Objective To investigate the efficacy and safety of hybrid surgery for the recanalization of carotid artery occlusion after stenting.Methods Clinical data and results of 17 patients with occlusion after carotid artery stenting and treated with hybrid surgery from June 2016 to April 2023 at the Department of Neurosurgery Cerebral Blood Flow Reconstruction Center of Xuanwu Hospital,Capital Medical University were retrospectively analyzed.According to whether the recanalization was successful,17 patients were divided into the the successful recanalization group and the failed recanalization group.Successful recanalization was defined as achieving modified thrombolysis in cerebral infarction(mTICI)grade ≥2b and residual stenosis＜50％.Baseline data(age,sex,body mass index,smoking history,alcohol consumption history,hypertension history,diabetes history,hyperlipidemia history,coronary heart disease history),clinical data(National Institutes of Health Stroke Scale[NIHSS]score at admission,fasting blood glucose,low density lipoprotein,high density lipoprotein,total cholesterol,triglyceride,occlusion side and segment,combination with severe stenosis or occlusion of the contralateral carotid artery,opening of the anterior communicating artery,opening of the posterior communicating artery,compensation of the external and internal carotid artery,compensation of the pia artery,stump morphology,and time from imaging diagnosis of occlusion to recanalization)were documented and compared between groups.The recanalization of occlusive vessels and perioperative complications were recorded.Imaging and clinical follow-up were performed 3,6 months and≥1 year after surgery.Results Among the 17 patients,the ratio of successful recanalization was 13/17.One patient had re-occlusion after operation,which was re-opened after thrombolysis,but neck hematoma with dyspnea occurred,and recovered after emergency operation.There was no postoperative stroke or death.The incidence of perioperative complications was 1/17.Compared with the successful recanalization group,the levels of high density lipoprotein and total cholesterol in the failed recanalization group were higher,and the differences between the groups were statistically significant(high density lipoprotein[1.3±0.3]mmol/L vs.[0.9±0.3]mmol/L,t=-2.139;total cholesterol:[4.2±0.8]mmol/L vs.[3.1±0.7]mmol/L,t=-2.649;both P＜0.05);There were no significant differences in other baseline data and clinical data(all P＞0.05).Imaging follow-up was completed in 9 of the 13 patients in the successful recanalization group,and the follow-up time was 3.8-36.9 months,with a median follow-up time of 22.8(12.8,34.7)months.Among them,1 patient(1/9)developed restenosis of recanalization vessels at 33.0 months after surgery and underwent stent implantation again.Conclusions The preliminary analysis showed that the occlusion after carotid artery stenting had better recanalization success and lower perioperative complications.In patients with chronic occlusion after carotid stenting,the application of a hybrid surgery for opening may be attempted under multimodal imaging assessment.

OBJECTIVE: To demonstrate the mechanism of mechanical ventilation (MV) induced endoplasmic reticulum stress (ERS) promoting mechanical ventilation-induced pulmonary fibrosis (MVPF), and to clarify the role of angiotensin receptor 1 (AT1R) during the process. METHODS: The C57BL/6 mice were randomly divided into four groups: Sham group, MV group, AT1R-shRNA group and MV+AT1R-shRNA group, with 6 mice in each group. The MV group and MV+AT1R-shRNA group mechanically ventilated for 2 hours after endotracheal intubation to establish MVPF animal model (parameter settings: respiratory rate 70 times/minutes, tidal volume 20 mL/kg, inhated oxygen concentration 0.21). The Sham group and AT1R-shRNA group only underwent intubation after anesthesia and maintained spontaneous breathing. AT1R-shRNA group and MV+AT1R-shRNA group were airway injected with the adeno-associated virus one month before modeling to inhibit AT1R gene expression in lung tissue. The expressions of AT1R, ERS signature proteins [immunoglobulin heavy chain-binding protein (BIP), protein disulfide isomerase (PDI)], fibrosis signature proteins [collagen I (COL1A1), α-smooth muscle actin (α-SMA)] in lung tissues were detected by immunofluorescence and Western blotting. Hematoxylin-eosin (HE) staining was used to evaluate lung injury and Masson staining was used to evaluate pulmonary fibrosis. RESULTS: Compared with the Sham group, the degree of pulmonary fibrosis and lung injury were more significant in the MV group. In the MV group, the protein expressions of AT1R, BIP, PDI, COL1A1 and α-SMA were increased (AT1R/β-actin: 1.40±0.02 vs. 1, BIP/β-actin: 2.79±0.07 vs. 1, PDI/β-actin: 2.07±0.02 vs. 1, COL1A1/α-Tubulin: 2.60±0.15 vs. 1, α-SMA/α-Tubulin: 2.80±0.25 vs. 1, all P < 0.01). The number of E-cad⁺/AT1R⁺ and E-cad⁺/BIP⁺ cells in lung tissue increased, and the fluorescence intensity of COL1A1 and α-SMA increased. Compared with the MV group, the degree of pulmonary fibrosis and lung injury were significantly relieved in the MV+AT1R-shRNA group. In the MV+AT1R-shRNA group, the protein expressions of AT1R, BIP, PDI, COL1A1 and α-SMA were decreased (AT1R/β-actin: 0.53±0.03 vs. 1.40±0.02, BIP/β-actin: 1.73±0.15 vs. 2.79±0.07, PDI/β-actin: 1.04±0.07 vs. 2.07±0.02, COL1A1/α-Tubulin: 1.29±0.11 vs. 2.60±0.15, α-SMA/α-Tubulin: 1.27±0.10 vs. 2.80±0.25, all P < 0.01). The number of E-cad⁺/AT1R⁺ and E-cad⁺/BIP⁺ cells in lung tissue decreased, and the fluorescence intensity of COL1A1 and α-SMA decreased. There was no statistically significant difference in the indicators between AT1R-shRNA group and Sham group. CONCLUSIONS MV up-regulate the expression of AT1R in alveolar epithelial cells, activate the AT1R pathway, induce ERS and promote the progression of MVPF.
Mice ; Animals ; Pulmonary Fibrosis/chemically induced* ; Lung Injury ; Respiration, Artificial/adverse effects* ; Actins/metabolism* ; Tubulin ; Mice, Inbred C57BL ; Endoplasmic Reticulum Stress ; RNA, Small Interfering

OBJECTIVE To eval uate the effectiveness ，safety and economy of deferasir ox for the treatment of iron overload in thalassemia with rapid health technology assessment ，and to provide evidence-based basis for rational clinical use. METHODS Retrieved from Chinese and English database/website as PubMed ，Embase，Cochrane Library ，NHS EED ，CADTH，CNKI and Wanfang database ，health technology assessment （HTA），systematic evaluation/meta-analysis and pharmacological studies about deferasirox versus deferoxamine/deferiprone for the treatment of iron overload in thalassemia were collected from the inception to June 2021. Based on literature screening and data extraction ，the quality of literature about HTA reports ，systematic evaluation/ Meta-analysis and pharmacoeconomic research were evaluated with HTA checklist ，A Measurement Tool to As sess Systematic Reviews，standard scale of economic evaluation report. The effectiveness and safety results were described quantitatively ，and the economic evaluation results were described qualitatively. RESULTS One HTA report ，five systematic evaluation/meta-analysis and five pharmacoeconomic studies were selected from 1 569 literature. Included HTA reports ， systematic evaluation/meta-analysis，pharmacoeconomic studies were high in quality. Most studies reported that 30 mg/（kg·d） deferasirox was E-mail：aydgs@126.com better than deferoxamine in reducing the levels of s erum ferritin and liver iron overload ；ADR induced by deferasirox were mainly gastrointestinal irritation symptoms ，skin itching ，joint pain，transaminase elevation ，etc.，which generally did not affect subsequent treatment. There was no statistical significance in severe ADR between deferoxamine group and deferasirox group [RR ＝0.96，95％CI（0.85，1.08），P＝0.52]. Compared with deferoxamine，deferasirox had higher cost-effectiveness ；but deferasirox was less likely to be cost-effective than deferiprone. CONCLUSIONS Deferasirox has good effectiveness and safety for iron overload in thalassemia ，and has good economic advantages in Britain and Iran ，compared with deferoxamine.

Objective:To investigate the Chinese version of rheumatoid arthritis stigma scale (ISMI-RA) and test its reliability and validity.Methods:The English version of ISMI-RA was translated into Chinese, translated back and culturally adapted in strictly accordance with the Brislin translation model. A total of 20 patients were selected for preliminary investigation and some items were revised to create the Chinese version of ISMI-RA. From April 2020 to April 2021, 258 patients with rheumatoid arthritis were investigated by convenience sampling method, Pearson correlation intraclass correlation coefficient (ICC) coefficient and Cronbach's α coefficient were used to evaluate the test-retest reliability and internal consistency of the scale. The stigma scale for chronic illness-8 was used as the standard, and the correlation coefficient was calculated to verify the criterion validity. Confirmatory factor analysis was used to evaluate the construct validity of the scale.Results:The internal consistency Cronbach's α coefficient was 0.86, the Cronbach's α coefficient of each dimension was 0.34-0.93, and Pearson correlation analysis of retest reliability showed that it was 0.94. The Cronbach's α coefficient of stigma resistance subscale was as low as 0.34, and the Cronbach's α coefficient of stigma resistance subscale was 0.90 after removal. The retest reliability was 0.98. The criterion coefficient between this scale and the stigma scale for chronic illness-8 was 0.73 ( P<0.001), and the criterion coefficient of the subscales were 0.52-0.71. The theoretical factor structure of ISMI-RA that is composed of five factors showed suboptimal model fitting [root-mean-square error of approximation ( RMSEA)=0.10, Tucker-Lewis index ( TLI)=0.88, comparative fit index (CFI)=0.89)], and the model fitting effect was better after removing the dimension of resistance to stigma and three items ( RMSEA=0.09, CFI=0.94, TLI=0.93). Conclusion:The Chinese version of ISMI-RA has good reliability and validity, and can be used as an evaluation tool to measure the level of stigma in rheumatoid arthritis patients, and to provide a basis for clinical development of intervention programs to facilitating the rehabilitation process.

【Objective】 To compare the efficacy of percutaneous vertebroplasty （PVP） and facet blocking （FB） in the treatment of osteoporotic vertebral compression fractures. 【Methods】 From January 2015 to June 2019， 162 patients with osteoporotic vertebral compression fracture were treated with PVP and FB. Among them， PVP group （86 cases） received PVP treatment and FB group （76 cases） received FB treatment. We compared the perioperative related indexes， the height of the anterior edge of the injured vertebrae， the sagittal kyphosis Cobb angle， visual analogue score， dysfunction index and lumbar dysfunction score of preoperative and postoperative follow-up （1 day， 1 week， 1 month， 3 months， 6 months， and 12 months） in both groups. 【Results】 There was significant difference in operation time between PVP group ［（34.25±6.04）min）］ and FB group ［（21.47±4.58）min］ （P<0.05）. There was no significant difference in the height of the anterior edge of injured vertebra between the two groups before operation （P>0.05）， but there was significant difference in the height of anterior margin of injured vertebrae between the two groups at 3 days， 6 months and 12 months after operation （P<0.05）. In FB group， there was no significant change in the height of the anterior edge of the injured vertebrae at 3 days， 6 months and 12 months after operation. The two groups did not significantly differ in Cobb angle before operation （P>0.05）， but after operation（P<0.05）. The scores of VAS， ODI and RMD were lower in PVP group than in FB group 1 day and 1 week after operation （P<0.05）， but they did not significantly differ after follow-up for more than one month （P>0.05）. 【Conclusion】 Both PVP group and FB group have effectively relieved pain. The results of this study suggest that FB can become an alternative treatment for PVP in some patients， such as the poor， elderly and pain-tolerant ones.

Objective:To observe the effect of contralateral controlled functional electrical stimulation (CCFES) on the recovery of upper limb motor function after a stroke.Methods:Stroke survivors 1 to 6 months after onset were randomly divided into a CCFES group (14 cases, group A), a CCFES intensive group (14 cases, group B) and a neuromuscular electrical stimulation group (15 cases , group C). In addition to routine rehabilitation training, groups A and B received contralateral controlled functional electrical stimulation, while Group C received routine neuromuscular electrical stimulation. Group B was treated twice daily, while the other two groups were given 1 session each day, 5 times a week for 3 weeks. Each session lasted 20 minutes. The Fugl-Meyer assessment (FMA), the Modified Barthel Index (MBI), surface electromyography and the active range of motion for wrist dorsiflexion were used to evaluate the subjects′ upper limb function before and after the treatment.Results:There was no significant difference in any of the measurements among the three groups before the treatment. After the treatment, all of them had improved significantly, with the improvements in groups A and B significantly greater than in group C, on average.Conclusions:Both normal and intensive contralateral controlled functional electrical stimulation have significant advantages over neuromuscular electrical stimulation in promoting functional recovery of the upper limbs. Intensive CCFES training is superior to routine training in improving muscle strength and range of motion.

Objective: To investigate the clinical significance of combined examinations for neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fecal occult blood (OB) in the differential diagnosis of Crohn′s disease and irritable bowel syndrome. Methods: A total of 129 patients with Crohn′s disease and 120 patients with irritable bowel syndrome from October 2014 to October 2017 in Changhai Hospital were enrolled in this study. The results of NLR, CRP, ESR and OB were recorded. Logistic regression was used to study the association of the four indicators. The combined impact of the four indicators was explored with multivariable regression. ROC curve was used to compare the diagnostic value of the combined examinations with the four indicators for Crohn′s disease. The diagnosis was performed by substituting the data of individual patient into regression model. Results: The levels of NLR, CRP, ESR and OB in Crohn′s disease group were higher than those in irritable bowel syndrome group (Z=-7.067--4.148, P＜0.01). The area under the curve of combined diagnostic indicator was 0.881, which was higher than that of single NLR, CRP, ESR or OB (0.759, 0.695, 0.652, 0.643) respectively (Z=3.19-5.60, P＜0.01). When the cutoff value was 0.498, the sensitivity was 79.1%, the specificity was 83.3% and the diagnostic accuracy was 81.1%. A patient who was not included within the statistical range of this experimental study was randomly assigned to the model and 0.831 of P value was obtained, which was higher than the cutoff value of 0.498, indicating that the patient suffered from Crohn′s disease with accuracy of 81.1%. Conclusion The logistic regression model established with the combined diagnostic indicators, which was formulated by examinations of NLR, CRP, ESR and OB, exhibited higher diagnostic value than any single indicator in the differential diagnosis of Crohn′s disease and irritable bowel syndrome.

The pathogenesis of Alzheimer's disease (AD) has not been fully elucidated.Mitochondria play critical roles in neuronal function;and damage of hippocampal neurons by dysfunction of mitochondrial dynamics is the major pathological mechanism of AD.Improvement of mitochondrial dynamics imbalance in time should alleviate or reverse damage of hippocampal neurons.After a brief overview of basic mechanisms involved in regulation ofmitochondrial fission,fusion,and transportion,and how mitochondrial dynamics affects AD,this review article focuses on discussing the role of key sites such as Drpl,Mfnl/2,Opal and Miro/Milton in regulating mitochondria dynamics and their effects on

Objective To explore the impact of antiplatelet agents on the occurrence of hemorrhage after percutaneous nephrostomy (PCN).Methods Totally 197 patients (244 kidneys) underwent PCN were enrolled and divided into postoperative hemorrhage group and without postoperative hemorrhage group.The possible factors of the postoperative hemorrhage were analyzed.Results Post-operative hemorrhage occurred in 23 patients with 27 kidneys (27/244,11.07％).Univariate analysis showed that except for antiplatelet drugs,the other factors had no statistical difference between the two groups (P＞0.05).Logistic regression analysis showed that taking dual-antiplatelet was the risk factor of hemorrhage after PCN (OR=12.381,P =0.002).Conclusion Single aspirin therapy can not increase the risk of hemorrhage after PCN,while taking dual-antiplatelet might increase the risk of hemorrhage.Normal clotting function is also a guarantee of preventing hemorrhage after PCN.

Objective: To investigate the relationship between radiofrequency ablation immediately after enhanced CT scanning and the occurrence of contrast agent spillover and postoperative severe bleeding, and analyze the risk factors for hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 199 patients with hepatocellular carcinoma who underwent radiofrequency ablation of liver cancer in our hospital from January 2016 to January 2017 was reviewed. A total of 232 cases were treated with ablation. The agent spillovers were divided into two groups, one for the contrast agent spill group and the other for the non-contrast agent spill group. Its basic clinical data, laboratory data related to the risk of bleeding, and imaging data were analyzed to explore their clinical treatment effects and the risk factors for their occurrence. According to different data, t-test, χ2 test or logistic regression test was used for statistical analysis. Results: In 199 patients, a total of 232 cases were treated with ablation, including 138 males and 61 females. The average age was (57.56 ± 12.09) years and the average diameter of lesions was (3.42 ± 2.30) cm. A total of 30 cases (12.93%) of contrast agent spillover occurred immediately after the ablation of CT scanning needle. There were no severe bleeding and no special clinical intervention after the operation. The other 202 cases were non- contrast agent spill group, but 2 cases had severe bleeding and had corresponding clinical interventions. Univariate analysis showed that there were statistically significant differences in thoracentesis (P = 0.019), complications of cirrhosis (P < 0.001), and histological types of liver cancer (P = 0.013), and other clinical data [age, lesion size]. There were no significant differences in Child-Pugh classification, preoperative hemoglobin (HGB), platelet count, prothrombin time, APTT, international standardized ratio, number of puncture needles, and puncture length. There was also no significant difference in postoperative HGB (P = 0.160), preoperative-postoperative HGB change (P = 0.999), and length of hospital stay (P = 0.730) between the two groups. Logistic regression analysis showed that with cirrhosis (OR = 5.59, P < 0.001), transthoracic puncture (OR = 2.67, P = 0.021) may be a risk factor for contrast agent spillover after CT-enhanced CT scan in patients with hepatocellular carcinoma. Conclusion Contrast agent spillover is not uncommon in the evaluation of curative effect of CT immediately after ablation (12.93%). It is not predictive for the occurrence of postoperative severe bleeding and does not require excessive clinical intervention. Liver cirrhosis and transthoracic cavity puncture may be the risk factors for its occurrence. The risk of severe postoperative bleeding should not be ignored for patients who have no contrast agent spills after surgery.