Bilateral medial medullary infarction(MMI)was a rare subtype of stroke.The clinical manifestations of bilateral MMI were complicated,which leaded to misdiagnosis.Patients with bilateral MMI could progress rapidly,and were easy to progress to respiratory failure and even death.Patients with this type of cerebral infarction did not respond well to medication.One case data of a patient with bilateral MMI was reviewed and analyzed.The weakness on the right side of the body was presented,accompanied by slurred speech,and was finally diagnosed with atherosclerosis of the large arteries through cranial MR examination.The patient had occlusion of the left posterior inferior cerebellar artery distal to the left vertebral artery V4 segment on the left side.The patient was treated with stent thrombectomy and balloon angioplasty,and the follow-up phone call at 3 months after discharge was showed good prognosis.Through a review of the literature,combined with the clinical and imaging features of this case,a preliminary analysis suggested that atherosclerosis of the large arteries may be the most common cause of bilateral MMI.Cranial MR imaging is an important method for diagnosing this condition.For patients with bilateral MMI accompanied by occlusion of the vertebral artery V4 segment,endovascular intervention may be attempted.

Objective:To observe the clinical efficacy of Yin-Yang balancing acupuncture plus Tuina(Chinese therapeutic massage)for post-stroke depression(PSD). Methods:A total of 72 PSD patients were randomized into an acupuncture-Tuina group and a Western medicine group using the random number table method,with 36 cases in each group.The Western medicine group was treated with fluoxetine hydrochloride capsules.The acupuncture-Tuina group was treated with Yin-Yang balancing acupuncture plus Tuina therapy.Both groups were treated for 4 weeks.After treatment,the clinical efficacy was compared,and the changes in Hamilton depression scale(HAMD)score,National Institute of Health stroke scale(NIHSS)score,serum neurotransmitter levels,and electroencephalogram(EEG)were observed. Results:The total effective rate of the Western medicine group and the acupuncture-Tuina group was 83.3%and 94.4%,respectively.There was a significant difference in the total effective rate between the two groups(P<0.05).After treatment,the serum levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),and dopamine(DA)were higher than those in the same group before treatment,and the intra-group differences were all statistically significant(P<0.05).The serum levels of 5-HT,NE,and DA in the acupuncture-Tuina group were higher than those in the Western medicine group,and the differences between the groups were statistically significant(P<0.05).After treatment,the scores of HAMD and NIHSS in both groups decreased,and the intra-group differences were statistically significant(P<0.05).The scores in the acupuncture-Tuina group were lower than those in the Western medicine group,and the differences between the two groups were all statistically significant(P<0.05).After treatment,the EEG diffuse wave[(delta+theta)/(alpha+beta)]ratio(DTABR)and delta/beta ratio(DBR)in both groups decreased,and the intra-group differences were statistically significant(P<0.05).The ratios in the acupuncture-Tuina group were lower than those in the Western medicine group,and the differences between the two groups were statistically significant(P<0.05). Conclusion:Yin-Yang balancing acupuncture plus Tuina therapy has a better efficacy than oral fluoxetine hydrochloride capsules in the treatment of PSD,which can increase the levels of serum 5-HT,DA,and NE,and regulate brain waves.

Objective:The clinical characteristics of patients with primary central nervous system lymphoma-diffuse large B-cell lymphoma (PCNSL-DLBCL) and the effects of different treatment schemes on their survival and prognosis were analyzed retrospectively.Methods:A total of 49 patients with PCNSL-DLBCL who presented at the Tianjin Medical University General Hospital from July 2014 to December 2020 were included, and their clinical data were retrospectively analyzed. They were divided into four groups: the MTX group, the R-CDOP group, the BTKi-R-MTX group, and the RLZT group. The median overall survival (OS) and progression-free survival (PFS) were calculated, and the survival prognosis was compared by univariate and multivariate prognostic analysis.Results:The median OS time of the MTX group, the R-CDOP group, the BTKi-R-MTX group, and the RLZT group was 16.5 months, 4.5 months, 42 months, and not reached, respectively ( P<0.001) . The median PFS time of the MTX group, the R-CDOP group, the BTKi-R-MTX group, and the RLZT group was 7 months, 1.5 months, 20 months, and 5 months, respectively ( P=0.005) . Multivariate prognostic analysis showed that double expressor lymphoma, IESLG risk grade, and different treatment methods were the prognostic factors of PCNSL-DLBCL. Conclusion:The survival and prognosis of PCNSL-DLBCL are affected by different treatment schemes. The role of CD20 monoclonal antibody in the treatment of PCNSL-DLBCL is still controversial. The treatment scheme containing BTKi has great potential for PCNSL-DLBCL. RLZT scheme has a good prospect for elderly patients who cannot tolerate high-dose chemotherapy and radiotherapy.

Objective:To investigate the clinical features and prognosis of low triiodothyronine syndrome (LT3S) in patients with acute myeloid leukemia (AML) .Methods:A total of two 236 patients with AML who presented at the Jiangsu Provincial Hospital between January 2013 and December 2019 were included, and their data were retrospectively reviewed. The patients were divided into two groups, including the LT3S group and the non-LT3S group, according to their serum thyroxine level. The clinical characteristics and prognosis of the two groups were compared.Results:Among the 236 patients, 62 (26.3%) patients had LT3S. Serum-free T3 level was positively correlated with albumin ( r=0.443, P<0.001) and hemoglobin ( r=0.187, P=0.005) levels and negatively correlated with C-reactive protein ( r=-0.406, P<0.001) and lactate dehydrogenase ( r=-0.274, P<0.001) levels. The overall survival (OS) (7.5 months vs 29.9 months, P<0.001) and progression-free survival (PFS) (2.0 months vs 24.0 months, P<0.001) were significantly shortened in the LT3S group compared with the non-LT3S group. After propensity score matching, the OS (9.6 months vs 30.4 months, P=0.010) and PFS (3.0 months vs 30.0 months, P=0.014) were still significantly reduced in the LT3S group compared with the non-LT3S group. Therefore, LT3S was an independent risk factor for OS ( HR=2.553, 95% CI 1.666-3.912, P<0.001) and PFS ( HR=1.701, 95% CI 1.114-2.597, P=0.014) in patients with AML. Subgroup analysis suggested that patients with LT3S had a worse prognosis in patients with AML who were obese, fragile, or treated with standard chemotherapy. Conclusions:The occurrence of LT3S reflects the poor clinical status and prognosis of patients with AML.

Objective To evaluate the hereditary relation of genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR)C677T with the risk of schizophrenia.Methods According to established strategy and selection criteria and exclusion criteria,a search had been performed on Chinese Wanfang Database,Chinese National Knowledge Infrastructure and Database,Chongqing VIP Database for Chinese Technical Periodicals,PubMed,Embase,Schizophrenia-Gene and HuGENet to identify all the case-control studies associated with MTHFR C677T genetic polymorphisms and schizophrenia.Hand searches of cross references were also conducted for further references.The quality of included studies was evaluated by Strengthening the Reporting of Genetic Association Studies (STREGA).In addition to common meta-analysis,cumulative meta-analysis,regressive meta-analysis,subgroup analysis,sensitive analysis and publication bias testing were used to analyze the data.Results Twenty-eight eligible studies with moderate to obvious heterogeneity were included,involving total 7 257 cases and 8 900 controls.There were significant associations between C677T polymorphisms and schizophrenia risk throughout whole populations by T-allele vs.C-allele (odds ratio,OR; OR =1.15,Z =3.53,P =0.000) and by TT-genotype vs.CCgenotype (OR =1.37,Z =3.63,P =0.000),but not by CT-genotype vs.CC-genotype (OR =1.10,Z =1.86,P =0.064).Since the regressive meta-analysis demonstrated most studies from China accounted for the whole heterogeneity by 68.74％ (t =3.69,P =0.001),a further subgroup-analysis was carried out to show that TT-genotype relative to CC-genotype led to significantly higher risks of schizophrenia throughout the Chinese-subgroup(OR =4.12,Z =5.27,P =0.000) and non-Chinese subgroup(OR =1.25,Z =2.92,P =0.003),while CT-genotype only in Chinese-subgroup (OR =2.18,Z =3.84,P =0.000).As stratified by gender,only male-subgroup who carried TT-genotype represented a significant association (TT vs.CC:OR =1.51,Z =2.55,P =0.011).The performed meta-analyses showed consistent results to cumulative meta-analysis and sensitive analysis,and no evidence of publication bias by Begg's test (Z =1.46,P =0.143) and Egger's test (t =1.96,P =0.060).Conclusion The study provides evidence for a hereditary associations between the MTHFR C677T variant and schizophrenia risk,however it is obviously various between different regions,ethnicities and genders.

Objective To evaluate the hereditary relation of genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR)C677T with the risk of schizophrenia.Methods According to established strategy and selection criteria and exclusion criteria,a search had been performed on Chinese Wanfang Database,Chinese National Knowledge Infrastructure and Database,Chongqing VIP Database for Chinese Technical Periodicals,PubMed,Embase,Schizophrenia-Gene and HuGENet to identify all the case-control studies associated with MTHFR C677T genetic polymorphisms and schizophrenia.Hand searches of cross references were also conducted for further references.The quality of included studies was evaluated by Strengthening the Reporting of Genetic Association Studies (STREGA).In addition to common meta-analysis,cumulative meta-analysis,regressive meta-analysis,subgroup analysis,sensitive analysis and publication bias testing were used to analyze the data.Results Twenty-eight eligible studies with moderate to obvious heterogeneity were included,involving total 7 257 cases and 8 900 controls.There were significant associations between C677T polymorphisms and schizophrenia risk throughout whole populations by T-allele vs.C-allele (odds ratio,OR; OR =1.15,Z =3.53,P =0.000) and by TT-genotype vs.CCgenotype (OR =1.37,Z =3.63,P =0.000),but not by CT-genotype vs.CC-genotype (OR =1.10,Z =1.86,P =0.064).Since the regressive meta-analysis demonstrated most studies from China accounted for the whole heterogeneity by 68.74％ (t =3.69,P =0.001),a further subgroup-analysis was carried out to show that TT-genotype relative to CC-genotype led to significantly higher risks of schizophrenia throughout the Chinese-subgroup(OR =4.12,Z =5.27,P =0.000) and non-Chinese subgroup(OR =1.25,Z =2.92,P =0.003),while CT-genotype only in Chinese-subgroup (OR =2.18,Z =3.84,P =0.000).As stratified by gender,only male-subgroup who carried TT-genotype represented a significant association (TT vs.CC:OR =1.51,Z =2.55,P =0.011).The performed meta-analyses showed consistent results to cumulative meta-analysis and sensitive analysis,and no evidence of publication bias by Begg's test (Z =1.46,P =0.143) and Egger's test (t =1.96,P =0.060).Conclusion The study provides evidence for a hereditary associations between the MTHFR C677T variant and schizophrenia risk,however it is obviously various between different regions,ethnicities and genders.

Objective To explore on location of the segments of the facial nerve being easy to damage in mastoid surgery.Methods Retrospective analysis was conducted according to the clinical data of 97cases with chronic suppurative otitis media performed with radical mastoidectomy (or radical mastoidectomy + tympanoplasty) from May 2010 to September 2012,and summarized the methods to locate the segment of the facial nerve being easy to damage in operation.Results ①One case of congenital defect of facial nerve canal was found in 97 cases.②The horizontal segments of the facial nerve of 97 cases were successfully located depending on combined/partial anatomic landmarks including eminence of the lateral semicircular canal,short limb of incus,cochlearform process,tympanic tegmen,stapes.③The pyramidal segment of facial nerve of 97 cases were successfully located depending on combined/partial anatomic landmarks including eminence of the lateral semicircular canal,short limb of incus.④The proximal part of vertical segment of the facial nerve of 97 cases were successfully located depending on combined /partial anatomic landmarks including short limb of incus,chorda tympani nerve,pyramidal eminence,eminence of the lateral semicircular canal.Conclusion The eminence of the lateral semicircular canal,short limb of incus,cochlearform process,tympanic tegmen,stapes,pyramidal eminence,chorda tympani nerve in the area in which the facial nerve being easy to damage are important landmarks by which the segment of facial nerve easy to damage might be located in mastoid surgery.

Objective To evaluate the association between methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism and depression risk.Methods Available studies containing genotype frequencies of MTHFR C677T were chosen,and pooled odds ratio (OR) with 95％ confidence interval (CI) was used to assess the strength of the association.Results Twenty-five eligible studies including 4 048 cases and 12 827 controls were identified.Meta-analysis showed a significant effect in the co-dominant model (T vs.C:OR 0 =1.25; Z=3.82,P=0.000;TTvs.CC:OR1=1.55,Z=3.79,P=0.000 ; except CT vs.CC:OR2=1.13; Z=1.78,P=0.076).Stratified analysis denoted that there was significantly higher risk in depression onset before 60 years old than depression onset after 60 years old.In subgroup analysis stratified by regressive meta-analysis,MTHFR C677T variant was statistically significantly relevant to depression risk in Chinese populations (OR 0 =1.58,Z=3.95,P=0.000; OR 1 =2.55,Z=3.92,P=0.000; OR 2 =1.43,Z=2.72,P=0.007),but not in no-Chinese populations (OR 0 =1.12,Z=2.10,P=0.035 ; OR 1 =1.23,Z=2.23,P=0.025 ; OR 2 =1.06,Z=0.74,P=0.456).Evidentiary strength rated by GRADE showed that 1 study moderate,3 studies low and 7 stdudies very low.Conclusion Our study provides evidence for a hereditary association between the MTHFR C677T variant and depression susceptibility,whereas there is an obvious variety in different regions,ethnicities and onset age.

Objective To investigate the expression of TET2 and DLK1 mRNA in bone marrow CD3+ T cells of patients with myelodysplastic syndrome (MDS) and their clinical significance and to explore the potential mechanism of abnormal cell-mediated immunity.Methods CD3+ T cells were sorted by magnetic activated cell-sorting system.The expressions of TET2 and DLK1 mRNA in bone marrow CD3+ T cells from 26 MDS patients and 16 healthy controls were detected by fluorescence quantitative PCR.Results The expression of TET2 mRNA in CD3+ T cells was down-regulated in the MDS patients by (0.16 ±0.15) fold compared with the controls ( P ＜ 0.05 ).The expression of TET2 mRNA in CD3+ T cells of MDS patients was positively correlated with serum complement C3 ( r =0.404,P ＜ 0.05 ).The expression of DLK1 mRNA in CD3+ T cells was up-regulated in the MDS patients by (1.61 ±0.88) folds compared with the controls (P＜0.05).Grouped by the chromosomes,the patients with chromosome abnormalities presented significantly higher DLK1 mRNA level than those with normal chromosomes [ ( 1.45 ± 0.44 ) folds,P ＜0.05 ].The expression of DLK1 mRNA in CD3+ T cells of MDS patients was positively correlated with the proportion of bone marrow blasts ( r =0.343,P ＜ 0.05 ).Conclusions The mRNA expression of TET2 in CD3+ T cells of MDS patients was decreased while the mRNA expression of DLK1 was increased,which might decline the immune surveillance function.The findings would be useful for exploring the mechanism of immune tolerance.