Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer(VLU),so as to provide a reference basis for early identification of people at high risk of delayed healing.Methods Using a convenience sampling method,331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group,and 112 patients admitted to another tertiary A hospital were selected as an external validation group.Risk factors for delayed healing in VLU patients were screened using univariate analysis,LASSO regression,and multivariate logistic regression analysis,and a risk prediction model was constructed using R software,and the predictive effects of the models were examined using the area under the receiver operating characteristic curve,the Hosmer-Lemeshow test,decision curve,and the bootstrap resampling for internal validation and spatial external validation were performed,respectively.Results The predictors that ultimately entered the prediction model were diabetes(OR=4.752),deep vein thrombosis(OR=4.104),lipodermatosclerosis(OR=5.405),ulcer recurrence(OR=3.239),and ankle mobility(OR=5.520).The model had good discrimination(AUC:0.819 for internal validation and 0.858 for external validation),calibration(Hosmer-Lemeshow test:χ2=13.517,P=0.095 for internal validation and χ2=3.375,P=0.909 for external validation)and clinical validity.Conclusion The model constructed in this study has good differentiation and calibration,and it can effectively predict people at high risk of delayed healing of VLU,which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Gefitinib is the well-tolerated first-line treatment of non-small cell lung cancer. As it needs analgesics during oncology treatment, particularly in the context of the coronavirus disease, where patients are more susceptible to contract high fever and sore throat.This has increased the likelihood of taking both gefitinib and antipyretic analgesic acetaminophen (APAP). Given that gefitinib and APAP overdose can predispose patients to liver injury or even acute liver failure, there is a risk of severe hepatotoxicity when these two drugs are used concomitantly. However, little is known regarding their safety at therapeutic doses. This study simulated the administration of gefitinib and APAP at clinically relevant doses in an animal model and confirmed that gefitinib in combination with APAP exhibited additional hepatotoxicity. We found that gefitinib plus APAP significantly exacerbated cell death, whereas each drug by itself had little or minor effect on hepatocyte survival. Mechanistically, combination of gefitinib and APAP induces hepatocyte death via the apoptotic pathway obviously. Reactive oxygen species (ROS) generation and DNA damage accumulation are involved in hepatocyte apoptosis. Gefitinib plus APAP also promotes the expression of Kelch-like ECH-associated protein 1 (Keap1) and downregulated the antioxidant factor, Nuclear factor erythroid 2-related factor 2 (Nrf2), by inhibiting p62 expression.Taken together, this study revealed the potential ROS-mediated apoptosis-dependent hepatotoxicity effect of the combination of gefitinib and APAP, in which the p62/Keap1/Nrf2 signaling pathway participates and plays an important regulatory role.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:To investigate the effect of alanine aminotransferase(ALT) level in early pregnancy and its interaction with maternal body mass index(BMI) on neonatal birth weight.Methods:Data of full-term singleton delivery mother-infant pairs from 2014 to 2016 in Wenzhou were collected. The exposure(ALT>40 U/L) and non-exposure(ALT≤40 U/L) groups were matched using 1∶4 propensity score matching. Logistic regression analysis was used to analyze the relationship between increased ALT level in the first trimester and abnormal birth weight as well as the effect of its interaction with BMI on abnormal birth weight.Results:Multivariate analysis showed that the risks of macrosomia and large for gestational age(LGA) in pregnant women with ALT>40 U/L were 1.584(95% CI 1.323-1.896) and 1.292(95% CI 1.142-1.461) compared with those with ALT≤40 U/L. ALT in the first trimester displayed an additive interaction with BMI on the risk of macrosomia [the relative excess risk due to interaction( RERI)=2.032, 95% CI 0.307-3.757, the attributable proportion due to interaction( API)=0.448, 95% CI 0.221-0.684, the synergy index( S)=2.348, 95% CI 1.274-4.324]. In addition, there was no interaction between ALT and BMI on the risk of LGA, and nor did the association of ALT in the first trimester with low birth weight or small for gestational age exist. Conclusion:ALT>40 U/L in the first trimester increases the risk of high birth weight, especially in overweight or obese pregnant women in the first trimester. Therefore, it is suggested to strengthen the monitoring of ALT level in obese pregnant women during the first trimester.

Objective To observe the protective effect of polypyrimidine bundle-binding proteinrelated splicing factor (PSF) over-expression on RPE cell injury induced by advanced glycation end products (AGEs).Methods The human RPE cells cultured in vitro were divided into three groups:normal control group (N group),blank control group (N + AGEs group),empty vector control group (Vec + AGEs group),and PSF high expression group (PSF + AGEs).group).RPE cells in N group were routinely cultured;RPE cells in N + AGEs group were only transfected but did not introduce any exogenous genes combined with AGEs induction;Vec +AGEs group and PSF + AGEs group were transfected with pcDNA The empty vector or pcDNA-PSF eukaryotic expression plasmid was introduced into RPE cells and induced by AGEs.Except the N group,the other 3 groups of cells were transfected accordingly,and were stimulated with 150 μg/ml AGEs for 72 h after 24 h.HE staining and Hoechst 33258 staining were used to observe the effect of high PSF expression on the morphological changes of RPE cells;ROS level detection was used to analyze the effect of PSF high expression on the ROS expression of RPE cells induced by AGEs;MTT colorimetric method was used to detect the high PSF expression Effects on the viability of RPE cells;Western blot was used to detect the effects of different time and dose of PSF on the expression of heme oxygenase 1 (HO-1).Results HE staining and Hoechst 33258 staining observation showed that the cells in group N were full in shape,the nucleus was round,the cytoplasm was rich,and the staining was uniform;the cells in N + AGEs group and Vec + AGEs group were reduced in size,the eosinophilic staining was enhanced,and the nucleus was densely densely stained.Pyrolysis and even fragmentation;the morphology of cells in the PSF + AGEs group was still full,the cytoplasm staining was more uniform,and the nucleus staining was uniform.The results of MTT colorimetry showed that high expression of PSF can effectively improve the viability of RPE cells,but this effect can be effectively antagonized by ZnPP,and the difference is statistically significant (F=33.26,P＜0.05).DCFH-DA test results showed that compared with the N + AGEs group and Vec + AGEs group,the ROS production in PSF + AGEs group decreased,the difference was statistically significant (F=1 1.94,P＜0.05).Western blot analysis showed that PSF protein upregulated HO-1 expression in a time-and dose-dependent manner.The relative expression level of HO-1 at 24,48,and 72 h after PSF protein was significantly higher than that at 0 h,and the difference was statistically significant (F=164.91,P＜0.05).The relative expression level of HO-1 under the action of 0.1,0.5,1.0,1.5,and 2.0 μg PSF protein was significantly higher than 0.0 μg,and the difference was statistically significant (F=104.82,P＜0.05).Conclusion PSF may inhibit the production of ROS by up-regulating the expression of HO-1,thus protecting the RPE cells induced by AGEs.

Objective To investigate the inhibitory effect oflentivirus-mediated polypyrimidine bundle binding protein-associated splicing factor (PSF) on retinal neovascularization (RNV) in mice model of oxygeninduced retinopathy (OIR).Methods One hundred and twelve 5-day-old C57BL/6J mice were randomly divided into normal control group,simple OIR model group,OIR model + lentivirus empty vector treatment group (Vec group) and OIR model + PSF lentivirus treatment group (PSF group),with 16,32,32 and 32 mice,respectively.When the mice were 7 days old,the mice in the normal control group were fed in a routine environment,and the mice in the OIR model group,Vec group and PSF group were established OIR model.The mice in the Vec group and PSF group were given an intravitreal injection of 1 μl of lentiviral vector and PSF lentivirus (titer 1 × 10~ TU/ml) at the age of 12 days.No injection was performed in the normal control group and simple OIR group.RNV was evaluated by counting the number of pre-retinal neovascular cells and analysis of non-perfusion area by immunofluorescent staining of the mouse retina.Real-time quantitative PCR was applied to detect the mRNA expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and hemeoxygenase1 (HO-1).Western blot analysis was applied to detect the protein expression ofNrf2,HO-1 and PSF.Results Of the normal control group,simple OIR model group,Vec group and PSF group,the number of pre-retinal neovascular cell nuclei were 0.00,14.36 ± 5.50,15.67 ± 4.96,8.13 ± 2.09,the non-perfusion area were 0.00％,(35.71 ± 2.81)％,(36.57 ± 4.53)％,(15.33 ± 4.75)％,respectively.The differences of the number of pre-retinal neovascular cell nuclei and non-perfusion area among 4 groups were significant (F=24.87,165.70;P＜0.05).Compared with the normal control group,there were more pre-retinal neovascular cell nucleis and larger nonperfusion area in the simple OIR model group and Vec group (P＜0.05).Compared with the simple OIR model group and Vec group,there were lower pre-retinal neovascular cell nucleis and smaller non-perfusion area in the PSF group (P＜0.05).Real-time quantitative PCR and Western blot showed that the mRNA expression of Nrf2,HO-1 (F=53.66,83.54) and protein expression ofNrf2,HO-1 and PSF (F=58.38,52.69,24.79) among 4 groups were significant (P＜0.05).The rnRNA expression ofNrf2,HO-1 and protein expression of Nrf2,HO-1 and PSF in the simple OIR model group and Vec group decreased significantly than those in the normal control group (P＜0.05).The mRNA expression ofNrf2,HO-1 and protein expression ofNrf2,HO-1 and PSF in the PSF group were increased significantly than those in the simple OIR model group and Vec group (P＜0.05).model group and Vec group (P＜0.05).Conclusion Intravitreal injection of lentivirus-mediated PSF inhibits RNV in mice model of OIR possibly through up-regulating the expression of Nrf2 and HO-1.

Objective:To evaluate the surgical outcomes of 25G + vitrectomy with air tamponade and 1-day prone positioning for idiopathic macular hole (IMH). Methods:A prospective analysis was performed on 39 patients (39 eyes) underwent 25G + pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) removal and fluid-air exchange for IMH from July 2012 to December 2013. After vitrectomy, patients were instructed to keep prone positioning for only 1 day (the air group). These patients were compared to 30 consecutive patients from July 2010 to July 2012, who were conducted 25G + PPV with 25% SF 6 tamponade. They remained in the same face-down position for 3 days postoperatively (SF 6 group). Age, gender, logMAR BCVA, macular thickness, macular hole diameter, axial length, macular hole stages and pseudophakic status were collected as baseline characteristics in both groups. The initial hole-closure rate, visual outcome and intra-operative & post-operative complications were evaluated for 6 months. Group comparisons of numeric variables were made by using two sample t-test. Group difference of categorical variables was determined by using standard chi-square test or rank sum test. Results:Thirty nine patients (39 eyes) and 30 patients (30 eyes) were respectively enrolled in air group and SF 6 group. The distribution of age ( t=-1.63), gender ( χ 2=0.03), logMAR BCVA ( t=0.39), macular thickness ( t=-0.93), macular hole diameter ( t=-0.70), axial length ( t=-0.56), macular hole stages ( Z=-0.47) and pseudophakic status ( χ 2=0.13) was similar in both groups. Anatomical closure of macular holes was achieved in 35 (89.7%) of the 39 eyes in the air group and in 27 eyes (90.0%) in the SF 6 group. There was no significant difference of closure rate between the two groups ( χ 2=0.001, P=0.970). The postoperative visual acuity of gaining, stability and decreasing 2 or more 2 lines was achieved in 23 eyes, 10 eyes and 6 eyes in air group and 18 eyes, 6 eyes and 6 eyes in SF 6 group. The proportion of visual acuity improvement in air group was lower than that in SF 6 group without the statistical significance ( Z=-0.08, P=0.93). The gas bubble was absorbed sooner in the air group (mean 8.54±1.74 days) than in the SF 6 group (mean 31.10±3.20 days). No retinal break, retinal detachment or endophthalmitis occurred in either group. Postoperatively intraocular pressure was elevated temporarily in 2 eyes of the air group and 3 eyes in the SF 6 group. All returned to normal limit after local medication. Conclusion:Compared to SF 6 group, air group has similar anatomical macular hole closure rate and visual acuity rehabilitation.

Objective To study the safety and effectiveness of polymer-free sirolimus-eluting Nano stent in patients with unstable angina pectoris. Methods Three hundred and twenty-one patients with unstable angina pectoris were divided into Nano stent group(group A,n=157)and Endeavor resolute stent group(group B,n=164). The cardiovascular events were compared postoperative 12 months. The minimal intima cavity area and mini-mum bracket section area and neointimal area were compared postoperative 12 months by intravascular unltrasound (IVUS). Results There were 7 cases of cardiovascular events in group A and 6 in group B postoperative 12 months(P=0.727)and 2 patients in group A and 3 in group B were re-implanted stent because of restenosis post-operative 12 months(P=0.672). The neointimal area were(0.31 ± 0.11 mm2)in group A and(0.29 ± 0.12 mm2) in group B postoperative 12 months(P = 0.985). The minimal intima cavity area(P = 0.921)and the minimum bracket section area(P=0.934)were narrower postoperative 12 months than immediately after the operation in two groups. Conclusion With less cardiovascular events and being safe and reliable,the clinical effect of polymer-free sirolimus-eluting Nano stent implantation is similar to that of Endeavor resolute stent implantation.

OBJECTIVE:To provide reference for rational use of Shexiang tongxin dripping pills in clinic. METHODS:In retrospective study,the utilization of Shexiang tongxin dripping pills in outpatients and inpatients of our hospital during Jan. 2014-May 2015 was analyzed statistically in terms of gender,age,department,irrational drug use,ADR and DUI,etc. RE-SULTS:There were 719 outpatient prescriptions and 281 inpatient medical orders. The female was more than male with ratio of 1.42:1. Most patients aged 80-89 year-old(35.4%). Shexiang tongxin dripping pills were mostly used in cardiovascular medicine de-partment(760 pieces/copies,76.0%). There were 72 prescriptions/medical orders that did not conform to the indications(7.2%), and 7 prescriptions/medical orders for overdose use(0.7%). No obvious ADR was found. DUI of Shexiang tongxin dripping pills was 1.007. CONCLUSIONS:Although the clinical use of Shexiang tongxin dripping pills in our hospital is basically rational,there still are some nonstandard uses,which should be taken seriously. In order to reduce ADR,the clinical use of Shexiang tongxin dripping pills should be strictly in accordance with the drug instructions and should emphasize the syndrome differentiation based on treatment.