Acute cerebral infarction(ACI)has the characteristics of onset nasty and high mortality,and thus the rapid determination of the occurrence and development of ACI plays a key role in the diagnosis,treatment and prognosis of ACI patients.It has shown that the serum level of human haptoglobin(Hp)is related to ACI.In this study,surface enhanced Raman scattering(SERS)combined with immune recognition was applied to establish a quantitative analysis method for serum Hp.Firstly,the SERS substrate of silver nanoparticles was prepared on silicon wafer,and 4-mercaptobenzoic Acid(MBA)was used as a Raman probe by forming Ag—S bond and connecting it on the surface of nanoparticles.The carboxyl group of MBA was linked to amino group of self-made high-affinity antibody through forming CO—NH structure thus forming a SERS self-assembled chip of Hp(Ag/MBA/anti-Hp).Hp in serum could be specifically captured by antibodies on SERS substrate,which caused the shift of SERS characteristic peak of MBA.The results showed that there was a good linear relationship between the logarithm of Hp concentration and the SERS characteristic peak shift of MBA.The detection range was 1-1000 ng/mL(R2=0.988).The Hp concentrations in serum of 90 ACI patients were determined by this method,and the results were consistent with those of ELISA method,which proved the practicability and accuracy of this method.This method was highly specific,simple and convenient,which could realize the specific recognition and quantitative analysis of serum Hp,so as to be an effective means for clinical detection of serum Hp,thus providing a reference for the treatment and prognosis of ACI.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Tumor-associated macrophages (TAMs), one of the dominating constituents of tumor microenvironment, are important contributors to cancer progression and treatment resistance. Therefore, regulation of TAMs polarization from M2 phenotype towards M1 phenotype has emerged as a new strategy for tumor immunotherapy. Herein, we successfully initiated antitumor immunotherapy by inhibiting TAMs M2 polarization via autophagy intervention with polyethylene glycol-conjugated gold nanoparticles (PEG-AuNPs). PEG-AuNPs suppressed TAMs M2 polarization in both in vitro and in vivo models, elicited antitumor immunotherapy and inhibited subcutaneous tumor growth in mice. As demonstrated by the mRFP-GFP-LC3 assay and analyzing the autophagy-related proteins (LC3, beclin1 and P62), PEG-AuNPs induced autophagic flux inhibition in TAMs, which is attributed to the PEG-AuNPs induced lysosome alkalization and membrane permeabilization. Besides, TAMs were prone to polarize towards M2 phenotype following autophagy activation, whereas inhibition of autophagic flux could reduce the M2 polarization of TAMs. Our results revealed a mechanism underlying PEG-AuNPs induced antitumor immunotherapy, where PEG-AuNPs reduce TAMs M2 polarization via induction of lysosome dysfunction and autophagic flux inhibition. This study elucidated the biological effects of nanomaterials on TAMs polarization and provided insight into harnessing the intrinsic immunomodulation capacity of nanomaterials for effective cancer treatment.

OBJECTIVE: To investigate the incidence rate and risk factors for metabolic bone disease of prematurity (MBDP) in very low birth weight/extremely low birth weight (VLBW/ELBW) infants. METHODS: The medical data of 61 786 neonates from multiple centers of China between September 1, 2013 and August 31, 2016 were retrospectively investigated, including 504 VLBW/ELBW preterm infants who met the inclusion criteria. Among the 504 infants, 108 infants diagnosed with MBDP were enrolled as the MBDP group and the remaining 396 infants were enrolled as the non-MBDP group. The two groups were compared in terms of general information of mothers and preterm infants, major diseases during hospitalization, nutritional support strategies, and other treatment conditions. The multivariate logistic regression analysis was used to investigate the risk factors for MBDP. RESULTS: The incidence rate of MBDP was 19.4% (88/452) in VLBW preterm infants and 38.5% (20/52) in ELBW preterm infants. The incidence rate of MBDP was 21.7% in preterm infants with a gestational age of < 32 weeks and 45.5% in those with a gestational age of < 28 weeks. The univariate analysis showed that compared with the non-MBDP group, the MBDP group had significantly lower gestational age and birth weight, a significantly longer length of hospital stay, and a significantly higher incidence rate of extrauterine growth retardation ( CONCLUSIONS A lower gestational age, hypocalcemia, extrauterine growth retardation at discharge, and neonatal sepsis may be associated an increased risk of MBDP in VLBW/ELBW preterm infants. It is necessary to strengthen perinatal healthcare, avoid premature delivery, improve the awareness of the prevention and treatment of MBDP among neonatal pediatricians, and adopt positive and reasonable nutrition strategies and comprehensive management measures for preterm infants.
Birth Weight ; Bone Diseases, Metabolic/etiology* ; China/epidemiology* ; Female ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Pregnancy ; Retrospective Studies ; Risk Factors

Objective To observe distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery (MCA) using high?resolution magnetic resonance imaging (HR?MRI), and to investigate HR?MRI characteristics of atherosclerotic plaques in the MCA in patients with acute cerebral infarction. Methods A total of 57 symptomatic patients with MCA atherosclerotic plaques recruited in the Affiliated Hospital of Yangzhou University from January 2014 to January 2016 were imaged with diffusion weighted imaging (DWI), three dimensional time of flight magnetic resonance angiography (3D TOF?MRA) and HR?MRI scanning for plaque on a 3.0 T MRI scanner. According to the results of DWI examination, the 57 patients were divided into transient ischemic attack (TIA) group (27 cases) and acute cerebral infarction group (30 cases). The distribution of the narrowest lumen plaque was evaluated by cross?section division into four equal arcs (superior, inferior, ventral, dorsal arcs). For quantitative analysis, lumen area (LAMLN), vessel area (VAMLN) at maximal lumen narrow (MLN) and LAreference, VAreference were measured, then wall area (WA), plaque area (PA), percentage of plaque burden, rate of lumen stenosis and remodeling index (RI) were calculated. The data of each group were compared and analyzed. Results The location and morphological analysis of the 57 patients with symptomatic MCA atherosclerotic plaques revealed that plaques were located in the ventral wall in 19 cases (33.3%), the upper wall in 15 cases (26.3%), the dorsal wall in 10 cases (17.5%), and the lower wall in 13 cases (22.8%). For the location variations in ventral wall, upper wall, dorsal wall and lower wall, the TIA group was shown as six cases (22.2%), five cases (18.5%), seven cases (25.9%) and nine cases (33.3%), and the acute cerebral infarction group was shown as 13 cases (43.3%), 10 cases (33.3%), three cases (10.0%) and four cases (13.3%), respectively. There was no statistically significant difference in the distribution of each side wall between the two groups (P>0.05). VAreference, LAreference, VAMLN and RI of the TIA group and the acute cerebral infarction group were (19.89 ± 1.34) mm2, (15.19 ± 2.04) mm2, (20.78 ± 1.78) mm2, 1.09 ± 0.11 and (19.70 ± 1.34) mm2, (14.60 ± 2.33) mm2, (21.53 ± 2.34) mm2, 1.10 ± 0.11, respectively. There was no statistically significant difference between the two groups (P>0.05). The remodeling patterns of both groups were mainly positive remodeling, with a total of 44 cases (77.2%). In the TIA group and the acute cerebral infarction group, the WAMLN, PA, stenosis rate and plaque load percentages were (8.85±1.92) mm2, (4.00±3.00) mm2, 20.92%± 9.18%, 19.05% ± 14.93% and (11.10 ± 1.88) mm2, (6.00 ± 2.25) mm2, 28.56% ± 8.67%, 27.30% ± 7.69%, respectively. The differences between the two groups were statistically significant (t=-4.466, t=-2.865, t=-3.231, t=-2.580, P<0.01). There were eight patients (29.6%) with unsmooth plaque surface in the TIA group and 19 patients (63.3%) in the acute cerebral infarction group. The differences between the two groups were statistically significant (χ2=6.475, P<0.05). LAMLN in the TIA group and the acute cerebral infarction group was (11.93±1.59) mm2 and (10.43±2.08) mm2 respectively, and the difference between the two groups was statistically significant (t=3.033, P<0.01). Conclusions Symptomatic atherosclerotic plaques in MCA in the acute cerebral infarction group have higher plaque load, thicker vascular wall at the maximum stenosis and more unsmooth plaque surface. This indicates the characteristics of high?risk plaques to a certain extent.

Objective: To observe distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery (MCA) using high-resolution magnetic resonance imaging (HR-MRI), and to investigate HR-MRI characteristics of atherosclerotic plaques in the MCA in patients with acute cerebral infarction. Methods: A total of 57 symptomatic patients with MCA atherosclerotic plaques recruited in the Affiliated Hospital of Yangzhou University from January 2014 to January 2016 were imaged with diffusion weighted imaging (DWI), three dimensional time of flight magnetic resonance angiography (3D TOF-MRA) and HR-MRI scanning for plaque on a 3.0 T MRI scanner. According to the results of DWI examination, the 57 patients were divided into transient ischemic attack (TIA) group (27 cases) and acute cerebral infarction group (30 cases). The distribution of the narrowest lumen plaque was evaluated by cross-section division into four equal arcs (superior, inferior, ventral, dorsal arcs). For quantitative analysis, lumen area (LA_MLN), vessel area (VA_MLN) at maximal lumen narrow (MLN) and LA_reference, VA_reference were measured, then wall area (WA), plaque area (PA), percentage of plaque burden, rate of lumen stenosis and remodeling index (RI) were calculated. The data of each group were compared and analyzed. Results: The location and morphological analysis of the 57 patients with symptomatic MCA atherosclerotic plaques revealed that plaques were located in the ventral wall in 19 cases (33.3%), the upper wall in 15 cases (26.3%), the dorsal wall in 10 cases (17.5%), and the lower wall in 13 cases (22.8%). For the location variations in ventral wall, upper wall, dorsal wall and lower wall, the TIA group was shown as six cases (22.2%), five cases (18.5%), seven cases (25.9%) and nine cases (33.3%), and the acute cerebral infarction group was shown as 13 cases (43.3%), 10 cases (33.3%), three cases (10.0%) and four cases (13.3%), respectively. There was no statistically significant difference in the distribution of each side wall between the two groups (P>0.05). VA_reference, LA_reference, VA_MLN and RI of the TIA group and the acute cerebral infarction group were (19.89±1.34) mm², (15.19±2.04) mm², (20.78±1.78) mm², 1.09±0.11 and (19.70±1.34) mm², (14.60±2.33) mm², (21.53±2.34) mm², 1.10±0.11, respectively. There was no statistically significant difference between the two groups (P>0.05). The remodeling patterns of both groups were mainly positive remodeling, with a total of 44 cases (77.2%). In the TIA group and the acute cerebral infarction group, the WA_MLN, PA, stenosis rate and plaque load percentages were (8.85±1.92) mm², (4.00±3.00) mm², 20.92%±9.18%, 19.05%±14.93% and (11.10±1.88) mm², (6.00±2.25) mm², 28.56%±8.67%, 27.30%±7.69%, respectively. The differences between the two groups were statistically significant (t=-4.466, t=-2.865, t=-3.231, t=-2.580, P<0.01). There were eight patients (29.6%) with unsmooth plaque surface in the TIA group and 19 patients (63.3%) in the acute cerebral infarction group. The differences between the two groups were statistically significant (χ²=6.475, P<0.05). LA_MLN in the TIA group and the acute cerebral infarction group was (11.93±1.59) mm² and (10.43±2.08) mm² respectively, and the difference between the two groups was statistically significant (t=3.033, P<0.01). Conclusions Symptomatic atherosclerotic plaques in MCA in the acute cerebral infarction group have higher plaque load, thicker vascular wall at the maximum stenosis and more unsmooth plaque surface. This indicates the characteristics of high-risk plaques to a certain extent.

Objective: To assess the enhancement characteristics of plaques in patients with intracranial atherosclerotic stenosis using three-dimensional high-resolution magnetic resonance imaging (3D HR MRI), and to analyze the correlation between the enhancement characteristics of plaques and the time from onset of stroke symptoms to MRI examination. Methods: The enhancement characteristics of plaques were retrospectively analyzed in 61 patients with cerebral infarction who were scanned in MRI room of the Affiliated Hospital of Yangzhou University from January 2014 to January 2016. According to the elapsed time between symptom onset and MR examination, 61 patients were classified into early stage group (<4 weeks, n=26), middle stage group (4-12 weeks, n=20) and late stage group (>12 weeks, n=15). All cases underwent three-dimensional sampling perfection with application optimized contrast using different angle evolutions (3D-SPACE) T₁WI and enhanced 3D-SPACE T₁WI sequence scans, as well as routine head MRI examinations. The signal intensities of plaques before and after enhancement scanning were compared on the 3D-SPACE T₁WI sequence. The degrees of plaque enhancement were qualitatively analyzed, and the enhancement rates of plaques were quantitatively calculated. The correlation between the enhancement characteristics of plaques and time of symptom onset of stroke was analyzed. Results: Sixty-one intracranial atherosclerotic plaques on the 3D HR MRI showed eccentric thickening or annular thickening of the vessel wall, and slightly higher signals on the T₁WI. They showed different degrees of enhancement or no enhancement after enhancement scans. The characteristics of plaque enhancement in 61 patients with cerebral infarction were analyzed. The results showed that 26 plaques in the early stage group were obviously enhanced for 21 cases (80.8%), mildly enhanced for 4 cases (15.4%), no enhancement for 1 case (3.8%), and the enhancement rate was 80.49%±18.64%. Twenty plaques in the middle stage group were obviously enhanced for 2 cases (10.0%), mildly enhanced for 14 cases (70.0%), no enhancement for 4 cases (20.0%), and the enhancement rate was 52.09%±18.17%. Fifteen plaques in the late stage group were mildly enhanced for 2 cases (2/15), no enhancement for 13 cases (13/15), and the enhancement rate was 12.16%±10.44%. There were statistically significant differences in the degrees of plaque enhancement and plaque enhancement rates among the three groups (χ²=22.834, P<0.01; F=78.403, P<0.01). Further analysis showed that there was a statistically significant difference in the degree of enhancement and enhancement rate of plaques between the early stage group and the middle stage group (χ²=-4.177, P<0.01; t=5.179, P<0.01), and there was a statistically significant difference between the middle stage group and the late stage group (χ²=-2.484, P<0.05; t′=8.189, P<0.01), and the difference between the early stage group and the late stage group was also statistically significant (χ²=-3.796, P<0.01; t′=15.044, P<0.01). There was a significant negative correlation between the time from onset of stroke symptoms to MRI examination and the enhancement rate of plaques (r=-0.903, P<0.01). Conclusions Enhanced HR MRI scanning can clearly show the enhancement of intracranial atherosclerotic plaques. With the prolongation of the onset time interval, the enhancement of intracranial atherosclerotic plaques gradually weakens, which can assess the vulnerability of plaques and has important guiding significance for secondary prevention of ischemic stroke.

Objective To verify the feasibility and accuracy of the quantitative evaluation of the volume of internal abdominal hemorrhage based on CT images.Methods The clinical data of 76 patients diagnosed as abdominal hemorrhage or hemoperitoneum and performed with emergency surgery in the Second Affiliated Hospital to Wenzhou Medical University from January 2009 to September 2016 were retrospectively analyzed by case-control study.The Noboru Oriuchi's formula was used to calculate the volume of abdominal hemorrhage based on CT images,and the results were compared and adjusted with the volume of actual abdominal hemorrhage recorded during the operation.SPSS 21.0 was used to statistically analyze the data.The linear regression was analyzed on the results measured by the two methods.Results The volume of abdominal hemorrhage measured by the CT calculation method ranged from 10 to 4 335 ml,while the corresponding volume measured by operational calculation method ranged from 200 ml to 4 490 ml.The absolute difference in the volume measured by these two methods ranged from 4.8 ml to 500 ml.The ratio of the absolute difference to the volume of abdominal hemorrhage by operational calculation method ranged from 0.2％ to 95.0％,the median of which was 4.5％ (2.8％,8.9％).When the exact volume of abdominal hemorrhage was ＜ 500 ml,the absolute difference in the exact volume ranged from 30.0％ to 95.0％,the median of which was 69.1％ (51.2％,78.6％).When the volume was less than 500 ml,the ratio ranged from 0.2％-13.6％,the median of which was 4.2％ (2.7％,6.4％).Analysis of the numbers of the two measuring methods with linear correlation method after eliminating the cases in which the bleeding volume was less than 500 ml showed that two methods presented a linear correlation (r =0.971,P ＜ 0.05).Conclusion After the conventional abdominal CT scanning,the Noboru Oriuchi's formula can be used to accurately calculate the volume of abdominal hemorrhage in patients with volume of abdominal hemorrhage more than 500 ml.

It is investigated that the hepatotoxicity of Polygonum multiflorum (PM)was attenuated by its processed products of nine times steaming and nine times sunning(RPM)based on immunological stress-mediated animal model by using metabolomics method. Sprague-Dawley(SD)rats were intragastrically administered with(5.4 g crude drug per kg body weight)of 50% alcohol extracts of PM and its processed products of nine times steaming and nine times sunning respectively or co-treated with non-toxic dose of lipopolysaccharide(LPS, 2.8 mg·kg^-1)via tail vein injection. The plasma alanine aminotransferase(ALT)and aspartate aminotransferase(AST)activities were assayed and the isolated livers were evaluated for histopathological changes. Global metabolomics profiling, multivariate analysis and data base searching were performed to discover common differential metabolites for idiosyncratic liver injury. The results showed that co-treatment with non-toxic dose of LPS and PM could result in significant liver injury, indicated by the elevation of plasma ALT and AST activities, as well as obvious liver histologic damage; whereas RPM failed to induce detectable liver injury. Furthermore, 10 potential metabolomics biomarkers that differentially expressed in LPS/PM group compared with LPS/RPM without liver injury were identified by untargeted metabolomics, mainly involved ten pathways: sphingolipid metabolism, linoleic acid metabolism, taurine and hypotaurine metabolism, steroid hormone biosynthesis, galactose metabolism, steroid biosynthesis, metabolism of xenobiotics by cytochrome P450, pyrimidine metabolism, biosynthesis of unsaturated fatty acids, primary bile acid biosynthesis. This work illustrated the idiosyncratic hepatotoxicity of heshouwu and provided a metabolomic insight into diosyncratic liver injury of PM and RPM.

OBJECTIVETo evaluate the effectiveness of dynamic SPECT (99m)Tc-galactosyl human serum albumin (GSA) scintigraphy on the assessment of reserve function of cirrhosis liver.

METHODSFrom January 2010 to December 2011, 55 patients with cirrhosis liver were enrolled in this study. The case numbers of male and female were 43 and 12 respectively and the age was (51 ± 9) years (ranging from 35 to 69 years). After routine biochemistry test, CT scan and (99m)Tc-GSA dynamic SPECT scan were performed in turn using a juxtaposed SPECT/CT system. Then the morphologic volume of liver parenchyma (MLV), functional liver volume (FLV) and the hepatic cell absorption rate constant (GSA-K) were calculated. The correlations between GSA-K and routine biochemistry test, Child-Pugh score, indocyanine green clearance rate (ICG-K) were analyzed. The patients were further divided into 3 groups according to whether there was occlusion or stenosis in the main branch of left portal vein (group 1, n = 5), right portal vein (group 2, n = 13) or not (group 3, n = 37) and the regional hepatic functions index of the 3 groups were compared.

RESULTSThe value of FLV of the whole, left and right liver was (594 ± 152) ml, (244 ± 119) ml and (356 ± 171) ml, respectively. There were correlations between GSA-K and total bilirubin, prothrombintime, Child-Pugh score and ICG-K (r = -0.730--0.298, P < 0.05). The FLV and MLV ratios of involved hemiliver to uninvolved hemiliver were 0.09 ± 0.06 and 0.30 ± 0.14 in group 1, 0.57 ± 0.43 and 1.08 ± 0.63 in group 2, 0.71 ± 0.30 and 0.71 ± 0.48 in group 3. The difference in MLV-FLV ratio was signifcant between group 1 and group 3, between group 2 and group 3 (P = 0.000).

CONCLUSIONSThe dynamic SPCECT (99m)Tc-GSA scintigraphy can not only assess the whole liver function of cirrhosis liver effectively, but also evaluate the variation of regional liver function accurately.

Adult ; Aged ; Female ; Humans ; Liver ; physiopathology ; Liver Cirrhosis ; physiopathology ; Liver Function Tests ; Male ; Middle Aged ; Technetium Tc 99m Aggregated Albumin ; metabolism ; Technetium Tc 99m Pentetate ; metabolism ; Tomography, Emission-Computed, Single-Photon