Objective:To construct a predictive model for the risk of major adverse cardiovascular events(MACE) after surgery in patients with symptomatic arteriosclerosis obliterans(ASO) .Methods:From Jan 2018 to Dec 2021, 957 patients with symptomatic ASO admitted to Nanjing Drum Tower Hospital were selected and divided into MACE and non-MACE groups according to whether they had a post-op MACE. A risk prediction model was constructed based on a stepwise regression method with multi-factor COX regression analysis. The model was evaluated using the receiver operating characteristic curve (ROC), the calibration curve to assess the model fit, and the Bootstrap method for internal validation.Results:MACE occurred in 143 patients (14.94%). After COX regression analysis, BMI, creatinine clearance, fibrinogen, rivaroxaban and previous history of surgery were enrolled into model constructing. The ROC curve assessed the model with a C-statistic of 0.690 (95% CI: 0.644-0.736), sensitivity and specificity of 49.2% and 80.7% respectively, a Jorden index of 0.299 and an optimal cut-off value of 0.086. Calibration curves showing agreement between predicted and actual observed values. Internally validated C-statistic of 0.689 (95% CI: 0.672-0.700). The population was divided into high and low risk groups based on the best cut-off value and analysed for survival. The difference between the two groups was statistically different. Conclusion:The risk prediction model for the occurrence of MACE based on clinical parameters is simple and convenient, with good predictability and good discriminatory ability, and can provide reference for the assessment and treatment of MACE in ASO patients.

Restless legs syndrome (RLS) is a common sensorimotor disorder. Although it does not pose a threat to life, it seriously affects the quality of life of patients. RLS pathogenesis is still unclear, and its incidence is associated with a variety of risk factors, including genetic factors and non-genetic factors. Genetic factors involve more than 20 risk genes, such as meis homeobox 1 ( MEIS1), BTB domain containing 9 ( BTBD9), mitogen-activated protein kinase kinase 5 ( MAP2K5), and protein tyrosine phosphatase receptor type Db ( PTPRD). Non-genetic factors include regional age, gender, obesity, medical related diseases, neuropsychiatric diseases and drugs. This paper reviews the recent advance in risk factors and related pathogenesis of RLS to provide references for early prevention and treatment of the disease.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To explore the efficacy and safety of different antiplatelet drugs combined with rivaroxaban in patients with lower extremity arteriosclerosis obliterans.Methods The clinical data of patients with lower extremity arteriosclerosis obliterans who were symptomatic and underwent surgical treatment at the Vascular Surgery Department of Nanjing Drum Tower Hospital from January 2018 to December 2021 were retrospectively analyzed.According to the different antiplatelet medications taken by patients,patients were categorized into aspirin group,clopidogrel group and cilostazol group.Baseline data of patients were collected,and patients were followed up and the incidence of major adverse cardiovascular events,major adverse limb events,major bleeding and clinically related non-major bleeding events were compared in different groups.Results A total of 632 patients were included in the study.There was no significant difference in the incidence of major adverse cardiovascular events,major adverse limb events,major bleeding and clinically related non-major bleeding events after the baseline data was balanced by inverse probability of treatment weighting.The results of subgroup analysis were generally consistent with those of the overall study.Conclusion The combination of clopidogrel or cilostazol with rivaroxaban may serve as a novel option for dual antithrombotic therapy in patients diagnosed with lower extremity arteriosclerotic obliterans.

Objective:To evaluate the efficacy and safety of of rivaroxaban for different doses in the treatment of isolated distal deep vein thrombosis.Methods:The clinical data of 853 patients of isolated distal deep vein thrombosis attending Nanjing Drum Tower Hospital from Jan 2018 to Dec 2020 was retrospectively analyzed.Results:Thrombotic recurrence rate increased with increasing follow-up in the standard and low dose groups, and it was significantly lower in the standard dose group than in the low dose group (HR=0.44, 95% CI: 0.25-0.78, P=0.005) with most thrombosis occurring within the first year of follow-up. There was no statistical difference between the two groups in terms of major bleeding events (HR=1.70,95%CI 0.56-5.14, P=0.530) and the incidence of clinically relevant non-major bleeding events was significantly higher in the standard dose group than in the low dose group (HR=2.36, 95%CI 1.26-4.44, P=0.020). Subgroup analysis on anticoagulation duration found when anticoagulation duration was longer than 1.5 months, the risk of thrombosis was lower in the standard dose group than the low dose group (1.5-3 months:HR=0.11, 95%CI 0.01-0.87, >3 months: HR=0.19, 95%CI 0.04-0.95), there was an interaction between anticoagulation duration and dose ( P=0.007). Conclusions:Based on the risk of thrombosis recurrence and bleeding events, the standard dose of rivaroxaban (20 mg qd) is recommended for patients with isolated distal deep vein thrombosis, and the anticoagulant duration should be maintained for 1.5 months or more.

Objective:To investigate the possible role and mechanism of purinergic ligand-gated ion channel 7(P2X7)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3) inflammasome pathway in cognitive impairment induced by sleep deprivation (SD)mice.Methods:SPF grade male C57BL / 6J mice aged 6-8 weeks were randomly divided into 3 groups according to the random number table method with 6 mice in each group.They were normal control group (CC group), SD group and SD+ P2X7 receptor antagonist brilliant blue G(BBG) group (SD+ BBG group). Modified multiple platform method was used to establish a 5-day SD model in mice.During the SD intervention period, the mice in SD+ BBG group were injected with BBG(50 mg/kg) intraperitoneally once a day, while the mice in CC group and SD group were injected with the same volume of 0.9% sodium chloride solution.Morris water maze was conducted to evaluate the cognitive function of mice.The protein expression levels of P2X7, NLRP3, caspase-1, apoptosis-associated proteins(ASC) and interleukin-1β(IL-1β) in hippocampus were detected by Western blot.RT-qPCR was used to detect the mRNA expression levels of tumor necrosis factor-α(TNF-α), IL-1β, interleukin-18(IL-18) and microglial polarization surface markers CD206 and CD86 in hippocampus.Graph pad Prism 8.0 software and SPSS 25.0 software were used for statistical analysis and mapping.Results:(1) The interaction effect between time and groups of escape latency in three groups of mice was significant ( F=15.76, P<0.001). From the 2nd to 5th day, the escape latencies of mice in SD group were higher than those of CC group, while the escape latencies of mice in SD+ BBG group were lower than those of SD group (all P<0.05). (2)The results of the space exploration experiment showed that there were statistically significant differences in target quadrant residence time and the times of crossing the platform( F=6.65, P=0.009; F=12.39, P<0.001). The target quadrant residence time ((23.42±0.55) s) and times of crossing the platform ((17.67±0.71) times) of the SD group were both lower than those of the CC group ((29.48±1.78) s, (23.33±0.95) times) (both P<0.05), while the target quadrant residence time ((28.62±1.19) s) and the times of crossing the platforms ((21.33±0.76) times) of the SD+ BBG group were both higher than those of the SD group (both P<0.05). (3)There were statistically significant differences in the protein levels of inflammatory related proteins such as P2X7, NLRP3, caspase-1, ASC and IL-1β in the hippocampus of mice among the 3 groups( F=8.23, 8.97, 8.45, 54.42, 8.12, all P<0.05). Compared with CC group, the protein levels of P2X7 ((0.93±0.02), (0.71±0.04)), NLRP3 ((0.97±0.04), (0.62±0.09)), caspase-1 ((1.00±0.03), (0.76±0.07)), ASC ((0.96±0.02), (0.77±0.04)) and IL-1β ((0.85±0.07), (0.54±0.04)) in SD group were all higher (all P<0.05). Compared with SD group, the protein levels of P2X7 (0.74±0.05), NLRP3 (0.78±0.02), caspase-1 (0.74±0.04), ASC (0.67±0.02), IL-1β (0.53±0.07) in SD+ BBG group were all lower (all P<0.05). (4)There were statistically significant differences in the mRNA levels of IL-18, IL-1β, TNF-α, CD86 and CD206 in hippocampus among the three groups ( F=12.80, 12.28, 105.80, 7.06, 30.19, all P<0.05). The mRNA levels of IL-18, IL-1β, TNF-α, CD86 in SD group were all higher than those in CC group(all P<0.05), while the mRNA level of CD206 in SD group was lower than that in CC group( P<0.05). Compared with SD group, the mRNA levels of IL-18, IL-1β, TNF-α, CD86 were lower in SD+ BBG group (all P<0.05), while the CD206 mRNA level of SD+ BBG group was higher than that in SD group( P<0.05). Conclusion:SD intervention can lead to cognitive impairment and increased expression of P2X7 in hippocampus of mice, which may be related to the activation of P2X7/ NLRP3 inflammasome signaling pathway, promoting the polarization of microglia into pro-inflammatory type and up-regulating the expression of pro-inflammatory cytokines.Inhibition of P2X7 can improve the cognitive function of mice.

Objective:To investigate the correlation between single nucleic acid polymorphisms (SNPs) of MEIS1, BTBD9, MAP2K5, PTPRD and restless leg syndrome (RLS).Methods:By searching the literatures published before March 1, 2021 at home and abroad, case-control studies on risk genes associated with RLS were collected, and the Review Manager 5.3 and Stata 15.1 softwares were used for statistical analysis.Results:A total of 8 studies were included, with a total of 7 824 cases and 14 645 controls.Meta analysis results showed that the SNPs locus of the risk gene associated with RLS was MEIS1 rs2300478( OR=1.68, 95% CI: 1.59-1.78), BTBD9 rs9296249( OR=1.62, 95% CI: 1.47-1.77), BTBD9 rs9357271( OR=1.49, 95% CI: 1.44-1.55), MAP2K5 rs12593813( OR=1.44, 95% CI: 1.36-1.53), MAP2K5 rs11635424( OR=1.47, 95% CI: 1.34-1.60)and PTPRD rs1975197( OR=1.34, 95% CI: 1.21-1.49). Conclusion:MEIS1 rs2300478, BTBD9 rs9296249, BTBD9 rs9357271, MAP2K5 rs12593813, MAP2K5 rs11635424 and PTPRD rs1975197 are the risk loci of RLS.

Objective:To investigate the characteristics of transcranial sonography (TCS) in patients with restless legs syndrome (RLS), and analyze the correlations of scores of RLS Self-rating Severity Scale by International Restless Leg Syndrome Study Group (IRLS) and TCS parameters with clinical data of these patients.Methods:Twenty-one patients with RLS admitted to the Sleep Disorder Clinic of our hospital from September 2020 to January 2021 were selected as RLS group, and 23 healthy controls at the same time period were recruited as control group. IRLS was used to evaluate the severity of patients in the RLS group, and the 14-item Hamilton anxiety rating scale (HAMA-14) and 24-item Hamilton depression rating scale (HAMD-24) were used to evaluate the anxiety and depression of subjects from the 2 groups. Pittsburgh Sleep Quality Scale (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) were used to evaluate the sleep quality of subjects from the 2 groups. TCS was used to examine the occurrence of hypoechoic substantia nigra and raphe nucleus rupture and the width of the third ventricle in the two groups. The clinical data and TCS parameters of patients in the 2 groups were compared, and the correlations of IRLS scores and TCS parameters with clinical features of patients in the RLS group were analyzed.Results:As compared with those in the control group, the HAMA-14, HAMD-24, ISI and PSQI scores in the RLS group were statistically higher ( P<0.05). As compared with the control group, RLS group had significantly higher proportion of patients with hypoechoic substantia nigra or raphe nucleus rupture ( P<0.05). In RLS patients, the IRLS scores were positively correlated with HAMA-14, HAMD-24, and ISI scores ( P<0.05); ESS scores were negatively correlated with hypoechoic substantia nigra and width of the third ventricle ( rs=-2.005, P=0.045; r=-0.477, P=0.029); width of the third ventricle was negatively correlated with gender (male) and years of education ( rs=-0.592, P=0.005; r=-0.627, P=0.002), and positively correlated with age and course of the disease ( r=0.756, P<0.001; r=0.167, P=0.047). Conclusions:Patients with RLS are prone to anxiety, depression and sleep disorders; their TCS shows hypoechoic substantia nigra and raphe nucleus rupture. RLS severity may affect HAMA-14, HAMD-24, and ISI scores. Gender, age, years of education, course of disease, and ESS scores of RLS patients may affect TCS related parameters.

Objective:To evaluate the clinical effect of fibula flap in the repair of large segment of composite tissue defect in upper limb.Methods:From April, 2015 to June, 2019, 7 patients with large composite tissue defects in upper limbs were treated. All of them with various skin, vessel, nerve, tendon and other tissue defects. Repairing was well planned before surgery according to the type, location and size of defect. While in repairing of the bone and skin defect, fibula flap was taken from the shank and to repair the defects of nerve, tendon and vessels in upper limb. Regular followed-ups were made after surgery.Results:The 7 fibula flaps all survived. Postoperative follow-up ranged between 8 to 36 (averaged of 15) months. All the reconstructed limbs were in satisfactory appearance and function recovery. All the patients were able to manage their daily activities and live independently. The shape and function of donor sites were good. According to the Enneking system, the outcomes were graded as excellent in 4 cases and good in 3, with the average score was 25.9 points.Conclusion:Free grafting of vascularised fibula flap is especially feasible to be used in the repair of large bone tissue defect of upper limb. It repairs the defects of skin, vessel, nerve and tendon with the flap from a single donor site.

Restless legs syndrome (RLS) is a kind of common diseases of the nervous system, of which adult prevalence rate is from 1% to 15%. The etiology, pathogenesis and related gene therapy of RLS are not fully understood. Studies have shown that RLS may be associated with the polymorphism of some risk genes. Genome-wide association studies have revealed a total of seven risk sites to date, including MEIS1, BTBD9, MAP2K5/SKOR1, PTPRD, TOX3, NOS1 and 2p14 intergenic regions. This article reviewed the research progress of single nucleotide polymorphisms in RLS risk genes in recent years.