Objective To explore the application value and related factors of serum carbonic anhydraseⅢ(CAⅢ)in the clinical diagnosis of mild to moderate Alzheimer disease(AD).Methods A total of 106 elderly patients initially diagnosed with mild to moderate AD at Huashan Hospital,Fudan University from October 2020 to November 2022 were enrolled as the AD group,and 89 healthy elderly people during the same period were enrolled as the control group.The serum biochemical indicators including liver and kidney function,blood lipids,blood glucose,folic acid and homocysteine were detected in both groups.Cognitive function was assessed by Mini-mental State Examination(MMSE).Patient Health Questionnaire-9(PHQ-9)and Generalized Anxiety Disorder-7(GAD-7)were used to assess psychological status.The activities of daily living(ADL)were assessed by modified Barthel Index(BI).Serum CAⅢlevels were measured by enzyme-linked immunosorbent assay(ELISA).Correlation analysis and multivariate linear regression analysis were used to identify factors influencing serum CAⅢlevels,and receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic value of serum CAⅢlevels in elderly patients with mild to moderate AD.Results The MMSE score of the AD group was significantly lower than that of the control group(P＜0.001),and the PHQ-9 and GAD-7 scores were significantly higher than those of the control group(P＜0.001).The serum CAⅢlevel in the AD group was significantly lower than that in the control group(P＜0.000 1).In patients with AD,serum CAⅢlevels in patients with a disease course＞3 years,accompanied by depression or anxiety,moderate AD,and serum creatinine≤111 μmol/L were significantly lower than those in patients with a disease course≤3 years,normal emotions,mild AD,and serum creatinine＞111 μmol/L(P＜0.05).Correlation analysis and multivariate linear regression analysis showed that serum CAⅢlevels were negatively correlated with disease duration,PHQ-9 score,GAD-7 scores and severity degree,positively correlated with serum creatinine level(P＜0.05).The PHQ-9 score,severity degree,and serum creatinine level were independent related factors for serum CAⅢlevel in mild to moderate AD elderly patients(P＜0.05).ROC curve result showed that the area under the curve(AUC)of serum CAⅢin diagnosing mild to moderate AD in elderly patients was 0.946,with sensitivity and specificity of 88.79% and 96.74%,respectively.Conclusions Serum CAⅢlevels in elderly patients with mild to moderate AD are higher than those in healthy individuals.Mild AD,without depressive mood,and elevated serum creatinine levels are related factors for elevated serum CAⅢlevels in elderly AD patients.Serum CAⅢmay serve as a novel biological marker for the diagnosis of mild to moderate AD in the elderly.

Objective:To evaluate the safety and efficacy of 27G micro-incision vitrectomy surgery (MIVS) combined with intravitreal injection of ranibizumab (IVR) in the treatment of retinopathy of prematurity (ROP) with early intervention failure.Methods:Retrospective case series was performed. Fourteen eyes (11 infants) with ROP who underwent 27G MIVS combined with IVR were included from March 2016 to January 2018 in Shenzhen Eye Hospital. Among them, there were 5 males with 7 eyes, 6 females with 7 eyes. The average gestational age of the infants was 28.12±0.90 weeks; the average birth weight was 1 023.64±200.96 g. Before the early clinical intervention, 1 infant (2 eyes) had ROP in zone Ⅰ stage 3 with plus disease, 8 infants (10 eyes) had ROP in zone Ⅱ stage 3 with plus disease, and 2 infants had ROP in aggressive posterior ROP. Six eyes underwent laser photocoagulation, while 8 eyes received laser therapy combined with IVR. Six eyes of stage 4A ROP and 8 eyes in stage 4B. Retinal detachment was detected with a mean of 10.44±9.21 weeks. At the time of surgery, the average post-conceptional age was 48.02±8.09 weeks. All the affected eyes were treated with standard sclera with three incisions 27G MIVS. During the operation, only local vitrectomy was performed to release and clear fibroascular proliferation in the optic disc, anterior macular area and pericristal area. After surgery, 10 mg/ml of ranibizumab 0.03 ml was injected into the vitreous cavity. The average follow-up time was 23.36±8.34 months. The primary objectives were the condition of retinal reset, ROP progression control and complications.Results:All patients had uneventful surgeries with an average duration of 32.86±9.35 mins. Of the 14 eyes, 12 eyes (85.71%) were controlled, 8 eyes (57.14%) had a good rearrangement of macular structure, while 4 eyes with macular traction. Two eyes had ROP progression, recurrence of retinal detachment, posterior synechia. Complicated cataract was in 1 eye. Proliferative vitreoretinopathy and retinal detachment was in 1 eye after 7 months the operation.Conclusion:27G MIVS combined with IVR is a safe and effective treatment for ROP with early clinical intervention failure.

Objective To establish and validate a voxel-based method for the quantitative detection of air trapping (AT),and to explore its diagnostic value by preliminarily apply this method in chronic obstructive pulmonary disease (COPD) patients.Methods From March 2015 to February 2016,fifty healthy young volunteers and eighteen COPD patients who underwent both end-inspiratory and end-expiratory CT were included from the Digital Lung Multi-center Study.The quantitative parameters of AT and emphysema were measured by both the voxel-based quantitative method and the conventional threshold method,respectively.All subjects underwent pulmonary function examination within 3 days after CT examination.For healthy volunteers,paired sample rank-sum test was used to compare the difference of quantitative parameters between voxel-based method and threshold method,Spearman rank correlation analysis was used to investigate the correlation between quantitative parameters of the two methods and pulmonary function.For COPD patients,the distribution and extent of AT and emphysema in patients with similar degree of pulmonary function (PFT) injury were observed.Results There were varying degrees of AT in the asymptomatic youth,with a median value of 5.70％ for the voxel-based method and with a median value of 7.96％ for the conventional threshold method,there was significant difference(Z=-4.015,P＜0.001).The correlation between AT and emphysema parameters of the voxel-based method and PFT parameters (r=-0.399 and-0.494,-0.335 and-0.439 separately,P＜0.05) were higher than that of the conventional threshold method,respectively (r=-0.357 and-0.453,-0.284 and-0.391,respectively;all P＜0.05).Furthermore,the voxel-based method can classify COPD patients with similar degree of pulmonary function injury into three subtypes:AT-dominant,emphysema-dominant,and mixed.Conclusions The voxel-based AT quantitative measurement method not only has high sensitivity and accuracy,but also provides imaging phenotype for the diagnosis of COPD and provides assistant decision-making for clinical management.

A total of 1 789 patients with gastric cancer underwent radical gastrectomy in our hospital from September 2015 to August 2017, internal hernia (IH) developed in 7 cases with a incidence rate of 0.4%. The general condition, the symptoms, imaging findings, treatment methods and prognosis as well as the types of digestive tract reconstruction of patients were retrospective analyzed. There were 4 cases of Petersen′s hernia, 2 cases of jejuno-jejuno mesenteric hernia and 1 case of diaphragm hernia. All patients developed mechanical obstruction. Imaging examination showed mesenteric vessels overriding sign and double whirl sign. Six patients recovered smoothly, 1 patient gave up treatment due to extensive small bowel infarction. It is indicated that the formation of abnormal channels in the abdominal cavity after radical gastrectomy may lead to IH. The mesenteric vessels overriding sign and the double whirl sign are the unique imaging findings of IH after radical gastrectomy. Closing the abnormal channel can prevent the occurrence of IH after gastrectomy.

Objective To preliminarily discuss the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia (VBD).Methods From January 2013 to August 2016,16 patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.All patients received preoperative magnetic resonance angiography examination.The anatomical relationship between the trigeminal nerves and the peripheral vessels was identified.Microvascular decompression was conducted via suboccipital retrosigmoid approach.They were followed up for 12-52 months after procedure.The trigeminal neuralgia score standard of Barrow Neurological Institute was used to evaluate the degree of pain of the patients before procedure,after procedure,and during the follow-up period.Results Of the 16 patients,the pain disappeared immediately in 15 after procedure,and the pain was not obviously relieved in 1 case after procedure,and the pain disappeared gradually at 6 months after procedure.One patient had hearing loss after operation compared with pre-operation.The follow-up time ranged from 12 months to 52 months.Three patients had recurrent pain at 6,12,and 36 months,respectively after procedure.Conclusion Microvascular decompression treatment of trigeminal neuralgia caused by VBD has better safety and surgical efficacy,but there was a certain pain recurrence rate,which needed further research.

Objective To conduct the biomechanical evaluation of the effect of the new operative method,one stageanterior debridement and fusion combined withtitanium cage and dual screw-rod anterior instrumentation inter-fixation on the reconstruction of lumbosacral spine stability and provide biomechanical support for its further promotion in clinical practice.Methods Fifteen lumbosacral spine specimens were obtained from the department of anatomy,Xi'an Jiaotong University Health Science Center.Fracture,deformity and osteoporosis were removed by CT and bone density examination.The remaining specimens were randomly divided into intact group,anterior fixation group and posterior fixation group.L5 vertebral body and adjacent intervertebraldisc subtotal resection were performed on all specimens in the anterior fixation group and the posterior fixation group.The specimens in the anterior fixation group were fixed through titanium cage and dual screw-rod from front approach and the specimens inthe posterior group were fixed by dual screw-rod from posterior approach.Specimens in the intact group were not treated.All specimens were examined by X-ray and thin-slice CT after surgery to determine whether implant placement was appropriate andwhether there was spinal cord compression or not.Three groups of lumbosacral spine specimens were subjected to mechanical testsunder the conditions of flexion and extension,lateral bending,axial torsion and axial compression to evaluate the mechanical effect of anterior dual screw-rod system combined with titanium cage on the fixation of lumbosacral spine.Results All lumbosacralspine specimens were free of fractures,deformities,osteoporosis and other diseases.Postoperative imaging examination showed thatthe implant was in normal position and no adverse phenomena such as pedicle screw insertion into the spinal canal and spinalcord compression were observed.Mechanical test results in vitro showed that the load required for maximum loading displacement (5 mm) or rotation angle (5°) of the specimens in the intact group was less than that of the specimens in anterior and posterior fixation group in flexion,lateral bending and axial compression and torsion direction (Fflexion=1335.989,Pflexion=0.000;Fextenxion=166.688,Pextenxion=0.000;Fleft latebending=258.872,Pleft lateral bending=0.000;Fright lateral bending=335.766,Pright lateral bending=0.000;Faxial compression=481.444,Paxial compression =0.000;Fleft rotation=21.682,Pleft totation=0.000;Fright rolation=34.990,Pright rotation=0.000).When the maximum loading displacement (5 mm) was reached,the load required for the specimens in anterior fixation group was significantly greater than that for specimens in posterior fixation groupin the direction of flexion,left and right lateral bending and axial compression (Pflexion=0.000;Pleft lateral bending=0.006;Pright lateral bending=0.016;Paxial compression=0.000).However,the load required to reach the maximum loading displacement (5 mm) in the anterior fixation group in the direction of extension was significantly lower than that in the posterior fixation group (P=0.000).When the maximum load angle (5°) was reached intorsion direction,the required load of the specimens in both anterior and posterior fixation groups was similar (Pleft rotation=0.820;Pright rotation=0.259).Conclusion The anterior fixation of lumbosacral spine specimens with titanium cage combined with dualscrew rod can provide better immediate stability and its stability in flexion,lateral bending and axial compression is better than that of back double nailing rodfixed.

Objective To explore the therapeutic effect of Xiefu Zhuyu decoction joint brain protein hydrolysate injection in the treatment of patients with traumatic brain injury and its effect on cerebrospinal fluid of endothelin-1 ( ET-1 ) .Methods 102 cases of patients with craniocerebral injury were divided into control group (n=51) and experimental group (n=51),the control group were treated with brain protein hydrolyzate injection, the experimental group based on the control group were treated with Xuefu Zhuyu decoction, the curative effect, ET-1, inflammatory factor, protein, blood rheology, S-100β, neuron specific enolase (NSE), National Institutes of Health Stroke Scale (NIHSS) and complications of two groups were compared.Results The total effective rate of experimental group was higher than the control group (94.11% vs.78.43%), the difference was statistically significant (P<0.05).The ET-1 of experimental group was lower than the control group[(32.45 ±4.05) ng/L vs.(28.11 ±3.50) ng/L] (P<0.05).The inflammatory factor, protein, blood rheology, NSE, S-100βof experimental group were better than those of control group (P<0.05). The NIHSS of experimental group was lower than that of the control group ( P <0.05 ) .The complication rate had no difference between two groups. Conclusion The clinical curative effect of Xiefu Zhuyu decoction joint brain protein hydrolysate injection in the treatment of traumatic brain injury , can reduce cerebrospinal fluid levels of ET-1 and can improve inflammatory factors, proteins and hemorheology.

Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.

Objective To investigate the treatment measures of having trigeminocardiac reflex (TCR) for the primary trigeminal neuralgia via microvascular decompression.Methods From January 2016 to December 2016,the clinical data and anesthesia records of 79 consecutive patients with primary trigeminal neuralgia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and treated the first craniotomy microvascular decompression were analyzed retrospectively.They were divided into a no TCR group (n=63) and a TCR group (n=16) according to the intraoperative anesthesia monitoring.The differences of baseline conditions,preoperative complications and pain involved the trigeminal nerve branches were compared between the two groups.The treatment measures and short-term prognosis of the patients with TCR during operation were summarized.Results (1) The proportion of hypertension in the TCR group was 31.2％ (n=5),it was higher than 7.9％ in the no TCR group (n=5).There was significant difference (χ2=6.273,P<0.05).(2) During the operation of microvascular decompression,16 patients in the TCR group had 19-time TCR.The baseline heart rate was 74±10/min before operation,and the heart rate decreased to 51±6/min at onset of TCR.The mean baseline arterial blood pressure was 102±13 mmHg,and the mean arterial blood pressure decreased to 74±8 mmHg at the onset of TCR.There was significant difference (P<0.05).(3) After the onset of TCR,the operation of was stopped,heart rate and the blood pressure recovered spontaneously (n=4).Fifteen patients were treated with medications,including using atropine (12 times,dose 0.2-0.5 mg) and ephedrine hydrochloride (3 times,dose 5-10 mg).Heart rate and blood pressure returned to the baseline level within 20 seconds or 20 seconds after administration of medications.There was no TCR-related cardiac complication or neurological deficit from after procedure to before discharge.Conclusions In microvascular decompression of primary trigeminal neuralgia,if TCR occurs,the selective use of anticholinergic agents or vasoactive agents is needed as early as possible.The risk factors for the occurrence of TCR need to be further verified.

In order to construct a novel multifunctional targeting nano-carrier based on pH-redox characteristics of tumor microenvironment,ketone bonds and disulfide bonds were bonded to the oligomeric hyaluronic acid (oHA) being sensitive to pH and the reduction environment.The chemical structure of oligomeric hyaluronic acid-8-mercaptomenthone 1,2-glycerolketal (oHMST) was characterized by 1H NMR,IR and ESI-MS.Curcuminloaded micelles were prepared by dialysis.The single factor investigation was carried out on the dosage form.Some properties,including particle size zeta potential,the morphology of micelles,and pH-sensitivity were studied.The materials were synthesized successfully.The micelles were spheric with a diameter of about 100 nm.The Zeta potential of the micelles was-(21.97 ± 1.08) mV.The in vitro test showed that oHMST carriers have good pH-sensitivity and redox-sensitivity.