of CCR1 and CXCR2 are elevated in asthma children, so these three indicators could be used to predict the severity of airway inflammation in asthma children, thus providing reference for clinical diagnosis and treatment.

Objective:To investigate the clinical efficacy of finasteride combined with 5% minoxidil in the treatment of male androgenetic alopecia.Methods:A total of 102 males with androgenetic alopecia diagnosed and treated in Shaoxing Hospital of China Medical University during 2018-2019 were selected in the study and divided into two groups by random number table method.The control group (50 cases) was only given finasteride, and the treatment group(52 cases) was given finasteride combined with minoxidil.All the patients were treated for 6 months.The therapeutic effects and adverse reactions during the treatment were compared between the two groups.Results:The effective rate of the treatment group was 86.5%(45/52), which was significantly higher than 66.0%(33/50) of the control group(χ 2=4.93, P<0.05). The incidence of adverse reactions in the treatment group was 3.8%(2/52), which was significantly lower than 18.0%(9/50) in the control group(χ 2=5.22, P<0.05). Conclusion:Finasteride combined with 5% minoxidil is safe and effective in the treatment of male androgenetic alopecia, which is worthy of clinical promotion.

Objective To establish a multiplex real-time PCR mothed for rapid detection of seven species of intracranial bacteria after surgery. Methods Firstly ,the Gram′s identification was deter mined. Secondly , according to the results of Gram identification ,the bacterium was typed by the specific primers and probes to deter mine the distribution of bacteria. Simul taneously ,the sensitivity and specificity of this method were verified by making intracranial infected sim ulated samples and contrasting national standard method. Results The method established could complete detention within 4 hours with a good specificity. Staphylococcus aureus,Streptococcus pneumoniae ,Escherichia coli ,Pseudomonas aeruginosa pseudomonas ,Klebsiella pneumoniae and Acinetobacter baumannii could be detected at concentrations of ≥102 CFU/mL. Enterococcus faecalis could be detected at concen-trations of≥103 CFU/mL. The lowest detection limita of this method is higher than culture method for Streptococcus pneumoniae. Conclusions Real-time Multiplex PCR method was with high sensitivity and specificity. It reduced the detection time greatly and has great value in early diagnosis of bacteria in intracranial infection. It should be of great significance for guiding clinical treatment.

HM(hibernating myocardium)is an adaptive phenome-non of myocardium against sustained ischemia,which maintains its tissue vitality through balancing energy supply and demand.It widely exists in patients suffering from coronary heart disease. HMhas its own metabolic pattern,instead of regular FAO(fatty acid β-oxidation)-based metabolism,glycolysis became main pro-cedure.Reduction of FAO,TCA (tricarboxylic cacidcycle),ETC (electron transport chain)enzyme has been observed,ROS(reac-tive oxygen species)and UCP2(uncoupling protein 2)have been up-regulated.UCP2,which promotes proton leak across innermembrane of mitochondrial and leads to ATP reduction,has e-merged as an important regulator of the energy production.It is regulated by up-stream proteins such as AMPK,PPARs,PGC-1α,and other factors like FFA(free fat acid),ROS and purine nucleotide.HM has potential function of ischemic myocardium, which can improve cardiac function through reasonable interven-tion.Modulation of UCP2 can optimize energy production,and is essential to HM metabolism.

Objective    To investigate the effect of low-flow inhaling NO for short time on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension. Methods    Forty-five patients with congenital ventricular septal defect complicated with severe pulmonary hypertension from May 2014 to May 2016 in our hospital were enrolled. There were 19 males and 26 females, whose age ranged from 1 to 22 months (average age: 7.2±14.4 months) and weight ranged from 2.7 to 10.5 kg (average weight: 6.8±3.6 kg). The patients were randomly divided into three groups (n=15 in each): the blank group, the prior inhalation group and the posterior inhalation group. The blank group did not inhale NO, and the prior inhalation group inhalated NO for 10 min after tracheal and intubation. After the opening of the aorta, the posterior inhalation group inhaled NO for 10 min. The concentration of NO was 20 × 10–6. The pressure ratio of pulmonary circulation/systematic circulation, heart index and oxygenation index were calculated and the troponin value of the three groups was monitored 10 min after returning to intensive care unit (ICU) and postoperatively 1 h, 3 h and 24 h. Differences among above indicators between three groups were compared. Results    The troponin value of the posterior inhalation group within 3 h increased most, followed by the blank group and the prior inhalation group. Postoperatively 1 h and 3 h, the troponin value of the prior inhalation group was significantly less than that of the blank group and posterior inhalation group (P<0.01) and the value on postoperative 24 h in each group was lower than that on postoperative 3 h. The cardiac index of prior inhalation group was higher than that of the blank group and the posterior inhalation group at each time point. Postoperatively 3 h and 24 h as well as 10 min after returning to ICU, the cardiac index in prior inhalation group was significantly higher than that of the posterior inhalation group (P<0.05). The pressure ratio of pulmonary circulation/systematic circulation of posterior inhalation group increased more than that of blank group; the differences in two groups were significant between postoperative 3 h and 10 min after returning to ICU (P<0.01). There was no statistical significance in the pressure ratio on postoperative 24 h and 10 min after returning to ICU (P>0.05) in three groups. The index of oxygenation of the prior inhalation group was higher than that of the blank group and the posterior inhalation group and statistically different from that of posterior inhalation group (P<0.05). Conclusion    Inhaling NO 10 min preoperatively can reduce the injury to the heart and lung function effectively, but the result is the opposite when inhalating NO 10 min after aorta opening.

Carcinoma, Squamous Cell ; diagnosis ; Carcinoma, Verrucous ; diagnosis ; Epidermis ; pathology ; Humans