Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective To investigate the role of Wnt/β-catenin signaling pathway in the osteogenic differentiation of human dental pulp stem cells (hDPSCs). Methods After 14 days of the calcium hydroxide training, the cytoskeletal changes of hDPSCs, the expression of β-catenin, i.e. the key promoter of in the Wnt signaling pathway, and the cell localization were detected by laser scanning confocal technique. The Wnt signaling pathways were up-regulated and inhibited, and the osteogenic differentiation and mineralization of hDPSCs were detected by Western Blot and alizarin red staining after 14 days of the training. Results The cytoskeleton of hDPSCs was rearranged by the effect of calcium hydroxide, and theβ-catenin migration from nucleus to cytoplasm were observed. The number of calcium nodules in hDPSCs was decreased after blocking Wnt signaling pathway by Dickkopf-related protein 1 (DKK-1). The calcium hydroxide treatment can promoted dentin sialophosphoprotein (DSPP) expression in hDPSCs. Conclusions Calcium hydroxide can down-regulate the expression of canonical Wnt signaling pathway and promote osteogenic differentiation and mineralization and odontogenetic differentiation of hDPSCs.

OBJECTIVE:To study the chemical constituents in the chloroform extract of Fructus Canarii. METHODS:The chloroform extract of Fructus Canarii was isolated and purified by MCI,Toyopearl HW-40F,reverse-phase C18,Sephadex LH-20 column. The structure of compounds was analyzed and identified by physicochemical properties and spectral data(mass spectrum, hydrogen spectrum and carbon spectrum). RESULTS:Eight compounds were isolated from chloroform extract of Fructus Canarii, namely Dihydrophaseicacid-3′-O-β-D-glucopyranoside(1),3,4-Dihydroxybenzoic acid(2),3-O-galloylquinic acid(3),Gallic acid (4), Ethyl gallate(5), Scopoletin(6), Dllagic acid-4-O-α-L-rhamnopyranoside(7) and Isocorilagin(8). CONCLUSIONS:Compounds 1,2 and 7 were firstly obtained from Fructus Canarii. The study lays foundation for quality evaluation of Fructus Canarii.

Objective To explore the value of neuroendoscopy combined with Endport for the surgery of hypertensive intracerebral hemorrhage.Methods We retrospectively analyzed 92 cases of hypertensive intracerebral hemorrhage in our department from January 2016 to February 2018.According to the different surgical methods,they were divided into small bone window group and neuroendoscopic group,47 cases in small bone window group and 45 cases in neuroendoscope group.The amount of intraoperative bleeding,operative time,postoperative hematoma clearance,postoperative rebleeding,hospitalization time,postoperative complications and Glasgow prognosis expansion score (GOS-E) were recorded for statistical analysis.Results Compared with neuroendoscopy group,small bone window group had more bleeding loss [(182.6 ± 34.5) ml vs (103.3 ± 25.7) ml] and longer operation time [(168.7 ± 26.3) min vs (115.7 ± 18.7)min],with significant statistically difference (P ＜ 0.05).The hematoma clearance rate (90.3 ± 5.3) ％ in the small bone window group,was lower than that in the neuroendoscopic group (92.8 ± 6.8) ％,but with no statistical significance (P ＞ 0.05);Postoperative rebleeding occured in 3 cases (6.4％) in small bone window group and 2 cases (4.4％) in the neuroendoscopic group,with no statistically significant difference between the two groups (P ＞ 0.05).Compared with neuroendoscopy group,small bone window group had longer hospitalization time [(18.5 ± 4.3) days vs (13.5 ± 3.8) days],higher tracheotomy rate [15 (31.9％) vs 8 (17.8％)],with significant statistically difference (P ＜ 0.05).The number of patients with GOS-E score ＞ 4 in small bone window group 2 months after operation was less than that in neuroendoscopy group [42.6％ (20/47) vs 62.2％ (28/45)],with significant statistically difference (P ＜ 0.05).Conclusions Endoscopic treatment of intracerebral hemorrhage has the advantages of minimally invasive,short operation time,less intraoperative hemorrhage,low incidence of complications and fast recovery of postoperative function.

Objective To investigate the evaluation value of magnetic resonance spectroscopy (MRS) combined with S-100B protein in the severity and prognosis in patients with acute subdural hematoma ( ASDH).Methods Eighty cases of ASDH patients and 20 cases of healthy check-up were selected.MRS was used to test NAA/Cr, Cho/Cr, NAA/Cho, and Glx /Cr in thalamus and corpus callosum.The blood S-100B protein was detected in 72 h after injury.The relationships of those MRS detection indices with glasgow coma scale ( GCS) and glasgow prognostic score ( GOS) for 2 months after injury were analyzed .Results MRS detection in-dex and the S100B protein in ASDH were compared between each group relative to normal control group , all difference had statistical significance ( P <0.05).As aggravating the severity of traumatic brain injury , Cho/Cr, Glx/Cr ratio, and S-100B protein concentra-tion were elevated , and NAA/Cho and NAA/Cr were reduced .All differences were statistically significant among poor recovery , good recovery, and normal control groups ( P <0.05).For patients with traumatic brain injury, there were worse prognosis, the higher ra-tios of Cho/Cr and Glx/Cr, higher concentration of S-100B protein, and lower ratios of NAA/Cho and of NAA/Cr.GCS score and GOS scores were negatively correlated with Cho/Cr and Glx/Cr ratios of corpus callosum , and were positively correlated with NAA/Cho, NAA/Cr ratios of corpus callosum .S-100B protein was positively correlated with Cho/Cr and Glx/Cr, and was negatively correlated with NAA/Cho and NAA/Cr.MRS combined S-100B can improve the prognosis of patients with up to the accuracy of 81%.Conclu-sions MRS detection in the early stage after injury of ASDH patients has important value in assessment of the severity of the injury and its prognosis , the accuracy of assessment of prognosis is improved with a combination of MRS detection and blood S -100 B protein meas-urement.