Objective:To investigate the effect of theta-transcranial alternating current stimulation(θ-tACS)over the frontal-parietal cortex on working memory(WM)performance under different postural conditions(sitting and stand-ing)in healthy adults. Method:The study was a randomized,crossover,double-blind design.Sixteen healthy adults received tACS or sham stimulation in random order,with at least 72 hours interval between two sessions.Seven electrodes were placed in the left frontoparietal critical brain region with 6Hz for 21 mins.The sham stimulation used the same stimulation time and frequency as tACS group,but only 1 minute of stimulation(30s at the beginning and 30s at the end of the stimulation).WM performance was assessed before and immediately after stimulation,in-cluding accuracy,reaction time and inverse efficiency scores.Wilcoxon rank sum tests were used to observe between-and within-group differences on WM performance. Result:Fifteen participants completed the experiment and there were no significant differences in side effects be-tween two groups.There was a significant improvement in reaction time and inverse efficiency scores for sit-ting WM as well as reaction time for standing WM after the frontoparietal θ-tACS(P＜0.05).There was a trend towards improvement in inverse efficiency scores for standing WM(P=0.057),while there was no signif-icant difference in accuracy,reaction time and inverse efficiency scores of WM during the sitting and standing conditions in the sham stimulation(all P＞0.05). Conclusion:Frontoparietal θ-tACS can improve WM performance in both sitting and standing postures.This helps healthy adults cope with real-life multitasking cognitive activities and has important practical application value.

ObjectiveTo investigate the clinical features and outcomes of critically ill pregnant and parturient women with chronic hepatitis B virus （HBV） infection， and to provide clinical experience for the rescue of critically ill pregnant and parturient women and the prevention and treatment of the severe exacerbation of liver disease. MethodsA total of 41 pregnant and parturient women with chronic HBV infection who were admitted to Department of Critical Care Medicine， Nanjing Second Hospital， from March 2013 to March 2023 were enrolled in this study， and their clinical data were collected through the electronic medical record system of hospital to summarize the main causes of transfer to the intensive care unit （ICU）， the causes of death， and treatment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between two groups. ResultsAmong the 41 patients， 13 （31.71%） did not receive regular antenatal examination and 8 （19.51%） with a high viral load （HBV DNA ≥2×10⁵ IU/mL） did not receive antiviral therapy. Cesarean section was the main mode of delivery in 32 patients （78.05%）； 23 patients （56.10%） had premature delivery， and 5 patients died （12.20%）. The top three causes of transfer to the ICU were liver failure， postpartum hemorrhage， and hypertensive disorders of pregnancy. Liver failure mainly occurred in late pregnancy， with hepatic encephalopathy as the most common complication （28.57%） and intrahepatic cholestasis of pregnancy as the most common comorbidity （21.43%）； among the 14 patients with liver failure， 6 （42.86%） received regular antenatal examination， and 13 （92.86%） did not receive antiviral therapy before admission. The mean length of ICU stay was 3.31±1.65 days for the patients with postpartum hemorrhage， among whom the patients with severe liver disease had coagulation disorders before delivery， which were difficult to correct after 48 hours of treatment. ConclusionPregnant and parturient women with chronic HBV infection tend to have complex conditions and a relatively high mortality rate. For pregnant and parturient women with chronic HBV infection， assessment of liver status， regular antenatal examination， and timely antiviral therapy are of vital importance to reduce severe exacerbation and mortality rate.

Objective:The incidence of infections in patients with malignant hematologic diseases is extremely high and significantly affects their prognosis.Identifying early and precise biomarkers for infection is crucial for guiding the treatment of infections in these patients.Previous studies have shown that procalcitonin(PCT)can serve as an early diagnostic marker for bloodstream infections in patients with malignant hematologic diseases.This study aims to compare serum PCT levels in these patients with different pathogens,disease types,infection sites,and severity levels. Methods:Clinical data and laboratory results of infected patients with malignant hematologic diseases treated at the Department of Hematology,the Third Xiangya Hospital of Central South University from January 2018 to August 2023 were collected.General patient information was retrospectively analyzed.Serum PCT levels were compared among patients with different pathogens,types of malignant hematologic diseases,infection sites,and infection severity;Receiver operator characteristic(ROC)curves were used to determine the cut-off values and diagnostic value of serum PCT levels in diagnosing bloodstream infections versus local infections and severe infections versus non-severe infections.Mortality rates after 4-7 days of anti-infective treatment were compared among groups with rising,falling,and unchanged PCT levels. Results:A total of 526 patients with malignant hematologic diseases were included.The main pathogens were Gram-negative bacteria(272 cases,51.7%),followed by Gram-positive bacteria(120 cases,22.8%),fungi(65 cases,12.4%),viruses(23 cases,4.4%),and mixed pathogens(46 cases,8.7%).The main types of malignant hematologic diseases were acute myeloid leukemia(216 cases,41.1%),acute lymphoblastic leukemia(107 cases,20.3%),and lymphoma(93 cases,17.7%).Granulocyte deficiency was present in 68.3%(359 cases)of the patients during infection,with severe infection in 24.1%(127 cases).Significant differences in serum PCT levels were found among patients with different types of pathogens(P<0.001),with the highest levels in Gram-negative bacterial infections.Significant differences in serum PCT levels were also found among patients with different types of malignant hematologic diseases(P<0.05),with the highest levels in lymphoma patients.Serum PCT levels were significantly higher in systemic infections and severe infections compared to local infections and non-severe infections(both P<0.001).ROC curve analysis showed that the cut-off values for diagnosing bloodstream infections and severe infections were 0.22 and 0.28 ng/mL,with areas under the curve of 0.670 and 0.673,respectively.After 4-7 days of anti-infective treatment,the mortality rates of the PCT declining,PCT unchanged,and PCT rising groups were 11.9%,21.2%,and 35.7%,respectively,and pairwise comparisons were statistically significant(all P<0.05). Conclusion:PCT can be used as an auxiliary indicator for early identification of different pathogens,infection sites,and severity levels in patients with malignant hematologic diseases combined with infections.Dynamic monitoring of PCT levels after empirical antibiotic treatment provides important guidance for assessing patient's prognosis.

Aristolochic acids (AAs) have long been considered as a potent carcinogen due to its nephrotoxicity. Aristolochic acid I (AAI) reacts with DNA to form covalent aristolactam (AL)-DNA adducts, leading to subsequent A to T transversion mutation, commonly referred as AA mutational signature. Previous research inferred that AAs were widely implicated in liver cancer throughout Asia. In this study, we explored whether AAs exposure was the main cause of liver cancer in the context of HBV infection in mainland China. Totally 1256 liver cancer samples were randomly retrieved from 3 medical centers and a refined bioanalytical method was used to detect AAI-DNA adducts. 5.10% of these samples could be identified as AAI positive exposure. Whole genome sequencing suggested 8.41% of 107 liver cancer patients exhibited the dominant AA mutational signature, indicating a relatively low overall AAI exposure rate. In animal models, long-term administration of AAI barely increased liver tumorigenesis in adult mice, opposite from its tumor-inducing role when subjected to infant mice. Furthermore, AAI induced dose-dependent accumulation of AA-DNA adduct in target organs in adult mice, with the most detected in kidney instead of liver. Taken together, our data indicate that AA exposure was not the major threat of liver cancer in adulthood.

ObjectiveTo investigate the quality of life and demands of family members of patients with mental disorders in hospice care， in order to create a better medical care environment for patients to meet their demands. MethodsA total of 205 family members of patients with mental disorders in hospice care were consecutively sampled from two special psychiatric hospitals in Deyang city with convenient sampling method. The Chinese version of WHO Quality of Life-BREF （WHOQOL-BREF） and Critical Care Family Needs Inventory （CCFNI） were used to assess the quality of life and demands of family members. ResultsAmong the patients' family members， WHOQOL-BREF scored （68.08±9.98） in the physiological field， （63.82±9.39） in the psychological field， （70.73±12.61） in the social relations field， and （64.24±11.87） in the environmental field. Compared with the domestic general population， there were significant differences in other fields except the physiological field （t=3.066， 9.845， 16.109， P<0.01）. In CCFNI， the score of condition assurance factor was （3.20±0.41）， information support was （2.86±0.50）， proximity to patients was （2.79±0.46）， self comfort was （2.35±0.47）， and medical staff support was （2.60±0.44）. ConclusionThe quality of life of the family members of patients with mental disorders in hospice care may be higher than that of the general population， and their demands mainly focus on the condition assurance and information support.

Liver failure and intestinal barrier injury, especially intestinal microflora imbalance, interacts as both the cause and effect of each other. Intestinal barrier injury is observed during liver failure, including the injuries of chemical, mechanical, immune, and microbial barriers, and meanwhile, gut dysbiosis, increased bacterial endotoxins, and abnormal bile acid metabolism may affect hepatocyte regeneration, increase complications, and aggravate the conditions of liver failure. The maintenance of intestinal barrier function should be taken seriously in the treatment of liver failure, and the treatment targeting intestinal barrier injury, especially microecological disturbance, is a promising method.

Objective:To investigate the correlation between serum CCL20 level and disease severity in patients with rheumatoid arthritis (RA).Methods:From July 2018 to July 2019, a cross-sectional study was conducted in the Department of Rheumatology and Immunology, the Third Affiliated Hospital of Southern Medical University. The observation group consisted of 105 outpatients and inpatients diagnosed with RA, while the control group was 90 healthy people with age and gender matched physical examination in the Third Affiliated Hospital of Southern Medical University. According to Steinbroker classification, RA patients were divided into Steinbroker grade 2 group ( n=35), Steinbroker grade 3 group ( n=38) and steinbroker grade 4 group ( n=32); according to DAS28 score, RA patients were divided into remission group (DAS28<2.6)( n=39), mild active group (DAS28 2.6-3.2)( n=25), moderate active stage group (DAS28 3.2-5.1)( n=20) and severe active stage group (DAS28 ≥ 5.1)( n=21). The levels of chemokine ligand 20 (CCL20), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were detected by ELISA. The levels of CCL20 in each group were compared, and the correlation between CCL20 and other indicators was analyzed. The receiver operating characteristic (ROC) curve of CCL20 in diagnosis of RA was analyzed to explore the correlation between CCL20 and disease severity of RA patients. Results:Compared with the normal control group, the serum CCL20 level in RA patients was significantly increased [(48.1±16.7) pg/ml vs (17.6±5.9) pg/ml, t=19.39, P<0.001]. In addition, serum CCL20 in steinbroker grade 4 group was significantly higher than that in Steinbroker grade 3 group [(59.5±10.1) pg/ml vs (47.4±17.5) pg/ml, t=3.472, P<0.001], and the serum CCL20 level in steinbroker grade 3 group was significantly higher than that in steinbroker grade 2 group [(47.4±17.5) pg/ml vs (38.4±14.6) pg/ml, t=2.370, P<0.001], CCL20 level in steinbroker grade 2 group was significantly higher than that in normal control group [(38.4±14.6) pg/ml vs (17.6±5.9) pg/ml, t=7.738, P<0.001]. In addition, serum CCL20 level was significantly positively correlated with steinbroker score ( r=0.505, P<0.001); CCL20 level in active RA patients was significantly higher than that in remission RA patients [(57.2±13.2) pg/ml vs (32.7±8.9) pg/ml, t=10.31, P<0.001]. The serum CCL20 level in severe activity group was significantly higher than that in moderate activity group [(60.6±10.9) pg/ml vs (51.7±16.2) pg/ml, t=0.212, P=0.040], and the serum CCL20 level in moderate activity group was significantly higher than that in mild activity group [(51.7±16.2) pg/ml vs (40.5±18.6) pg/ml, t=0.217, P=0.037]. In addition, there was a significant positive correlation between serum CCL20 level and DAS28 score ( r=0.451, P<0.001). In addition, serum CCL20 level was positively correlated with serum CRP ( r=0.332, P<0.001). According to the ROC curve, the specificity of steinbroker grade 2 group was 0.53, and the sensitivity was 0.74, AUC was 0.659; the sensitivity of steinbroker grade 3 group was 0.78, and the specificity was 0.69, AUC was 0.734; the sensitivity of mild vs medium stage was 0.64, and the specificity was 0.70, AUC was 0.699; the sensitivity of medium stage vs severe stage was 0.57, and the specificity was 0.68,AUC was 0.678. Conclusion:Serum CCL20 level in RA patients is significantly increased and positively correlated with disease severity, which may be used as a marker to observe and evaluate the progression of RA.

Objective:To evaluate the effect of free interosseous posterior artery perforator flap in small hand defects.Methods:We retrospectively analyzed the case data of small hand skin and soft tissue defects treated with free interosseous posterior arterial perforator flaps from March 2019 to August 2020 in the Department of Burn Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University. According to the size of the defect during the operation, we designed free interosseous posterior artery perforator flap transplantation to repair wounds, and the perforating branch of the posterior interosseous artery is anastomosed with the proper digital artery and the common digital artery. The donor valve area is sutured directly. After the operation, the survival of the flaps was observed, and the repair effect of the flaps, hand function and complications were followed up.Results:Twenty-one cases were included, among whom there were 15 males and 6 females with a median age of 46 years (range, 23-61years). There were several causes of injury: 7 cases of heavy object injuries, 11 of machine strangulation, 3 of burns and scalds. For 8 cases, the defect sites were on the palms and 13 on the dorsal sites. The defect size ranged from 1.5 cm×2.0 cm to 3.0 cm×9.0 cm with exposed tendons and bones. The flap size ranged from 2.0 cm×2.0 cm to 3.5 cm×9.0 cm. Among them, compound tissue transplantation with tendon was used to reconstruct finger extension function in 1 case while tissue transplantation with nerve was used to repair the palmar wounds in 2 cases. The bilobed flaps were used in 4 cases, and the remaining 14 cases were single leaf free skin flaps. No arteriovenous crisis occurred in the flaps after the operation. All flaps of 21 patients survived, and there was no blood supply disorder in the flaps. After 6-12 months of follow-up, the texture and color of the flap were similar to adjacent skin, and unrestricted hand function was unrestricted. The two-point discernibility of the skin flap for patients with nerve grafts was 10-12 mm, serious complication in the donor sites, but the forearm donor area with linear scars.Conclusions:The application of interosseous posterior artery perforator flap is flexible. It can repair two adjacent small wounds at the same time with free bilobed transplantation, and can carry free cutaneous nerve transplantation to repair the palm side wound. This flap is one of the ideal flaps for repairing small defects on the hand.

Objective:To investigate the correlation between serum CCL20 level and disease severity in patients with rheumatoid arthritis (RA).Methods:From July 2018 to July 2019, a cross-sectional study was conducted in the Department of Rheumatology and Immunology, the Third Affiliated Hospital of Southern Medical University. The observation group consisted of 105 outpatients and inpatients diagnosed with RA, while the control group was 90 healthy people with age and gender matched physical examination in the Third Affiliated Hospital of Southern Medical University. According to Steinbroker classification, RA patients were divided into Steinbroker grade 2 group ( n=35), Steinbroker grade 3 group ( n=38) and steinbroker grade 4 group ( n=32); according to DAS28 score, RA patients were divided into remission group (DAS28<2.6)( n=39), mild active group (DAS28 2.6-3.2)( n=25), moderate active stage group (DAS28 3.2-5.1)( n=20) and severe active stage group (DAS28 ≥ 5.1)( n=21). The levels of chemokine ligand 20 (CCL20), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were detected by ELISA. The levels of CCL20 in each group were compared, and the correlation between CCL20 and other indicators was analyzed. The receiver operating characteristic (ROC) curve of CCL20 in diagnosis of RA was analyzed to explore the correlation between CCL20 and disease severity of RA patients. Results:Compared with the normal control group, the serum CCL20 level in RA patients was significantly increased [(48.1±16.7) pg/ml vs (17.6±5.9) pg/ml, t=19.39, P<0.001]. In addition, serum CCL20 in steinbroker grade 4 group was significantly higher than that in Steinbroker grade 3 group [(59.5±10.1) pg/ml vs (47.4±17.5) pg/ml, t=3.472, P<0.001], and the serum CCL20 level in steinbroker grade 3 group was significantly higher than that in steinbroker grade 2 group [(47.4±17.5) pg/ml vs (38.4±14.6) pg/ml, t=2.370, P<0.001], CCL20 level in steinbroker grade 2 group was significantly higher than that in normal control group [(38.4±14.6) pg/ml vs (17.6±5.9) pg/ml, t=7.738, P<0.001]. In addition, serum CCL20 level was significantly positively correlated with steinbroker score ( r=0.505, P<0.001); CCL20 level in active RA patients was significantly higher than that in remission RA patients [(57.2±13.2) pg/ml vs (32.7±8.9) pg/ml, t=10.31, P<0.001]. The serum CCL20 level in severe activity group was significantly higher than that in moderate activity group [(60.6±10.9) pg/ml vs (51.7±16.2) pg/ml, t=0.212, P=0.040], and the serum CCL20 level in moderate activity group was significantly higher than that in mild activity group [(51.7±16.2) pg/ml vs (40.5±18.6) pg/ml, t=0.217, P=0.037]. In addition, there was a significant positive correlation between serum CCL20 level and DAS28 score ( r=0.451, P<0.001). In addition, serum CCL20 level was positively correlated with serum CRP ( r=0.332, P<0.001). According to the ROC curve, the specificity of steinbroker grade 2 group was 0.53, and the sensitivity was 0.74, AUC was 0.659; the sensitivity of steinbroker grade 3 group was 0.78, and the specificity was 0.69, AUC was 0.734; the sensitivity of mild vs medium stage was 0.64, and the specificity was 0.70, AUC was 0.699; the sensitivity of medium stage vs severe stage was 0.57, and the specificity was 0.68,AUC was 0.678. Conclusion:Serum CCL20 level in RA patients is significantly increased and positively correlated with disease severity, which may be used as a marker to observe and evaluate the progression of RA.

Objective:To evaluate the effect of free interosseous posterior artery perforator flap in small hand defects.Methods:We retrospectively analyzed the case data of small hand skin and soft tissue defects treated with free interosseous posterior arterial perforator flaps from March 2019 to August 2020 in the Department of Burn Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University. According to the size of the defect during the operation, we designed free interosseous posterior artery perforator flap transplantation to repair wounds, and the perforating branch of the posterior interosseous artery is anastomosed with the proper digital artery and the common digital artery. The donor valve area is sutured directly. After the operation, the survival of the flaps was observed, and the repair effect of the flaps, hand function and complications were followed up.Results:Twenty-one cases were included, among whom there were 15 males and 6 females with a median age of 46 years (range, 23-61years). There were several causes of injury: 7 cases of heavy object injuries, 11 of machine strangulation, 3 of burns and scalds. For 8 cases, the defect sites were on the palms and 13 on the dorsal sites. The defect size ranged from 1.5 cm×2.0 cm to 3.0 cm×9.0 cm with exposed tendons and bones. The flap size ranged from 2.0 cm×2.0 cm to 3.5 cm×9.0 cm. Among them, compound tissue transplantation with tendon was used to reconstruct finger extension function in 1 case while tissue transplantation with nerve was used to repair the palmar wounds in 2 cases. The bilobed flaps were used in 4 cases, and the remaining 14 cases were single leaf free skin flaps. No arteriovenous crisis occurred in the flaps after the operation. All flaps of 21 patients survived, and there was no blood supply disorder in the flaps. After 6-12 months of follow-up, the texture and color of the flap were similar to adjacent skin, and unrestricted hand function was unrestricted. The two-point discernibility of the skin flap for patients with nerve grafts was 10-12 mm, serious complication in the donor sites, but the forearm donor area with linear scars.Conclusions:The application of interosseous posterior artery perforator flap is flexible. It can repair two adjacent small wounds at the same time with free bilobed transplantation, and can carry free cutaneous nerve transplantation to repair the palm side wound. This flap is one of the ideal flaps for repairing small defects on the hand.