Objective:To investigate the effect of holographic meridian copper coin scraping therapy on limb swelling and pain after a pit viper bite and the changes of related laboratory indicators.Methods:Seventy-four patients with limb swelling and pain after a pit viper bite who received treatment at the Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University from May 2023 to October 2023 were included in this study. Using a case-control study design, these patients were divided into a study group (holographic meridian copper coin scraping therapy) and a control group (conventional intervention), with 37 patients in each group, according to the treatment methods. The clinical data (gender, age, body mass index, education level, time of admission, severity, bite site), the degree of limb swelling, Visual Analogue Scale score, laboratory indicators, and adverse reactions were compared between the two groups.Results:Before intervention, there was no statistically significant difference in the degree of limb swelling between the two groups ( P > 0.05). At 1, 3, and 7 days after intervention, the degree of swelling in the study group [(52.41 ± 4.07) mm, (33.07 ± 3.25) mm, (10.45 ± 2.13) mm] was significantly lower than that in the control group [(58.56 ± 4.30) mm, (40.26 ± 3.41) mm, (13.98 ± 2.77) mm, t = 6.32, 9.28, 6.15, P < 0.001, < 0.001, < 0.001). Before intervention, there was no statistically significant difference in Visual Analogue Scale score between the two groups ( P > 0.05). At 1, 3, and 7 days after intervention, the Visual Analogue Scale scores in the study group [(3.41 ± 1.18) points, (3.01 ± 1.05) points, (2.74 ± 0.72) points] were significantly lower than those in the control group [(3.98 ± 1.25) points, (3.52 ± 1.10) points, (3.18 ± 0.96) points, t = 2.01, 2.04, 2.23, P = 0.047, 0.045, 0.029]. There were no statistically significant differences in laboratory indicators between the two groups before and 1 day after intervention (all P > 0.05). At 3 and 7 days after intervention, the levels of creatine kinase [(231.25 ± 25.96) IU/L, (190.67 ± 21.03) IU/L], creatinine [(74.34 ± 7.91) μmol/L, (70.08 ± 7.54) μmol/L], creatine kinase isoenzyme [(16.61 ± 2.06) IU/L, (12.02 ± 1.74) IU/L], and C-reactive protein [(6.54 ± 1.18) mg/L, (4.10 ± 0.96) mg/L] in the study group were significantly lower than those in the control group [(260.48 ± 28.51) IU/L, (215.34 ± 24.25) IU/L, (79.10 ± 8.23) μmol/L, (74.33 ± 7.91) μmol/L, (19.33 ± 2.31) IU/L, (15.68 ± 1.95) IU/L, (7.30 ± 1.52) mg/L, (5.92 ± 1.23) mg/L, t = 4.61, 4.67, 2.53, 2.36, 5.34, 8.51, 2.40, 7.09, all P < 0.05]. No serious adverse reactions occurred in each group. Conclusion:The holographic meridian copper coin scraping therapy can rapidly reduce the degree of limb swelling in patients, alleviate pain, reduce muscle injury, and is highly safe.

Objective To explore the dynamic changes in cerebral hemodynamics in patients with unilateral middle cerebral artery(MCA)occlusion after superficial temporal artery(STA)-MCA bypass surgery.Methods One hundred and nine patients diagnosed with unilateral MCA occlusion by DSA who underwent STA-MCA bypass surgery were retrospectively included in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University.Clinical data of patients were collected within 24 hours after admission,including age,sex,body mass index,stroke risk factors including hypertension,hyperlipidemia,diabetes,smoking,drinking history and atrial fibrillation,clinical manifestations(within the last 6 months;nonspecific symptoms[dizziness,memory loss,unresponsiveness,etc.],transient ischemic attack,and stroke),blood biochemical markers(low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,total cholesterol,fasting blood glucose,and hypersensitive C-reactive protein),and National Institutes of Health stroke scale(NIHSS)score at admission.Color Doppler ultrasound(CDU)and transcranial color coded Doppler(TCCD)ultrasound were used to evaluate the hemodynamic parameters of STA before and at different periods after surgery(4-7 days and 1,3,6,12 months after surgery)to analyze the patency of bypass arteries and intracranial hemodynamic changes,and to check the consistency of the results of the bridge artery patency at 12 months postoperatively by CDU and DSA,consistency test was performed.According to the results of the DSA examination 12months after surgery,the patients were divided into the bypass artery patency group and the non-patency group(stenosis or occlusion).The hemodynamic parameters at the trunk of STA,namely the extracranial segment,transcranial,and intracranial part of the bypass arteries,were compared between the two groups.It included inner diameter(D),peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI),pulsation index(PI),time-averaged mean velocity(TAMV),time-averaged peak velocity(TAPV),and calculated flow of the STA trunk including TAMV flow and TAPV flow.Head CT,CT angiography(CTA)above the aortic arch,and CT perfusion(CTP)of the whole brain were performed 1 to 3 days before surgery and 12 and 18 months after surgery to observe the changes in cerebral perfusion.Head CT was performed 1 to 2 days after the operation to observe whether there were new hemorrhagic and ischemic lesions in the operative area.the CTP parameters of the two groups were compared including 12 and 18 months after the operation with 1 to 3 days before the surgery,and the differences in CTP parameters between the two groups were compared.The modified Rankin scale(mRS)was used to evaluate the neurological function prognosis of the patients at 12 and 18 months after surgery.The mRS score 2 was divided into a good prognosis and mRS score≥3 was a poor prognosis.NIHSS score of the patients was recorded 7 days,12,and 18 months after surgery.Results(1)Consistency analysis of CDU and DSA:the consistency of the assessment of bypass artery patency was excellent at 12 months after surgery,and the Kappa value was 0.94(95％CI 0.81-1.00,P＜0.01).According to DSA,101 cases(92.7％)were in bypass artery patency group,while 8 cases(7.3％)in the non-patency group(no case of occluded bridge vessel was found),and the sites of stenosis in the bypass arteries were all located in the transcranial segment.(2)Hemodynamic parameters:compared with the preoperative results,the D of the extracranial segment increased on 4-7 days and 1,3,6,and 12 months after the operation(Wald x2=30.438).Hemodynamic parameters included increased blood velocity such as PSV,EDV,TAMV,and TAPV(Waldx2 was 12.117,29.310,31.075 and 17.525,respectively)and blood flow including TAMV flow and TAPV flow(Wald x2 was 54.503 and 34.986,respectively)increased,while RI and PI values were decreased(Waldx2 was 112.568 and 103.629,respectively),and the differences were statistically significant(all P＜0.05).However,there was no significant difference in hemodynamic parameters in the non-patency group at 12 months after operation(all P＞0.05).Compared with 4-7 days after surgery,PSV(252.0[206.8,315.3]cm/s vs.102.5[84.0,119.0]cm/s)and EDV(119.5[106.3,159.8]cm/s vs.43.5[36.8,52.0]cm/s)in the non-patency group were significantly higher at the cranial entrance 12 months after surgery(both P＜0.05),but there was no significant difference in RI and PI values(both P＞0.05).Compared with 4-7 days after surgery,the blood flow parameters of STA intracranial segment,including PSV(29.4[24.8,41.4]cm/s vs.111.5[63.3,120.0]cm/s),EDV(19.7[15.2,22.2]cm/s vs.58.5[28.3,70.0]cm/s)and PI(0.55[0.42,0.63]vs.0.83[0.61,0.90])values in the non-patency group at 12 months after surgery were significantly decreased(all P＜0.05).(3)CTP parameters:the relative cerebral blood flow(rCBF)of the patency group increased at 12 and 18 months after surgery compared to preoperative levels,while relative cerebral blood volume(rCBV),relative peak time(rTTP)and relative mean transit time(rMTT)decreased,with statistical significance(all P＜0.05).At 12 and 18 months after operation,rCBF increased,while rMTT decreased in the non-patency group(both P＜0.05),but there was no significant difference as for rCBV and rTTP.The rTTP of the patency group at 12 and 1 8 months was lower than that of the non-patency group(12 months after surgery:1.14[1.06,1.15]vs.1.20[1.14,1.28],P=0.024;1 8 months after surgery:1.14[1.06,1.15]vs.1.20[1.14,1.28],P=0.023),but there was no statistical significance for other parameters between the two groups(all P＞0.05).(4)NIHSS score and prognosis:clinical follow-up results 18 months after the operation showed that no new stroke occurred during the follow-up period.The NIHSS scores in the patency group and the non-patency group were remarkably lower at 7 days,12,and 18 months after surgery than at admission(patency group:2[0,4],1[0,2],0[0,2]vs.3[0,6],respectively;the non-patency group:3[1,5],3[1,6],2[1,6]vs.4[1,7],respectively),with significant differences(all P＜0.05);However,the NIHSS scores in the patency group were significantly lower than that in the non-patency group at 12 and 18 months after surgery,and the proportion of patients with good prognosis in the patency group was substantially higher than that in the non-patency group(12months:87.1％[88/101]vs.4/8,P=0.039;18 months:90.1％[91/101]vs.4/8,P=0.025).Conclusion CDU can quantitatively evaluate the hemodynamic changes of bypass arteries after the STA-MCA bypass procedure,which can be applied to the long-term dynamic follow-up after the surgery.

No case of moyamoya syndrome with bilateral posterior cerebral artery (PCA) occlusion has been reported in China so far as this disease is extremely rare. The case shown in this article is a middle-aged women who has a history of atrial fibrillation, hypertension and type 2 diabetes acutely attacked by this syndrome. The main clinical manifestations included binocular blindness, right limb weakness. Imaging findings showed bilateral acute cerebral infarction in the parietal occipital lobe, bilateral anterior cerebral artery and middle cerebral artery smoke angiogenesis, bilateral PCA occlusion with distal smoke angiogenesis. Considering the medical history of the patient, the cause of the disease was diagnosed as embolic stroke of undetermined source. The patient′s consciousness has been recovered and the limb weakness has been improved after active symptomatic treatment. However, the blindness did not see any improvements. This case report aims to improve clinicians′ understanding of bilateral PCA embolization in patients with moyamoya syndrome so the occurrence of cerebral infarction can be effectively prevented.

Objective: To analyze the occurrence and epidemiological characteristics of acute poisoning caused by Coriaria sinica maxdim in Guizhou Province during 2015 to 2020, and to provide scientific basis for prevention of Coriaria sinica maxim poisoning. Methods: A total of 176 cases of Coriaria sinica maxim poisoning were reported in Guizhou Province during 2015 to 2020, with all of the 505 affected were children and adolescents under 16 years old. No death was reported. Poisoning caused by Coriaria sinica maxim was most commonly reported in the year of 2020, with 97 reported incidents and 292 poisonings. Poisoning incidents were most freqently reported in the mature stage of Coriariasinica fruit during April to June, with 153 cases and 437 poisoning cases reported in May. The top three areas reporting Coriaria sinica maxim poisoning included Bijie, Anshun and Zunyi City, with the number of reported eventws being 57, 27, and 27, and poisoned children and adolescents of 160, 90, and 73. Most of the affected children were from rural areas. The median incubation period was 2 hours, and the primary clinical symptoms included vomiting( 93.66 %), nausea(58.02%) and abdominal pain(38.42%). Conclusion A large number of Coriaria sinica maxim poisoning incidents occur due to unsupervised access to Coriaria sinica maxim among rural children. The publicity and education of children, especially for rural left behind children, should be strengthened to reduce the incidence of Coriaria sinica maxim poisoning.

Allografts ; COVID-19 ; China/epidemiology* ; Disease Outbreaks ; Humans ; Kidney Transplantation/adverse effects* ; SARS-CoV-2

OBJECTIVES: Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients. METHODS: We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome. RESULTS: There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m CONCLUSIONS IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.
Adult ; Anemia, Iron-Deficiency ; Female ; Humans ; Intracranial Hypertension ; Male ; Middle Aged ; Pseudotumor Cerebri/diagnostic imaging* ; Retrospective Studies ; Ventriculoperitoneal Shunt ; Young Adult

Exosomes are spherical microvesicles(30-100 nm)secreted by a variety of cells and contain a variety of proteins, lipids, mRNAs, and microRNAs.These molecules into exosomes can be transferred to adjacent cells and distant tissues or cells by exosomes to develop full effects.Exosomes-released microRNAs are involved in the pathogenesis of Alzheimer's disease(AD)by regulating the abnormal expression of amyloid β-protein(Aβ)and p-Tau protein, initiating the inflammatory response by interacting with toll-like receptors.In addition, exosomal microRNAs can be used as a potential therapeutic target for AD.Exosomes as good carriers have great research values.This review summarized the literatures related to the role of exosomal microRNAs in the development of AD and the potential therapeutic effect on AD.A large amount of evidence indicates that expression disorder of exosomal microRNA plays an important role in the pathogenesis of AD and can be used as a new potential biomarker and therapeutic target for the diagnosis and treatment of AD.

Objective :To explore influence of different doses of clopidogrel combined aspirin on platelet related inde—xes and safety in patients with unstable angina pectoris (UAP).Methods : A total of 92 UAP patients treated in our hospital were randomly and equally divided into large dose clopidogrel combined group (received 150mg／d clopi—dogrel combined aspirin ) and routine dose clopidogrel combined group (received 75mg／d clopidogrel combined aspi—rin) ,both groups were continuously treated for three months .Therapeutic effect , medication safety , level of thrombolytic granule membrane protein (GMP)—140 ,maximum platelet aggregation rate (LTA—PAmax ) and ADP—induced maximum platelet amplitude (MAADP ) were compared between two groups .Results : After three—month treatment ,there were no significant difference in total effective rate ,incidence rate of major adverse cardiovascular events ,GMP—140 level ,LTA—PAmax and MAADP between two groups , P＞0. 05 all.Incidence rate of severe hemor—rhage in large dose clopidogrel group was higher than that of routine dose group (6.52% vs.2. 17%) without signifi—cant difference ( P＝0.609).Conclusion : Increased dose of clopidogrel combined aspirin doesn＇t obtain significant therapeutic effect ,but may be risk of hemorrhage for unstable angina pectoris ,which calls for clinical attention

Five patients with myopathy associated with anti-signal recognition peptide antibodies, admitted to our hospital from December 2015 to June 2018, were chosen in our study, and their clinical and pathological manifestations and treatments were retrospectively analyzed. Five patients showed subacute or chronic onset and proximal limb muscle weakness. Serum creatine kinase level was significantly elevated. Immunoblotting assay confirmed the positive anti-signal recognition particle antibody. EMG prompted myogenic damage. Pathological features included muscle degeneration, necrosis with regeneration, visible atrophy and hypertrophic of muscle fiber, connective tissue hyperplasia and a small amount of inflammatory cell infiltration. Immunohistochemical staining showed necrotizing muscle fiber infiltrated with CD4-positive and CD8-positive lymphocytes and CD68-positive macrophages, and no CD20-positive lymphocytes and CD303-positive dendritic cells were observed. Two patients had expressed a bit of c5b-9 positive capillary. Anti-sarcoglycans staining, anti-dysferlin staining and dystrophin staining showed continuous strong positive expression. Follow-up study found that all patients were response to glucocorticoid, and a combination therapy of immunoglobulin and immunosuppression were necessary for some patients.
Autoantibodies ; Follow-Up Studies ; Humans ; Muscular Diseases ; Protein Sorting Signals ; Retrospective Studies

To analyze the clinical and image features for 12 patients of cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL).
 Methods: A total of 12 CADASIL patients were collected in Xiangya Hospital of Central South University from January 2013 to December 2018. The clinical manifestation, risk factors, MRI imaging data and NOTCH3 mutations were analyzed retrospectively.
 Results: The mean age of 12 patients was (47.25±9.49) years. The clinical manifestation was most common in cognitive impairment (75%) and stroke events (58.3%), and 2 cases showed cerebral hemorrhage. Migraine was only seen in 25% patients. All MRI showed white matter hyperintensity (WMH), lacune and enlarged perivascular space (PVS). WMH mainly occurred in the frontal parietal lobe (100%), temporal lobe (83.3%), external capsule (66.7%), occipital lobe (41.6%), callosum 41.6% and the temporal pole (33.3%), while lacune mainly appeared in frontal lobe (91.6%), parietal lobe(83.3%), temporal lobe(66.7%), basal ganglia (66.7%), brain stem (41.6%), occipital lobe (33.3%), cerebellum (8.3%). Enlarged PVS located in the basal ganglia (100%), partly under the cortex (45.4%). WMH of the patient with intracerebral hemorrhage was mild (Fezakas score 1-2), which was not found in external capsule. 16.7% of the patients had intracranial arterial stenosis. In 12 patients, 8 different Notch3 mutations were detected. The c1013G>c p.(Cys338Ser) located in exon 6, which was a new pathogenic mutation of CADASIL.
 Conclusion: The patients with cerebral hemorrhage have mild WMH and specific genotype, indicating that the clinical characteristics of CADASIL with cerebral hemorrhage may be related to image features and genotype.
Adult ; CADASIL ; Cerebral Infarction ; Humans ; Leukoencephalopathies ; Middle Aged ; Retrospective Studies ; Temporal Lobe