Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Small cell lung cancer (SCLC) is the most malignant lung cancer with the highest mortality. At present, the first-line standard treatment is still based on Etoposide and Platinum chemotherapy. However, for SCLC that progresses after first-line therapy, the treatment options are still very limited. Since the molecular mechanism of first-line drug resistance of SCLC is still unclear, and the precision medicine strategy after first-line drug resistance is still in the pre-clinical stage. The proportion of secondary biopsy and genetic testing is very low after the progress of first-line treatment of SCLC. In this study, we report a case of a middle-aged woman who was first diagnosed with SCLC. Adenocarcinoma with sensitive gene mutations and repeated changes of small cell carcinoma were detected by multiple biopsies during the course of the disease, suggesting that the patient may be a special subtype of SCLC - mixed SCLC (M-SCLC). In this case, the patient has been treated with radiotherapy and chemotherapy, immunotherapy and targeted therapy successively, and the survival time has reached 2 years and 8 months. Through the case report and literature review retrospectively, this study aimed to explore the part patients may start to present hybrid histopathologic types or tissue type change after treatment of SCLC. Biopsy pathologic histology and genetic testing is necessary after disease progression to look for potential therapeutic targets, so as to give precise treatment based on molecular markers detection results and provide the patient with the benefit of survival for as long as possible.
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Adenocarcinoma of Lung ; Etoposide ; Female ; Humans ; Lung Neoplasms/genetics* ; Middle Aged ; Retrospective Studies ; Small Cell Lung Carcinoma/genetics*

A rapid analysis method based on ultraviolet-visual(UV-Vis) spectroscopy, near infrared(NIR) spectroscopy and multivariable data analysis was established for quality evaluation of Shengxuebao Mixture. The contents of eight active ingredients of Shengxuebao Mixture including albiflorin, paeoniflorin, 2, 3, 5, 4'-tetra-hydroxy-stilbene-2-O-β-D-glucopyranoside, specnuezhenide,ecliptasaponin D, emodin, calycosin-7-glucoside and astragaloside Ⅳ were simultaneously detected by using this method. HPLC-UV-MS was used as a reference method for determining the contents of these ingredients. Partial least squares(PLS) analysis was implemented as a linear method for multivariate models calibrated between UV spectrum/NIR spectrum and contents of 8 ingredients. Finally, the performance of the model was evaluated by 24 batches of test samples. The results showed that both UV-Vis and NIR models gave a good calibration ability with an R~2 value above 0.9, and the prediction ability was also satisfactory, with an R~2 value higher than 0.83 for UV-Vis model and higher than 0.79 for NIR model. The overall results demonstrate that the established method is accurate, robust and fast, therefore, it can be used for rapid quality evaluation of Shengxuebao Mixture.
Calibration ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; Least-Squares Analysis ; Mass Spectrometry ; Spectroscopy, Near-Infrared

BACKGROUND: The aim of this study is to systematically evaluate the efficacy and adverse effects of Lobaplatin and Cisplatin in the treatment of malignant pleural effusion. METHODS: The databases of Medline (PubMed), Embase, Web of Science, Cochrane, Wanfang, CNKI and VIP were retrieved so as to search the studies about the randomized controlled clinical trials (RCT) that compared the Lobaplatin and Cisplatin for malignant pleural effusion. The main outcome indicators include objective response rate, complete response, partial response, nephrotoxicity, chest pain, gastrointestinal reaction, myelosuppression, fever response and hepatotoxicity. Relative risk was used as the effect size, which was expressed as 95% confidence interval. The meta-analysis was performed using Stata 14.0 statistical software. RESULTS: A total of 12 RCTs and 720 MPE patients were included. The results showed that the ORR (RR=1.27, 95%CI: 1.15-1.40, P<0.001), CR (RR=1.39, 95%CI: 1.09-1.78, P=0.007), PR (RR=1.21, 95%CI: 1.02-1.42, P=0.026) in LBP thoracic perfusion chemotherapy were significantly higher than those in DDP thoracic perfusion chemotherapy. The incidence of nephrotoxicity (RR=0.31, 95%CI: 0.13-0.71, P=0.005) and gastrointestinal reactions (RR=0.44, 95%CI: 0.31-0.62, P<0.001) in the LBP group were significantly lower than those in DDP group. CONCLUSIONS Compared with DDP pleural perfusion chemotherapy, the ORR, CR and PR of LBP pleural perfusion chemotherapy for MPE are significantly better than DDP, and its nephrotoxicity and gastrointestinal reactions are remarkably lower than DDP.
Antineoplastic Agents ; adverse effects ; therapeutic use ; Cisplatin ; adverse effects ; therapeutic use ; Cyclobutanes ; adverse effects ; therapeutic use ; Humans ; Organoplatinum Compounds ; adverse effects ; therapeutic use ; Pleural Effusion, Malignant ; drug therapy ; Randomized Controlled Trials as Topic

In this study, the HPLC-UV-MS method for the simultaneous determination of eight active ingredients of Shengxuebao Mixture were developed based on the concept of quality by design（QbD）with a stepwise optimization approach. After the analytical target profile（ATP）had been defined, albiflorin, paeoniflorin, 2, 3, 5, 4'-tetra-hydroxy-stilbene-2-O-β-D-glucopyranoside, specnuezhenide, ecliptasaponin D, emodin, calycosin-7-glucoside, and astragaloside Ⅳ were identified as the indicator components. The resolution and the signal-to-noise ratio of indicator components were then selected as critical method attributes (CMA) for the first step optimization. According to the results collected from fractional factorial design, critical method parameters (CMP) were determined with a multiple linear regression method, which included the amount of acid addition in the mobile phase, temperature, gradient, and wavelength. After that, the amount of acid addition and the wavelength were optimized to improve the resolution and the signal-to-noise ratio of the indicator components. The peak symmetry factors of specnuezhenide and emodin were then set as CMA for the second step optimization. The Box-Behnken designed experiments were conducted. The temperature and gradient were optimized after modelling. The design space were calculated and verified. The optimized analytical method was validated, and the results showed a good precision, accuracy and stability, which means that it can be used for the quantification of the indicator components in Shengxuebao Mixture.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; analysis ; Mass Spectrometry ; Phytochemicals ; analysis ; Reproducibility of Results

OBJECTIVETo observe the effects of low-intensity pulsed ultrasound (LIPUS) pretreatment on pulmonary expression of high mobility group box-1 (HMGB1) in a rat model of lung ischemia-reperfusion (IR).

METHODSThirty-two male SpragueDawley rats weighing 250-300 g were randomly divided (=8) into sham-operated group, lung IR group, LIPUS pretreatment group and pretreatment with α7-nicotinic cholinergic receptor (α7nAChR) antagonist group. In the sham-operated group, the left pulmonary hilum was dissociated without occlusion; in the other 3 groups, the left pulmonary hilum was occluded for 45 min followed by reperfusion for 180 min; LIPUS pretreatment for 30 min and intraperitoneal injection of methyllycaconitine (2 mg/kg), an α7nAChR antagonist, were administered before the operation. The wet/dry weight ratio (W/D) and pulmonary permeability index (LPI) of the lung tissue were measured, and the lung histopathology was observed and scored. The contents of interleukin-1 (IL-1) and IL-6 in the lung tissues were measured using ELISA, and the pulmonary expression of HMGB1 protein was detected using immunofluorescence assay and Western blotting.

RESULTSCompared with those in the sham-operated group, the W/D of the lung tissue, LPI, pathological scores, IL-1 and IL-6 contents in the lung tissue, and pulmonary HMGB1 expression all significantly increased in the other 3 groups ( < 0.05). LIPUS preconditioning significantly lowered the W/D values, LPI, pathological score, IL-1 and IL-6 contents and HMGB1 expression in the lung tissues following lung IR, and these effects were significantly inhibited by administration of methyllycaconitine.

CONCLUSIONSLIPUS preconditioning can reduce lung IR injury possibly by activating α7nAChR-dependent cholinergic anti-inflammatory pathway to reduce lung tissue HMGB1 expression.

Objective To study the effect of direct cover vitrification (DCV ) on the morphology of follicles from human o‐varian tissue .Methods Biopsies of ovarian tissue was cryopreserved by DCV and some of them was cultured for 7 days .The rates of primordial follicles ,primary follicles and secondary follicles were counted .Results Compared to the fresh group and frozen group ,the percent of primordial follicle of fresh‐cultured group ,frozen group decreased ,primary follicle significantly increased(P<0 .05) .The percent of primordial follicle ,primary follicle ,secondary follicles of fresh‐cultured group were lower than those of fresh group(P<0 .01) .In frozen group ,the rates of the primary and secondary follicles with normal morphology were lower than those of fresh cultured group(P<0 .05) .The rate of normal morphology of secondary follicles of frozen‐cultured group was demonstrably lower than that of fresh‐cultured group(P<0 .05) .Conclusion Partial follicles might be injured in cryopreserved human ovarian tissues by direct cover vitrification .A period of post‐thaw culture may enhance follicle recovery .

Objective To evaluate uterine cavity of the patients who accept the treatment in vitro fertilization‐embryo trans‐fer(IVF‐ET)and determine the clinical value of hysteroscopy for the patients .Methods Between January 2012 and May 2014 ,539 cases who accepted the IVF‐ET and hysteroscopy ,were divided into two grops ,group A(258 patients examinated before IVF‐ET cycle) and group B(281 patients after the IVF‐ET failure) ,and retrospective analysis was performed for their uterine cavity and cervix canal data .Results The total incidence of abnormal hysteroscopic findings was 49 .54% ,and group B was significantly high‐er than that in group A(54 .10% vs .44 .57% ,χ2 =4 .5 ;P=0 .043) .The percent of abnormal cervix canal was 18 .74% ,and there wasn′t significant difference between the two groups .Conclusion The incidence of abnormal hysteroscopic findings in IVF‐ET is higher than that in normal patients ,so hysteroscopy has an important clinical value for diagnosis and evalution ,especially for pa‐tients with failure of IVF‐ET .

Objective To evaluate the clinical diagnosis and treatment of acute renal infarction.Methods Two cases (3 sides) of acute renal infarction were reported.The patients were 1 male and 1 female,with the age of 62 and 54 years.Case 1 presented acute left flank pain,and enhanced CT showed a non-enhanced area in the upper and mid pole of the left kidney.The diagnosis of focal renal infarction was made and treated with low-molecular heparin (6000 U ).Case 2 presented acute both right abdominal and flank pain,and enhanced CT showed right renal artery embolism and right renal complete infarction.Digital subtraction angiography (DSA) and catheter thrombolytic therapy was applied.4 months later,the patient presented acute left flank pain,and enhanced CT showed a low density area in left kidney without enhanced by contrast,and DSA and catheter thrombolytic therapy was applied again.Results In case 1,contrastenhanced MRI showed a still low signal area like enhanced CT after 2 days of treatment.The renal function remained normal in the follow-up of 36 months.In case 2,the right kidney resorted to moderate blood flow but became atrophy later.In the follow-up of 4 months,a recurrent focal infarction was confirmed in left kidney by enhanced CT.The left kidney also resorted to moderate bloodflow after DSA and catheter thrombolytic therapy.The renal function became normal after follow-up of 10 months and no new infarction was observed.Conclusions The diagnosis of acute renal infraction could be made by enhanced CT or MRI.Early diagnosis and location of the infraction renal artery is critical for recovery of the impaired renal function.Acute renal infraction should be suspected in patients with unexplained persistent and steady flank or abdominal pain in emergence department.

Objective To know the situation of teaching and teacher preparation for nursing under-graduates, and then reference to reasonable clinical teaching mode. Methods Investigated clinical pre-ceptors from 30 hospitals by serf-designed questionnair to know their basic situation, and then investigated nursing undergruaduates who had enter school in 2004 to know their evaluation about their preceptors in the aspect of basic quality. Results In professional tides, most of the teachers are nurse-in-charge, and have been working over 10 years, but qualification certificates levels were low and 50% of them teaching. Experience was short and not qualified to the popurse of bachelors degree, nurse-in-charge and more than five years nursing experience. The ratio in thesis writing, teaching training and awards are rather low. There were teaching assessment from students, mainly in teaching and research initiative. Conclusions The qualities of nursing teachers should be defined and should be established standard teaching training system and qualification organization, the capabilities of teaching and research innovations should be improved.