White matter hyperintensities(WMH)is prevalent in the elderly population and is associated with stroke,cognition,gait instability,and neuropsychiatric symptoms.WMH burden usually increases with the growth of age.However,in recent years,there are researches found that WMH is actually dynamic variable.During the development,part of the WMH may regress,accompanied by the slowdown of brain atrophy and cognitive improvement.While,its mechanism,influencing factors and clinical significance remains unclear,and the effective treatment to reverse WMH is not clear.The article reviewed the current studies on the regression of WMH,aiming to provide reference for clinicians to actively perform intervention in the WMH related factors,promote their reversal in the early stage and improve the brain health of patients.

Objective To explore the effect of pregabalin on sleep of patients after video-assisted thoracic surgery(VATS).Methods 120 cases of patients undergoing VATS under general anesthesia were randomly divided into 75 mg pregabalin group(group A),150 mg pregabalin group(group B),and placebo group(group C),with 40 patients in each group.On the night of the operation,the morning and evening of the first day and the second day after the operation,the patients in the three groups were given one tablet of pregabalin(75 mg),one tablet of placebo with the same shape and smell,two tablets of pregabalin(150 mg)and two tablets of placebo with the same shape and smell respectively.Athens insomnia scale(AIS)was used to evaluate the incidence of postoperative sleep disturbance(PSD)on the night of operation,and the patients'sleep quality every night from one night before operation to the 2nd day after operation was assessed using the St.Mary's Hospital sleep questionaire(SMH).Pittsburgh sleep quality index(PSQI)was used to evaluate the patients'sleep quality one day before the operation,7 days after operation,and 1 month after the operation.The digital rating scale(NRS)was used to evaluate the patients'pain at the incision and the surgical side.The remedial analgesia,incidence of adverse events in the 72 h postoperative period,and patient satisfaction score were recorded.Results The incidence of PSD in group A,group B and group C was 45.0％,42.5％and 72.5％,respectively,the incidence of group A and group B was significantly lower than in group C(group A,B and C compared in pairs,P＜0.016 7).The SMH scores in group A and group B were significantly higher than in group C on the day of operation,the first day and the second day after operation(group A,B and C compared in pairs,P＜0.016 7).The incidence of NRS scores in groups A and B at the incision and postoperative remedial analgesia was significantly lower than in group C on postoperative day 1 and postoperative day 2(group A,B and C compared in pairs,P＜0.016 7).There was no statistically significant difference in the pain scores at the incision and shoulder among the three groups at the remaining time points.The postoperative patient satisfaction scores were significantly higher in group A and group B than in group C(P＜0.01).The incidence of dizziness in group B was significantly higher than in the other two groups(P＜0.016 7).Conclusion Oral administration of pregabalin(75 mg/150 mg)for 3 days after VATS can reduce the incidence of PSD and improve the quality of sleep that night,but oral administration of 150 mg pregabalin may increase the incidence of dizziness.

Objective:To analyze the current status of anesthesiology research in the world and China in 2023 and to identify the anesthesiology research hotspots using bibliometrics.Methods:The literature related to anesthesiology published in PubMed in 2023 was searched, and the country and author of the literature, as well as the key words of the literature were visually analyzed by using the software CiteSpace6.2. R4.Results:A total of 22 473 articles were included, the country with the largest number of publications was the United States, and China ranked second. The author with the highest number of publications in the field of anesthesiology in the worldwide in 2023 was Kaye Alan D from the United States. Chronic pain, general anesthesia and pain management were the research hotspots in the field of anesthesiology worldwide in 2023. The research hotspots in the field of anesthesiology in China focused on general anesthesia, oxidative stress and neuropathic pain.Conclusions:The United States is the leader in the research in the field of anesthesiology, with China following behind. The keywords of the literature in the field of anesthesiology between China and the world are roughly the same, reflecting the convergence of Chinese scientific research with global scientific research. Domestic anaesthesia practitioners can refer to or learn from the research hotspots of related countries and strengthen communication and cooperation between teams while conducting academic research.

Microglial surveillance plays an essential role in clearing misfolded proteins such as amyloid-beta, tau, and α-synuclein aggregates in neurodegenerative diseases. However, due to the complex structure and ambiguous pathogenic species of the misfolded proteins, a universal approach to remove the misfolded proteins remains unavailable. Here, we found that a polyphenol, α-mangostin, reprogrammed metabolism in the disease-associated microglia through shifting glycolysis to oxidative phosphorylation, which holistically rejuvenated microglial surveillance capacity to enhance microglial phagocytosis and autophagy-mediated degradation of multiple misfolded proteins. Nanoformulation of α-mangostin efficiently delivered α-mangostin to microglia, relieved the reactive status and rejuvenated the misfolded-proteins clearance capacity of microglia, which thus impressively relieved the neuropathological changes in both Alzheimer's disease and Parkinson's disease model mice. These findings provide direct evidences for the concept of rejuvenating microglial surveillance of multiple misfolded proteins through metabolic reprogramming, and demonstrate nanoformulated α-mangostin as a potential and universal therapy against neurodegenerative diseases.

Objective:To analyze clinical characteristics and genetic characteristics of children with ATP sensitive potassium passage (K ATP-HI). Methods:Forty-five children with genetically confirmed K ATP-HI and their families admitted to Beijing Children′s Hospital of Capital Medical University between February 2002 and December 2018 were selected as the study subjects. A detailed retrospective analysis of the patient's clinical characteristics, diagnosis and treatment process, disease-causing gene carrying status and later follow-up data was performed. ABCC8/KCNJ11 gene was sequenced by second-generation sequencing technology. Results:Among 45 children with K ATP-HI, 34 cases (75.6%) were neonatal onset, the first symptoms of 21 cases (46.7%) were convulsions. 39 cases had been treated with diazoxide, including 12 cases (30.8%) with good efficacy, 16 cases (41%) with poor efficacy and 11 cases with uncertain efficacy. Octreotide was further applied in 18 patients with uncertain or ineffective efficacy after diazoxide treatment, and 13 cases (72.2%) were effective, 3 cases were ineffective, and 2 cases were uncertain. 10 CHI patients who were ineffective to drug treatment or had clearly focal lesions confirmed by 18F-dopa positron emission by computed tomography ( 18F-DOPA PET) scans had undergone surgical treatment, 8 of which underwent partial pancreatectomy and blood glucose returned to normal after the operation; the other 2 cases underwent subtotal pancreatectomy and both had secondary diabetes after operation. Among 45 children with K ATP-HI, 1 case carried both ABCC8 and KCNJ11 mutations, 10 cases carried ABCC8 compound heterozygous mutations, and the remaining 34 cases carried ABCC8/KCNJ11 single genetic mutation. Among them, 21 cases had paternal inheritance, and 3 cases had maternal inheritance, 6 cases were identified with de novo mutations. Conclusions:Diazoxide treatment was ineffective for most K ATP-HI children, but octreotide had a higher effective rate. Partial pancreatectomy for focal type patients had a higher cure rate, and there was a risk of secondary diabetes after subproximal pancreatectomy, so it was very important to clarify the histological type of children before surgery. ABCC8 gene mutations and KCNJ11 gene mutations were the main pathogenic genes of K ATP-HI. Among patients carrying mutations in single ABCC8 or KCNJ11 gene mutation, K ATP-HI inherited by paternity were the majority. Some K ATP-HI children can relieve the hypoglycemia symptoms by themselves.

Objective: To analyze the clinical features and genetic characteristics of Chinese children with glutamate dehydrogenase type of congenital hyperinsulinism (GDH-HI). Methods: Pedigrees with 10 GDH-HI children admitted to Beijing Children′s Hospital from February 2008 to December 2018 were selected as subjects. Clinical features, the detection of pathogenic genes and follow-up data were retrospectively analyzed. Polymerase chain reaction DNA (PCR-DNA) direct sequencing method and second generation sequencing technique were used to analyze the GLUD1 genetic sequences of 10 GDH-HI children and their relatives. Results: Of the 10 GDH-HI children, 9 had normal birth weight and 1 was a giant. Nine patients were accompanied by asymptomatic hyperammonemia, and one had normal blood ammonia. 9 had ever been treated with diazoxide, which was all effective. All 10 children carried GLUD1 gene mutations, 5 patients carried c. 965C>T (p.R322H) GLUD1 gene mutation, and the remaining 5 cases carried c. 1388A>T (p.N463I), c. 1495C>A(p.G499C), c. 1493C>T(p. S498L), c. 1519G>A(p.H507Y) and c. 1388A>G(p.N463S), respectively. 9 cases (90%) had de novo mutations, and 1 case had paternal autosomal dominant inheritance. 8 children were followed up in long term. One child had spontaneous remission in 8 years after being diagnosed, and seven patients required long-term oral diazoxide to maintain normal blood glucose levels, two of whom had epilepsy. Conclusions The birth weight of children with GDH-HI in China was usually normal. A small number of GDH-HI children had normal serum ammonia levels. Most of the GLUD1 gene mutations in GDH-HI children in China were de novo mutations, among which the GDH p. R322H mutation was a hot spot mutation in Chinese children with GDH-HI. Most of GDH-HI children were diazoxide-responsive. As the disease progresses, some children may have epilepsy, and a few children have a tendency to relieve by themselves.

Objective To investigate the change and significance of follicular helper T cells (Tfh) percentage in the peripheral blood of the patients with rheumatoid arthritis (RA).Methods The RA patients treated in this hospital from September to November 2016 were selected and divided into the RA active group and RA stable group,35 cases in each group.Contemporaneous 35 individuals undergoing physical examination were selected as the healthy control group.The percentage of peripheral blood CD4+ CXCR5+ ICOS+ Tfh cells was detected by flow cytometry.The correlations between the percentage of peripheral blood Tfh cells in RA patients with the RA disease activity score 28 (DAS28),anti-CCP antibody and rheumatoid factor(RF) levels were analyzed.Results The percentage of peripheral blood Tfh cells in the RA active group was (0.84±0.16) ％,which was significantly higher than (0.64±0.15)％ in the RA stable group and (0.56±0.14)％ in the healthy control group,the difference was statistically significant (P＜0.01);moreover the percentage of peripheral blood Tfh cells in the RA stable group was also higher than that in the healthy control group (P＜0.05).The percentage of peripheral blood Tfh cells in RA patients had significantly positive correlation with DAS28 score and anti-CCP antibody level (r=0.355,0.324;P＜0.01),and had no correlation with the RF level (r=0.205,P＞0.05).Conclusion The percentage increase of peripheral blood Tfh cells in the patients with RA might be related with the pathogenesis and development of RA.

Objective:To explore the pharmaceutical care for the elderly cancer patients complicated with bone marrow suppres-sion by clinical pharmacists. Methods:Clinical pharmacists performed the pharmaceutical care through the evaluation of chemothera-py, symptomatic treatment for bone marrow suppression and infection prevention after bone marrow suppression etc. Results:The bone marrow suppression was alleviated without bleeding related with the decrease of platelet and infection. Conclusion:The pharmaceutical care performed by clinical pharmacist can enhance the safety and effectiveness of medication.

BACKGROUNDAllergic asthma is a chronic airway inflammatory disease partly characterised by high concentration of T help 2 (Th2) cytokines in bronchoalveolar lavage fluid (BALF). There is no report on the relation of peripherally circulating blood lymphocytes and asthma. We explored the balance of Th2/Th1 cytokines in asthmatic mice. Exogenous recombinant interleukin (IL) 33 acted on murine peripheral circulating blood lymphocytes, IL-5 cytokine was selected for assessing Th2 cytokines and interferon-gamma (IFN-γ) for Th1 cytokines.

METHODSFemale specific pathogen free BABL/c mice were sensitised by intraperitoneal injection of 20 µg of ovalbumin emulsified in 1 mg of aluminium hydroxide gel in a total volume of 200 µl, and challenged for 30 minutes in 7 consecutive days with an aerosol of 2 g ovalbumin in 100 ml of PBS. Then we collected BALF and isolated lymphocytes from the peripheral blood. The lymphocytes were divided into two groups: asthmatic group and normal group. Th1/Th2 cytokines was detected by enzyme-linked immunosorbent assay (ELISA) kits.

RESULTSIn the asthma group, we found numerous eosinophils and lymphocytes on the glass slides. We then confirmed that the optimal concentration of IL-33 was 10 ng/ml and time of IL-33 stimulating lymphocytes was 24 hours. In the asthma group, the production of IL-5 was significantly increased over normal group after stimulation with IL-33 (P < 0.05) and the production of IFNγ was supressed from IL-33 stimulated lymphocytes (P < 0.05).

CONCLUSIONIL-33 acts on lymphocytes of peripheral blood increasing secretion of Th2 cytokines and inhibiting secretion of Th1 cytokines.

Animals ; Asthma ; chemically induced ; immunology ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Interferon-gamma ; immunology ; metabolism ; Interleukin-33 ; Interleukin-5 ; immunology ; metabolism ; Interleukins ; immunology ; metabolism ; Lymphocytes ; immunology ; metabolism ; Mice ; Mice, Inbred BALB C

Objective To investigate the compliance status of secondary prevention in patients with coronary artery disease (CAD) following revascularization.MethodsA total of 512 patients with CAD who received procedures for coronary revascularization were enrolled in the study from January 2009 to October 2010,including 472 cases of percutaneous coronary intervention stenting,25 cases of coronary artery bypass grafting and 15 cases of stenting plus bypass.The demographic information,prophylactic drug therapies, lifestylechangesandmodifiableriskfactorsweresurveyedwithquestionnaires,anthroposomatologicalmeasurementsandlaboratorytestsinpatients3monthsaftercoronary revascularization.ResultsThe proportion of patients on statins,aspirin,β-blockers,angiotensin-converting enzymeinhibitors/angiotensinreceptorblockers(ACEIs/ARBs)andinfluenzavaccinationwere 81.4％ (417/512),93.9％ ( 481/512 ),82.0％ ( 420/512 ),76.2％ ( 390/512 ) and 3.7％ ( 19/512 ) respectively.Based on the criteria recommended by the American Heart Association/American College of Cardiology (AHA/ACC)Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update, the percentages of achieving therapeutic targets of modifiable risk factor management were as follows:glycosylated hemoglobin (90.2％,462/512 ),total cholesterol ( 68.6％,351/512 ),triglycerides ( 58.8％,301/512 ),high-density lipoprotein cholesterol ( 91.6％,469/512 ),low-density lipoprotein cholesterol ( 44.5 ％,228/512 ),systolic pressure ( 75.2 ％,385/512 ) and diastolic pressure (90.4％,463/512 ) respectively.And the proportions of improved lifestyle were as follows:smoking cessation/non-smoking 81.4％ (417/512),diet control 78.5％ ( 402/512 ),achieving weight targets 61.7％ (316/512)and regular exercise 58.2％ (298/512).ConclusionsThere is a relatively high percentage of standardized antiplatelet therapy and continuous statins medication in patients with coronary artery disease following revascularization. However,many significant modifiable risk factors have not been controlled optimally and lifestyle of patients needs further improvement. There is still a considerable scope for further improvement of secondary prevention in this group of patients.