Objective To explore the occurrence and influencing factors of MODS in elderly pa-tients with SAH.Methods A retrospective analysis was conducted on 187 elderly SAH patients admitted in the Second Affiliated Hospital of Guizhou Medical University from January 2021 to June 2024.According to the presence or absence of MODS,they were divided into MODS group(81 cases)and non-MODS group(106 cases).Their general clinical data were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors for MODS in elderly SHA patients.ROC curve analysis was applied to evaluate the predictive value of the major risk factors for MODS in the patients.Results The MODS group had significantly ad-vanced age,larger proportion of modified Fisher grades Ⅲ—Ⅳ,higher APACHE Ⅱ score,and in-creased FPG level than the non-MODS group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that APACHE Ⅱ score(OR=1.108,95％CI:1.070-1.148,P=0.000)and mo-dified Fisher grade(OR=1.143,95％CI:1.095-1.194,P=0.000)were independent risk factors for MODS in elderly SAH patients.ROC curve analysis suggested that the AUC value of APACHE Ⅱ score,modified Fisher grade and their combination in predicting the occurrence of MODS in elderly SAH patients was 0.809,0.737 and 0.880,respectively,with a sensitivity of 59.35％,88.93％and 84.02％,and a specificity of 88.73％,58.52％and 81.15％,respectively.The combined detection showed better predictive performance than the indicator alone(P＜0.01).Con-clusion The incidence of MODS is quite high in elderly patients with SAH.APACHE Ⅱ score and modified Fisher grade are the main risk factors affecting the occurrence of MODS.

AIM: To evaluate the expression of tumor necrosis factor-α(TNF-α)in the iris and ciliary body of Wistar rats in the endotoxin-induced uveitis(EIU), and the effect of Xuebijing injection on its expression.METHODS:A total of 65 Wistar rats were randomly divided into three groups: Group A(normal saline, n=5), Group B(normal saline+endotoxin-injected, n=30), and Group C(Xuebijing+endotoxin-injected, n=30). The EIU model was induced in Wistar rats of the groups B and C by injecting LPS into the plantar surfaces of the hind feet, and normal saline(15 mL/kg)or Xuebijing(15 mL/kg)were intraperitoneally administered 30 min before LPS administration. The rats of the groups B and C were further divided into 6 subgroups after LPS injection, including 6, 12, 18, 24, 48, and 72 h subgroups, with 5 rats in each group. Furthermore, the intraocular inflammation of the rats was observed at each time above, the number of infiltrating cells in the aqueous humor was counted, and the pathological changes were observed in the iris and ciliary body of rats using hematoxylin and eosin(HE)staining. TNF-α expression in iris and ciliary tissue at different postoperative time points was evaluated using immunohistochemistry.RESULTS: Clinical observations indicated no signs of uveitis in the group A, signs of uveitis were observed in the group B. Both iris symptoms and damage were significantly reduced in the group C compared to the group B(P<0.01). Cell counts in the aqueous humor revealed no inflammatory cells in the group A, while the number of aqueous humor cells in the group C was significantly reduced compared to Group B(P<0.01). HE staining revealed no cellular infiltration in the group A. In the group B, some cellular infiltration was observed in the eyes at 6 h post-LPS exposure. The number of infiltrating cells increased over time, peaked at 24 h, and gradually declined thereafter. In the group C, cell infiltration was not obvious at 6 h, few at 24 h, and nearly disappeared by 48 h. Immunohistochemical staining showed higher TNF-α expression in the ciliary body and iris in the group B than in the group A(P<0.01). Compared to the group C, TNF-α expression in the group B was significantly upregulated following LPS injection(P<0.01).CONCLUSION:TNF-α expression was elevated in EIU rats, and there was a positive correlation between its mean optical density ratio and inflammation degree. Moreover, Xuebijing injection could alleviate inflammation response through the reduction of TNF-α levels.

Objective To explore the occurrence and influencing factors of MODS in elderly pa-tients with SAH.Methods A retrospective analysis was conducted on 187 elderly SAH patients admitted in the Second Affiliated Hospital of Guizhou Medical University from January 2021 to June 2024.According to the presence or absence of MODS,they were divided into MODS group(81 cases)and non-MODS group(106 cases).Their general clinical data were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors for MODS in elderly SHA patients.ROC curve analysis was applied to evaluate the predictive value of the major risk factors for MODS in the patients.Results The MODS group had significantly ad-vanced age,larger proportion of modified Fisher grades Ⅲ—Ⅳ,higher APACHE Ⅱ score,and in-creased FPG level than the non-MODS group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that APACHE Ⅱ score(OR=1.108,95％CI:1.070-1.148,P=0.000)and mo-dified Fisher grade(OR=1.143,95％CI:1.095-1.194,P=0.000)were independent risk factors for MODS in elderly SAH patients.ROC curve analysis suggested that the AUC value of APACHE Ⅱ score,modified Fisher grade and their combination in predicting the occurrence of MODS in elderly SAH patients was 0.809,0.737 and 0.880,respectively,with a sensitivity of 59.35％,88.93％and 84.02％,and a specificity of 88.73％,58.52％and 81.15％,respectively.The combined detection showed better predictive performance than the indicator alone(P＜0.01).Con-clusion The incidence of MODS is quite high in elderly patients with SAH.APACHE Ⅱ score and modified Fisher grade are the main risk factors affecting the occurrence of MODS.

BACKGROUND:Olfactory dysfunction is an early biological marker of various diseases.However,the neuroimaging mechanism by which olfactory dysfunction occurs following cerebral small vessel disease is unclear. OBJECTIVE:To explore the different neuroimaging mechanisms of olfactory function regulation in patients with cerebral small vessel disease and Parkinson's disease,and explore the potential application value of olfactory function assessment in patients with cerebral small vessel disease. METHODS:Neuropsychological and olfactory tests,high-resolution structural magnetic resonance and resting-state functional magnetic resonance data were collected in 80 patients with cerebral small vessel disease,44 healthy controls and 29 patients with Parkinson's disease.DPABI,SPM12 and SPSS were used to analyze and compare the amplitude of low frequency fluctuation,regional homogeneity and functional connectivity values between the cerebral small vessel disease,control and Parkinson's disease groups.Correlations between the significantly altered resting-state functional magnetic resonance imaging measures and olfactory and cognitive scores were evaluated. RESULTS AND CONCLUSION:Compared with the control group,low-frequency fluctuation amplitude of the right dorsolateral superior frontal gyrus and the regional homogeneity of the left wedge leaf were significantly reduced in the cerebral small vessel disease and Parkinson's disease groups.The right dorsolateral superior frontal gyrus and the left cuneiform lobe are the seed points.Compared with the Parkinson's disease group,the functional connectivity values of the right anterior cunei,inferior temporal gyrus,anterior central gyrus and dorsolateral superior frontal gyrus,left posterior central gyrus and inferior temporal gyrus were significantly enhanced in the control and cerebral small vessel disease groups.The left cuneiform lobe was the seed point.Compared with the control group,the functional connectivity of the left lingual gyrus was significantly weakened in the cerebral small vessel disease and Parkinson's disease groups.The functional connectivity values of the left middle temporal gyrus and the right posterior central gyrus were enhanced in the control group compared with the cerebral small vessel disease and Parkinson's disease group,and that was enhanced in the cerebral small vessel disease group compared with the Parkinson's disease group.Correlation analysis showed that the olfactory score and cognitive score were positively correlated in the cerebral small vessel disease group,and the regional homogeneity of the left wedge lobe was negatively correlated with the Montreal Cognitive Assessment Scale score,while the functional connectivity of left wedge lobe-left middle temporal gyrus in the Parkinson's disease group was positively correlated with the olfactory recognition score,and the functional connectivity values of the left wedge lobe-left posterior central gyrus and left wedge lobe-left lingual gyrus were positively correlated with the olfactory identification score and the total olfactory score,respectively.The regulation of olfactory function in patients with cerebral small vessel disease has a different neuroimaging mechanism from that of olfactory dysfunction in patients with Parkinson's disease.The olfactory function of patients with cerebral small vessel disease is related to cognitive function.It is speculated that the olfactory function following cerebral small vessel disease is a secondary change of brain dysfunction,while olfactory dysfunction following Parkinson's disease is directly caused by abnormal function of olfactory-related brain areas.Olfactory function assessment in patients with cerebral small vessel disease has potential application in predicting cognitive function.

Objective:To explore the efficacy and safety of sodium stibogluconate (SSG) and liposomal amphotericin (L-AmB) as well as their combination regimen in the treatment of Kala-azar (also known as visceral leishmaniasis) in China.Methods:Clinical data of patients with Kala-azar hospitalized in the First Hospital of Lanzhou University from January 2012 to December 2021 were collected, including patient demographic information, clinical characteristics of Kala-azar, previous treatment history, therapeutic drugs, clinical efficacy and adverse drug reactions (ADRs) in the treatment. The clinical characteristics, efficacy and occurrence of ADRs related to SSG and L-AmB in patients treated with SSG (SSG group) and L-AmB or SSG+L-AmB (L-AmB or SSG+L-AmB group) were analyzed by descriptive statistics.Results:A total of 44 patients were included in the analysis, including 25 males and 19 females; 25 were children (56.8%) and 19 were adults (43.2%). Thirty-seven patients (84.1%) were treated with SSG (SSG group), which was used as an initial treatment in 32 patients and was used also in previous treatment in 5 patients. Seven patients (15.9%) were treated with L-AmB, including 2 with L-AmB monotherapy and 5 with SSG+L-AmB, and all of them have been treated with SSG before. Among the 32 patients used SSG as initial treatments in the SSG group, 29 (90.6%) were clinically cured. All the 5 patients, who had been treated before, were also clinically cured after prolonged treatments. Seven patients in the L-AmB or SSG+L-AmB group were treated with a low-dose and long-term L-AmB regimen, and all of them were cured without Kala-azar recurrence. The common ADRs of SSG were abnormal liver function and elevated pancreatic enzymes; the common ADRs of L-AmB were hypokalemia and mild elevation of serum creatinine.Conclusions:The efficacy of SSG in initial treatment of patients with Kala-azar is more than 90%, and it can still be used as the preferred drug to treat Kala-azar. The monitoring of liver function and pancreatic enzymes should be paid attention to during the treatment. For patients that have been treated before, especially those with multiple Kala-azar recurrences, L-AmB or SSG+L-AmB should be advised. Low dose and long-term administration of L-AmB can obtain better efficacy and reduce the risk of ADR, and electrolytes and renal function should be monitored during the treatment.

Objective:To explore the efficacy and safety of sodium stibogluconate (SSG) and liposomal amphotericin (L-AmB) as well as their combination regimen in the treatment of Kala-azar (also known as visceral leishmaniasis) in China.Methods:Clinical data of patients with Kala-azar hospitalized in the First Hospital of Lanzhou University from January 2012 to December 2021 were collected, including patient demographic information, clinical characteristics of Kala-azar, previous treatment history, therapeutic drugs, clinical efficacy and adverse drug reactions (ADRs) in the treatment. The clinical characteristics, efficacy and occurrence of ADRs related to SSG and L-AmB in patients treated with SSG (SSG group) and L-AmB or SSG+L-AmB (L-AmB or SSG+L-AmB group) were analyzed by descriptive statistics.Results:A total of 44 patients were included in the analysis, including 25 males and 19 females; 25 were children (56.8%) and 19 were adults (43.2%). Thirty-seven patients (84.1%) were treated with SSG (SSG group), which was used as an initial treatment in 32 patients and was used also in previous treatment in 5 patients. Seven patients (15.9%) were treated with L-AmB, including 2 with L-AmB monotherapy and 5 with SSG+L-AmB, and all of them have been treated with SSG before. Among the 32 patients used SSG as initial treatments in the SSG group, 29 (90.6%) were clinically cured. All the 5 patients, who had been treated before, were also clinically cured after prolonged treatments. Seven patients in the L-AmB or SSG+L-AmB group were treated with a low-dose and long-term L-AmB regimen, and all of them were cured without Kala-azar recurrence. The common ADRs of SSG were abnormal liver function and elevated pancreatic enzymes; the common ADRs of L-AmB were hypokalemia and mild elevation of serum creatinine.Conclusions:The efficacy of SSG in initial treatment of patients with Kala-azar is more than 90%, and it can still be used as the preferred drug to treat Kala-azar. The monitoring of liver function and pancreatic enzymes should be paid attention to during the treatment. For patients that have been treated before, especially those with multiple Kala-azar recurrences, L-AmB or SSG+L-AmB should be advised. Low dose and long-term administration of L-AmB can obtain better efficacy and reduce the risk of ADR, and electrolytes and renal function should be monitored during the treatment.

Objective To explore the effects of escitalopram on coagulation function in depression patients. Methods This was a self-controlled prospective study. The subjects were depression patients (Hamilton Depression Scale(HAMD)score>17)who presented to or hospitalized in the Department of Psychosomatic Disorders in the Third People′s Hospital of Huzhou City from June 1,2016 to June 1,2017. The patients in accordance with inclusion criteria were treated with escitalopram(initial dose was 5 mg/d and increased to 10-20 mg/d within 2 weeks). HAMD rating scale were performed,prothrombin time (PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)were detected before treatment and 4 weeks after treatment. Response was defined as a 50% reduction in HAMD score. Results A total of 95 patients finished the 4 weeks treatment with escitalopram. Of them,38 patients were male with ages from 21 to 64 years and mean age of(39 ± 12)years,with illness duration from 14 to 60 months and mean illness duration of(32 ± 12)years;57 cases were female with ages from 20 to 64 years and mean age of(38 ± 13)years,with illness duration from 12 to 54 and mean illness duration of (28 ± 12)years. HAMD score were(21.8 ± 3.4)and(9.1 ± 3.3)before and after 4 weeks treatment, respectively(t=26.125,P<0.001). The levels of PT,APTT,and TT in patients after 4 weeks treatment were significantly higher than those before treatment[(11.14 ±1.22)s vs.(11.66 ±1.41)s,(29.45 ± 5.24)s vs.(31.28 ± 5.64)s,(20.32 ± 2.08)s vs.(21.15 ± 2.21)s,respectively,all P<0.05]. However, the FIB level after 4 weeks treatment was significantly decreased than that before treatment[(1.92 ± 0.28) g/L vs.(2.01 ± 0.34)g/L,P <0.05]. There were no significant differences among the indexes of coagulation function among the patients with different sex(P>0.05). After treatment,the increased values of PT and TT levels and the decreased value of FIB level in female patients were significantly higher than those in male patients(all P<0.05). After treatment,there were no significant differences in the increased value of PT,TT and APTT and the decreased value of FIB between the response group(80 cases)and the non-response group(15 cases)(all P >0. 05). One 24-year-old female patient presented with upper gastrointestinal bleeding after more than 1 month of escitalopram treatment at a dose of 15 mg/d. Conclusion Escitalopram has an influence on coagulation function in depression patients,especially in female patients,which may increase the risk of bleeding.

Objective To explore the effects of escitalopram on coagulation function in depression patients. Methods This was a self-controlled prospective study. The subjects were depression patients (Hamilton Depression Scale(HAMD)score>17)who presented to or hospitalized in the Department of Psychosomatic Disorders in the Third People′s Hospital of Huzhou City from June 1,2016 to June 1,2017. The patients in accordance with inclusion criteria were treated with escitalopram(initial dose was 5 mg/d and increased to 10-20 mg/d within 2 weeks). HAMD rating scale were performed,prothrombin time (PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)were detected before treatment and 4 weeks after treatment. Response was defined as a 50% reduction in HAMD score. Results A total of 95 patients finished the 4 weeks treatment with escitalopram. Of them,38 patients were male with ages from 21 to 64 years and mean age of(39 ± 12)years,with illness duration from 14 to 60 months and mean illness duration of(32 ± 12)years;57 cases were female with ages from 20 to 64 years and mean age of(38 ± 13)years,with illness duration from 12 to 54 and mean illness duration of (28 ± 12)years. HAMD score were(21.8 ± 3.4)and(9.1 ± 3.3)before and after 4 weeks treatment, respectively(t=26.125,P<0.001). The levels of PT,APTT,and TT in patients after 4 weeks treatment were significantly higher than those before treatment[(11.14 ±1.22)s vs.(11.66 ±1.41)s,(29.45 ± 5.24)s vs.(31.28 ± 5.64)s,(20.32 ± 2.08)s vs.(21.15 ± 2.21)s,respectively,all P<0.05]. However, the FIB level after 4 weeks treatment was significantly decreased than that before treatment[(1.92 ± 0.28) g/L vs.(2.01 ± 0.34)g/L,P <0.05]. There were no significant differences among the indexes of coagulation function among the patients with different sex(P>0.05). After treatment,the increased values of PT and TT levels and the decreased value of FIB level in female patients were significantly higher than those in male patients(all P<0.05). After treatment,there were no significant differences in the increased value of PT,TT and APTT and the decreased value of FIB between the response group(80 cases)and the non-response group(15 cases)(all P >0. 05). One 24-year-old female patient presented with upper gastrointestinal bleeding after more than 1 month of escitalopram treatment at a dose of 15 mg/d. Conclusion Escitalopram has an influence on coagulation function in depression patients,especially in female patients,which may increase the risk of bleeding.

Objective To evaluate the efficacy and safety of lenalidomide in a real-world clinical practice in Chinese patients with multiple myeloma (MM).Methods It was a prospective,multi-center,observational study.A total of 165 consecutive patients with MM treated with lenalidomide-based regimens were enrolled in 12 hospitals from June 2013 to November 2015.Relevant information was recorded,such as baseline clinical data,cytogenetic abnormalities,treatment regimens,and duration of treatment,safety,and survival.Results (1)There were 126 relapsed and refractory MM (RRMM) patients,25 newly diagnosed patients and 19 maintenance patients.The evaluable RRMM patients accounted for 120 cases,among which 74 cases(61.7％) reached the partial response (PR) or above,and a very good partial response (VGPR) in 16 patients (13.3％),a complete response (CR) in 14 cases (11.7％),a strictly complete response (sCR) in 4 cases (3.3％).Thus,a VGPR or above in 34 patients accounted for 28.3％.(2)The median follow-up was 13 months,the median time to progression 12 months.The median survival after receiving lenalidomide was 19 months,and the median overall survival (OS) was 62 months.(3) The univariate analysis in 120 RRMM patients suggested that prognostic factors for significant improvement in PFS included normal karyotype,international staging system (ISS) Ⅰ-Ⅱ,t(4;14) negative (detected by fluorescence in situ hybridization),non-bortezomib resistance and response to previous regimens.As to OS,nonbortezomib resistance,response to previous regimens and non-primary refractoriness were positive factors.Multivariate analysis showed that the response to previous regimens (PR or better) was an independent good prognostic factor for progress-free survival (PFS),non-bortezomib resistance and non-primary refractoriness for OS.(4) Grade 3 or 4 adverse events that occurred in more than 10％ of all enrolled patients were neutropenia (12.7％),leukocytosis (11.5％) and thrombocytopenia (12.7％).Owing to intolerance of toxic side effects,7 cases withdrew lenalidomide.Conclusions No matter what combination,regimens containing lenalidomide are effective to RRMM patients with overall response rate 61.7％,a time to progression 12 months and an overall survival 62 months.The toxicity is quite tolerable and manageable.In addition,the response to previous treatment (reached PR or above) is the independent good prognostic factor for PFS,non-bortezomib resistance and non-primary refractoriness for OS.Clinical trail registration Clinicaltrials.gov,NCT01947309

Objective To evaluate the construction of expression vector for fusion protein of cell-penetrating pep-tide CCL (PEP-CCL).Methods CCL6-PEP-6XHis was inserted into plasmid pABP,pABP-CCL6-PEP plasmid was extracted and then transfected into HEK293 cells,CCL6-PEP-6XHis was expressed and purified by chromatog-raphy and detected with Western Blot.Results PEP-CCL express vector was successfully constructed and purified. PCR product of CCL6-PEP-6XHis Tag was ligated with T vector,recombinant was transferred into the host cells, then host cells were cultured,plasmid was extracted and sequenced,the sequence was identical to targeted gene. CCL6-PEP-6XHis was successfully inserted into the eukaryotic expression vector pABP,plasmid was extracted and digested,electrophoresis results revealed that a fragment with 430bp was digested by Hind Ⅲ+XbaⅠ,which was identical to the expected value.Western Blot revealed that CCL6-PEP fusion protein could be recognized by His monoclonal antibody.Conclusion PEP-CCL express vector can be constructed and expressed in eukaryotic cells.