BACKGROUND:At present,there are some limitations in evaluating the severity of acute spinal cord injury,and a rapid and accurate evaluation method is urgently needed. OBJECTIVE:To analyze the correlation between the expression levels of serum oxidative stress and nerve injury indexes and the severity of the disease in patients with acute spinal cord injury. METHODS:A total of 65 patients were included in the study from August 2020 to May 2022,including 32 patients in the experimental group(acute spinal cord injury)and 33 patients in the control group(simple spinal fracture).American Spinal Injury Association(ASIA)Impairment Scale and neurological function score were evaluated within 8 hours of admission.Meanwhile,serum levels of superoxide dismutase,malondialdehyde,glutathione,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase were detected and compared between the two groups.The correlation between the expression levels of the above serological indicators in serum and ASIA impairment grade and AISA neural function score was analyzed. RESULTS AND CONCLUSION:The average serum levels of superoxide dismutase and glutathione in the experimental group were significantly lower than those of the control group(P<0.001),while the average serum levels of malondialdehyde,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase in the experimental group were higher than those of the control group(P<0.01).The serum levels of superoxide dismutase and glutathione in the experimental group were positively correlated with the damage grade of AISA(r=0.862 4,0.849 3,P<0.01),while the serum levels of malondialdehyde,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with the damage grade of AISA(r=-0.866 1,-0.638 1,-0.746 6,P<0.001),and the serum level of nitric oxide was not significantly correlated with the damage grade of AISA(r=-0.177 5,P>0.05).The serum level of glutathione in the experimental group was positively correlated with AISA sensory function scores(r=0.569 9,P<0.001),while the serum levels of malondialdehyde,glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with AISA sensory function scores(r=-0.574 1,-0.099 2,-0.708 6,P<0.05),and the serum levels of superoxide dismutase and nitric oxide were not significantly correlated with AISA sensory function scores(r=0.230 8,-0.376 2,P>0.05).The serum levels of superoxide dismutase and glutathione in the experimental group were positively correlated with ASIA motor function scores(r=0.380,0.524 7,P<0.05);the serum levels of malondialdehyde,glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with AISA motor function scores(r=-0.577 9,-0.452 2,-0.662 8,P<0.05);and the level of nitric oxide had no significant correlation with AISA motor function scores(r=-0.049 7,P>0.05).To conclude,the serum levels of superoxide dismutase,malondialdehyde,glutathione,nitric oxide,glial fibrillary acidic protein and neuron-specific enolase in serum of patients with acute spinal cord injury are significantly correlated with ASIA impairment grade and ASIA neural function score,which could be used as biomarkers for early clinical assessment of disease severity.

Background::Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.Methods::We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention’s Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models.Results::In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/10 5) and rural areas (123.0/10 5) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/10 5), the western region had a slightly lower mortality (123.5/10 5), and the eastern region had the lowest mortality (97.3/10 5). The age-specific mortality showed an accelerated upward trend from aged 55-59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02-3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030. Conclusion::The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control.

Objective: Sialidosis type 2 has variants that are both catalytically inactive (severe), while sialidosis type 1 has at least one catalytically active (mild) variant. This study aimed to discuss the structural changes associated with these variants in a newly reported family carrying N-acetyl-α-neuraminidase-1 (NEU1) variants and explore the clinical characteristics of different combinations of variants in sialidosis type 1. Methods: First, whole-exome sequencing and detailed clinical examinations were performed on the family. Second, structural analyses, including assessments of energy, flexibility and polar contacts, were conducted for several NEU1 variants, and a sialidase activity assay was performed. Third, previous NEU1 variants were systematically reviewed, and the clinical characteristics of patients in the severe-mild and mild-mild groups with sialidosis type 1 were analyzed. Results: We report a novel family with sialidosis type 1 and the compound heterozygous variants S182G and V143E. The newly identified V143E variant was predicted to be a mild variant through structural analysis and was confirmed by a sialidase activity assay. Cherry-red spots were more prevalent in the severe-mild group, and ataxia was more common in the mild-mild group. Impaired cognition was found only in the severe-mild group. Moreover, patients with cherry-red spots and abnormal electroencephalographies and visual evoked potentials had a relatively early age of onset, whereas patients with myoclonus had a late onset. Conclusion Changes in flexibility and local polar contacts may be indicators of NEU1 pathogenicity. Sialidosis type 1 can be divided into two subgroups according to the variant combinations, and patients with these two subtypes have different clinical characteristics.

To investigate the γ pass rate limit of plan verification equipment for volumetric modulated arc therapy (VMAT) plan verification and its sensitivity on the opening and closing errors of multi-leaf collimator (MLC), 50 cases of nasopharyngeal carcinoma VMAT plan with clockwise and counterclockwise full arcs were randomly selected. Eight kinds of MLC opening and closing errors were introduced in 10 cases of them, and 80 plans with errors were generated. Firstly, the plan verification was conducted in the form of field-by-field measurement and true composite measurement. The γ analysis with the criteria of 3% dose difference, distance to agreement of 2 mm, 10% dose threshold, and absolute dose global normalized conditions were performed for these fields. Then gradient analysis was used to investigate the sensitivity of field-by-field measurement and true composite measurement on MLC opening and closing errors, and the receiver operating characteristic curve (ROC) was used to investigate the optimal threshold of γ pass rate for identifying errors. Tolerance limits and action limits for γ pass rates were calculated using statistical process control (SPC) method for another 40 cases. The error identification ability using the tolerance limit calculated by SPC method and the universal tolerance limit (95%) were compared with using the optimal threshold of ROC. The results show that for the true composite measurement, the clockwise arc and the counterclockwise arc, the descent gradients of the γ passing rate with per millimeter MLC opening error are 10.61%, 7.62% and 6.66%, respectively, and the descent gradients with per millimeter MLC closing error are 9.75%, 7.36% and 6.37%, respectively. The optimal thresholds obtained by the ROC method are 99.35%, 97.95% and 98.25%, respectively, and the tolerance limits obtained by the SPC method are 98.98%, 97.74% and 98.62%, respectively. The tolerance limit calculated by SPC method is close to the optimal threshold of ROC, both of which could identify all errors of ±2 mm, while the universal tolerance limit can only partially identify them, indicating that the universal tolerance limit is not sensitive on some large errors. Therefore, considering the factors such as ease of use and accuracy, it is suggested to use the true composite measurement in clinical practice, and to formulate tolerance limits and action limits suitable for the actual process of the institution based on the SPC method. In conclusion, it is expected that the results of this study can provide some references for institutions to optimize the radiotherapy plan verification process, set appropriate pass rate limit, and promote the standardization of plan verification.
Humans ; Radiotherapy, Intensity-Modulated ; Immune Tolerance ; Nasopharyngeal Carcinoma ; ROC Curve ; Nasopharyngeal Neoplasms/radiotherapy*

Objective:To investigate the clinical features of pregnant associated Takotsubo cardiomyopathy (PTCM).Methods:We reviewed reported PTCM cases published from January 2007 to June 2022 using the keywords "Tako-tsubo cardiomyopathy""Takotsubo cardiomyopathy" "stress cardiomyopathy" AND "parturition" "pregnancy" "cesarean delivery" "postpartum" "peripartum" "eclampsia" "abortion" in Pubmed and Web of Science databases and the corresponding Chinese words in Wanfang and Chinese Medical Journal Network. Age, obstetric history, mode of delivery, mode of anesthesia, etiological factors, clinical manifestations, treatment, and prognosis of PTCM were recorded. Descriptive statistical analysis was adopted.Results:A total of 55 articles were included, covering 60 patients with PTCM. (1) Age and time of onset: The age of onset was (32.4±6.0) years old. PTCM occurred most frequently during labor [42% (25/60)] and within one day postpartum [32% (19/60)] and during the gestational period [13%(8/60), 33.0 weeks (24.5-37.7 weeks)]. (2) Delivery-related factors: There were 38% (16/42) primiparas and 60% (25/42) multiparas. Among them, 67% (38/57) and 18% (10/57) were delivered by cesarean section and vaginal delivery, respectively. PCTM often lacks obvious triggers [40% (24/60)], with the most common inducing factor being pregnancy-related diseases [27% (16/60)]. (3) Clinical features: The initial symptoms of PTCM were dyspnea [44% (26/59)], followed by chest pain accompanied by dyspnea [17% (10/59)]. The most common subtype of PTCM was the apical type [45% (26/58)], followed by the basal type [24% (14/58)], while the biventricular type was the least common [3% (2/58)] in the PTCM classification. The left ventricular ejection fraction was (31.6±12.1) % at the onset of PTCM, which recovered to (58.2±7.6) % at discharge. PCTM was often complicated by pulmonary edema [67% (40/60)] and cardiogenic shock [55% (33/60)]. (4) Treatment and prognosis: Patients with PCTM usually require noninvasive or invasive ventilator-assisted ventilation [40% (23/58)]. One pregnant woman and five neonates died, while the remaining patients recovered well.Conclusions:PTCM should be considered in differential diagnosis of patients experiencing dyspnea and chest pain during labor and pregnancy. PTCM patients are younger and have more pulmonary edema and cardiogenic shock. Mechanical ventilation is often required, but the prognosis is favorable.

OBJECTIVE: To investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. METHODS: A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. RESULTS: Patients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points ( P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation ( P<0.05), but there was no significant difference between 7 days and 6 months after operation ( P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. CONCLUSION After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body's own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.
Humans ; Female ; Adult ; Male ; Rhinoplasty ; Retrospective Studies ; Reoperation ; Nasal Cartilages ; Nasal Septum ; Cicatrix

Objective:To explore the morbidity, clinical features and mortality of unilateral pulmonary edema (PE) in the intensive care unit (ICU).Methods:Clinical data of PE patients in ICU between January 2018 and January 2021 were retrospectively collected. All patients were divided into the bilateral PE and unilateral PE groups according to imaging manifestations. Etilogy, clinical performance, cardiac ultrasound parameters, complications, treatment and prognosis were compared between the two groups. Binary logistic regression analysis was used to screen out the risk factors of death.Results:Of the 314 PE patients, 14 (4.5%) were unilateral PE patients , and 11 (78.5%) were right-sided unilateral PE. There were no differences in age, gender, heart rate, respiratory rate and left ventricular eject fraction between the unilateral and bilateral PE groups. Compared with the bilateral PE group, systolic and diastolic blood pressure were significantly lower in the unilateral PE group [128 (102.7-138) mmHg vs. 135 (116-166) mmHg, 72 (54-88.2) mmHg vs. 82 (69-97.7)mmHg, respectively]. The incidence of cardiac arrest and hospital mortality were higher in the unilateral PE group [28.6% vs. 8.0%, 42.9% vs. 10%, all P<0.05]. Binary logistic regression analysis showed that age, unilateral PE, and use of vasoactive agent were associated with poor prognosis. Odds ratio of unilateral PE and use of vasoactive agent were 17.78 and 11.67, respectively. Conclusions:Unilateral PE is not rare, which is an independent risk factors for mortality and should be promptly recognized to avoid delays in treatment.

The pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to major public health challenges globally. The increasing viral lineages identified indicate that the SARS-CoV-2 genome is evolving at a rapid rate. Viral genomic mutations may cause antigenic drift or shift, which are important ways by which SARS-CoV-2 escapes the human immune system and changes its transmissibility and virulence. Herein, we summarize the functional mutations in SARS-CoV-2 genomes to characterize its adaptive evolution to inform the development of vaccination, treatment as well as control and intervention measures.

Objective:To observe the expression levels of glial fibrillary acidic protein (GFAP), β-tubulin Ⅲ and synaptophsin, and explore the role of tripartite synapse in the mechanism of central nervous system (CNS) injury and the neuroprotective effect of chondroitin sulfate (CS).Methods:One month old clean grade, 48 female Sparague-Dawley rats and 48 male Sparague-Dawley rats, were randomly divided into 8 groups according to body weight (90 - 120 g) by random number table method, with 12 rats in each group, half male and half female. These rats were fed with water containing different concentrations of sodium fluoride (NaF) [ < 0.5 mg/L (control, CN), 10.0 mg/L (low dose fluoride, LF) and 50.0 mg/L (high dose fluoride, HF)]. Some rats were fed directly for 185 days (CN, LF and HF groups). In addition, rats of CN + normal saline (NS), LF + NS, HF + NS groups and LF + CS, HF + CS groups, were intraperitoneally injected with NS or 0.66 mg/kg CS for 5 consecutive days after 180 days of feeding. After the experiment, the pathological changes of hippocampal CA4 of brain tissue in each group were observed by hematoxylin eosin staining under light microscope, and the expression and distribution of GFAP, β-tubulin Ⅲ and synaptophsin in hippocampal CA4 of rats were detected by immunohistochemistry, the expression of GFAP, β-tubulin Ⅲ and synaptophsin at protein level in hippocampus of rats were detected by Western blotting.Results:Under light microscope, eosinophilic change, loss and irregular arrangement of neuron in the hippocampal CA4 were observed in LF, HF, LF + NS and HF + NS groups. The morphology of LF + CS and HF + CS groups was not significantly changed compared with CN group, but was significant changed compared with LF, HF, LF + NS and HF + NS groups. Immunohistochemical results showed that the rates of positive area of GFAP, β-tubulin Ⅲ and synaptophsin in female and male rats in LF and HF groups were significantly decreased than those in CN group ( P < 0.05); the positive area rates of female and male rats in LF + CS and HF + CS groups were higher than those in LF and HF groups, respectively ( P < 0.05). Western blotting results showed that the proten expression levels of GFAP, β-tubulin Ⅲ and synaptophsin of female and male rats in LF and HF groups (LF group: 0.90 ± 0.09, 0.82 ± 0.08, 1.43 ± 0.14, 0.92 ± 0.02, 1.21 ± 0.15, 0.87 ± 0.02, HF group: 0.58 ± 0.14, 0.73 ± 0.03, 0.63 ± 0.06, 0.67 ± 0.03, 0.87 ± 0.04, 0.70 ± 0.05) were lower than those in CN group (1.24 ± 0.08, 1.09 ± 0.10, 2.64 ± 0.30, 1.54 ± 0.09, 1.72 ± 0.10, 1.13 ± 0.06, P < 0.05). Conclusions:The tripartite synapse and extracellular matrix may take part in pathogenesis of the damages of CNS results from chronic fluorosis; CS may reduce the injury to a certain extent.

Objective:To study the protective effect and effect of SphK1 overexpression on the injury of nerve cells induced by acrylamide.Methods:ACR with 99% purity was prepared into 1.25 mmol/L and 2.5 mmol/L solutions. SH-SY5Y cells were divided into control group (NC group) , experimental group and SphK1 activator group. The experimental group was given ACR solution with final concentration of 1.25 mmol/L and 2.5 mmol/L respectively for 24 h. In the SphK1 activator group, on the basis of the exposure concentration of the experimental group, the SphK1 specific activator (12-) phorbol tetradecanoate (-13-) acetate (PMA) solution[prepared by dimethyl sulfoxide (DMSO) , the final concentration was 100 nmol/l], and other treatments were the same as the experimental group. Control group (NC group) added PMA solution into normal cells. Western blot was used to detect the expression of SphK1 protein; CCK-8 was used to detect the proliferation of SH-SY5Y cells; hoechst33342 method was used to observe the morphological changes of nerve cells; flow cytometry was used to analyze the apoptosis of cells.Results:Compared with NC group, the expression of SphK1 protein in the experimental group and the SphK1 activator group was significantly lower ( P<0.05) . Compared with the experimental group, the expression of SphK1 protein in each concentration of SphK1 activator group was increased, and the difference was statistically significant ( P<0.05) . In addition to 1.25 mmol/L SphK1 activator group, compared with NC group, the relative growth survival rate of experimental group and 2.5 mmol/L SphK1 activator group were lower, the difference was statistically significant ( P<0.05) . Compared with the experimental group, the relative survival rate of cells in the SphK1 activator group was higher, and the difference was statistically significant ( P<0.05) . With the increase of exposure concentration, the cells in the experimental group showed the morphological characteristics of early apoptosis at ACR 1.25 mmol/L and late apoptosis at ACR 2.5 mmol/L. Compared with NC group, the apoptosis rate of experimental group and SphK1 activator group at ACR 2.5 mmol/L was significantly different ( P<0.05) ; compared with experimental group, the apoptosis rate of SphK1 activator group at ACR 2.5 mmol/L was lower, the difference was statistically significant ( P<0.05) . Conclusion:The SphK1 excessive expression plays the protective function to the nerve cell damage caused by acrylamide.