Objective To investigate the neuroprotective effect of Huangpu Tongqiao Capsule(HPTQ)in a rat model of Wilson disease(WD)and explore the underlying mechanisms.Methods SD rat models of WD were established by feeding of copper-supplemented chow diet and drinking water for 12 weeks,and starting from the 9th week,the rats were treated with low-,moderate-and high-dose HPTQ,penicillamine,or normal saline by gavage on a daily basis for 3 weeks.Copper levels in the liver and 24-h urine of the rats were detected,and their learning and memory abilities were evaluated using Morris water maze test.HE staining was used to observe morphological changes of CA1 region neurons in the hippocampus,and neuronal apoptosis was detected with TUNEL staining.Hippocampal expressions of endoplasmic reticulum stress(ERS)-mediated apoptosis pathway-related proteins GRP78,CHOP,caspase-12,cleaved caspase-9,and cleaved caspase-3 at both the mRNA and protein levels were detected using RT-qPCR,immunofluorescence assay or Western blotting.Results Compared with normal control rats,the rat models with copper overload-induced WD exhibited significantly increased copper levels in both the liver and 24-h urine,impaired learning and memory abilities,obvious hippocampal neuronal damage in the CA1 region and increased TUNEL-positive neurons(P<0.01),with also lowered mRNA and protein expressions of GRP78,CHOP,caspase-12,cleaved caspase-9,and cleaved caspase-3 in the hippocampus(all P<0.01).Treatments with HPTQ and penicillamine significantly lowered copper level in the liver but increased urinary copper level,improved learning and memory ability,alleviated neuronal damage and apoptosis in the hippocampus,and decreased hippocampal expressions of GRP78,CHOP,caspase-12,cleaved caspase-9,and cleaved caspase-3 in the rat models(P<0.01 or 0.05).Conclusion HPTQ Capsule has neuroprotective effects in rat models of WD possibly by inhibiting ERS-mediated apoptosis pathway.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

Objective To explore the clinical features,diagnostic methods,and treatment strategies for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)encephalitis confirmed through cerebrospinal fluid(CSF)analysis.Methods The clinical data of patients diagnosed with SARS-CoV-2 encephalitis through CSF analysis in the Neurology Intensive Care Unit of the First Affiliated Hospital of Nanchang University from March 2022 to March 2023 were collected.Additionally,the relevant literature published in both domestic and international databases was analyzed and synthesized.Results The main neurological manifestations of five cases included decreased consciousness(5/5),psychiatric disorder(2/5),seizures(2/5),quadriplegia(1/5),and headaches(1/5).Two cases had abnormal brain magnetic resonance imaging(MRI)changes,involving the temporal lobe,insular lobe,thalamus,hippocampus,and pons.Additionally,CSF analysis showed mildly elevated protein levels in two cases.Next-generation sequencing(NGS)of the CSF identified SARS-CoV-2 in all five cases(sequence:41-1620),and human herpesvirus 1 in one case(sequence:21).The treatment regimen for all cases included antiviral therapy,three were additionally treated with glucocorticoids and one received immunoglobulin therapy.All cases achieved a favorable outcome(mRS:0-2).Conclusion SARS-CoV-2 has the potential to induce encephalitis/meningitis due to its neurotropic nature.The consideration of this condition is warranted in patients with relevant epidemiological history and symptoms related to the central nervous system.CSF NGS serves as a valuable tool for early diagnosis,while active antiviral therapy and immunotherapy may improve patient outcomes.

Objective To investigate the neuroprotective effect of Huangpu Tongqiao Capsule(HPTQ)in a rat model of Wilson disease(WD)and explore the underlying mechanisms.Methods SD rat models of WD were established by feeding of copper-supplemented chow diet and drinking water for 12 weeks,and starting from the 9th week,the rats were treated with low-,moderate-and high-dose HPTQ,penicillamine,or normal saline by gavage on a daily basis for 3 weeks.Copper levels in the liver and 24-h urine of the rats were detected,and their learning and memory abilities were evaluated using Morris water maze test.HE staining was used to observe morphological changes of CA1 region neurons in the hippocampus,and neuronal apoptosis was detected with TUNEL staining.Hippocampal expressions of endoplasmic reticulum stress(ERS)-mediated apoptosis pathway-related proteins GRP78,CHOP,caspase-12,cleaved caspase-9,and cleaved caspase-3 at both the mRNA and protein levels were detected using RT-qPCR,immunofluorescence assay or Western blotting.Results Compared with normal control rats,the rat models with copper overload-induced WD exhibited significantly increased copper levels in both the liver and 24-h urine,impaired learning and memory abilities,obvious hippocampal neuronal damage in the CA1 region and increased TUNEL-positive neurons(P<0.01),with also lowered mRNA and protein expressions of GRP78,CHOP,caspase-12,cleaved caspase-9,and cleaved caspase-3 in the hippocampus(all P<0.01).Treatments with HPTQ and penicillamine significantly lowered copper level in the liver but increased urinary copper level,improved learning and memory ability,alleviated neuronal damage and apoptosis in the hippocampus,and decreased hippocampal expressions of GRP78,CHOP,caspase-12,cleaved caspase-9,and cleaved caspase-3 in the rat models(P<0.01 or 0.05).Conclusion HPTQ Capsule has neuroprotective effects in rat models of WD possibly by inhibiting ERS-mediated apoptosis pathway.

Objective:To investigate the effect of absorbable material internal fixation in the treatment of phalanx fracture and its effect on the complications related to hypersensitive C-reactive protein (hs-CRP), interleukin-10 (IL-10), adrenocorticotropic hormone (ACTH) and foreign body reaction.Methods:The clinical data of 98 patients with phalangeal fracture in Huishan District People′s Hospital of Wuxi City from January 2018 to January 2020 were divided into absorbable group (49 cases, treated with absorbable material internal fixation) and microplate group (49 cases, treated with minimally invasive plate internal fixation). The rates of excellent and good treatment, operation conditions, serum inflammatory stress response indexes levels before and 1 d and 1 week after surgery were compared, and recovery at 3 and 6 months after surgery, the incidence of complications and the degree of treatment satisfaction were counted.Results:The rates of excellent and good treatmentin the absorbable group were higher than that in the micro plate group: 95.92%(47/49) vs. 81.63%(40/49), χ2 = 5.02, P<0.05. The duration of operation in the absorbable group was longer than that in the microplate group: (43.28 ± 12.18) min vs. (31.29 ± 11.69) min; and the duration of hospital stay, fracture healing time and recovery time were shorter than those in the microplate group: (4.09 ± 1.18) d vs. (6.89 ± 2.12) d, (4.35 ± 1.05) weeks vs. (5.69 ± 1.38) weeks, (4.89 ± 1.10) d vs. (6.20 ± 2.01) d; the differences were statistically significant ( P<0.05). The levels of serum hs-CRP, IL-10 and ACTH in absorbable group were lower than those in microplate group at 1 d and 1 week after surgery ( P<0.05). At 3 and 6 months after surgery, the range of motion of metacarpophalangeal joint in the absorbable group was greater than that in the microplate group, and the loss of grip strength of the healthy side was less than that in the microplate group ( P<0.05). The incidence of complications in absorbable group was lower than that in microplate group: 6.12%(3/49) vs. 20.41%(10/49), χ2 = 4.35, P<0.05. Conclusions:The absorbable material internal fixation can achieve good results in the treatment of phalanx fracture, the postoperative recovery is fast, the incidence of complications is lower.

Objective: To understand the relationship between eye strain and eye health behavior in college students learning at home during the period of COVID-19 epidemic, and to provide a scientific reference for improving the hygiene of using eyes among the college students. Methods: A cross sectional study and stratified cluster sampling was used to select 2 671 college students from 8 colleges in Anhui Province during the March 1st to July 1st in 2020, and an online questionnaire was survey included general information,eye strain,and daily eye health behavior. Results: The prevalence of eye strain in college students was 69.64%. Multivariable Logistic regression analysis showed that eye strain was correlated with gender, myopia, siesta habit, staying up until 2:00 am, and the use of eye liquid, with OR values(95% CI ) were 0.64(0.53-0.76), 1.77(1.42- 2.20 ),0.71(0.59-0.86), 1.39(1.17-1.65), and 2.18(1.71-2.79), respectively. There was no correlation among daily outdoor activity time, daytime reading time and the occurrence of eye strain( P >0.05). Conclusion During the period of COVID-19 epidemic, eye strain among college students is common. The daily eye health behavior is related to the occurrence of eye strain. Under the special learning context, eye care measures should be encouraged specifically.

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease. Skin biopsy, as a screening method, has greatly improved the diagnostic efficiency of the disease. Recently, researchers have successfully identified that the GGC repeat expansion in the 5' region of the NOTCH2NLC gene is the causative mutation of NIID. In addition to the typical NIID phenotype presenting with episodic/progressive encephalopathy, peripheral neuropathy, and autonomic disturbance, the gene mutation had also been reported to be associated with a small portion of Alzheimer 's disease, Parkinsonism, multiple system atrophy and essential tremor patients. So, the name of NOTCH2NLC-related repeat expansion disorder was proposed to include these variable phenotypes. We revisited the discovery milestones, clinical phenotype, laboratory examinations, as well as new insight into diagnosis and treatment of NIID.

Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.

Objective:To explore the clinical efficacy of alanyl glutamine (Ala-Gln) combined with octreotide in the treatment of severe acute pancreatitis (SAP) and its effects on the serum interleukin-6 (IL-6),C reactive protein (CRP) levels and related biochemical parameters.Methods:100 cases of patients with SAP in our hospital from January 2013 to December 2016 were selected and randomly divided into two groups.The control group was treated by octreotide,while the observation group was treated by Ala-Gln combined with octreotide.The clinical effect,changes of serum IL-6,CRP,amylase (AMY),lactate dehydrogenase (LDH),prealbumin (PA) and albumin (ALB) levels before and after therapy were compared between two groups.Results:On the 10th day after treatment,the overall effective rate of observation group was 88.0％ which was significantly higher than that of the control group (64.0％,P＜0.05).The serum IL-6,CRP,AMY and LDH levels of both groups on the 10th day after treatment were significantly lower than those before treatment (P＜0.01).Compared with the control group,the improvement of serum IL-6,CRP,AMY,LDH levels of observation group were more significant(P＜0.01).Compared with those before treatment,the serum PA and ALB levels of both groups were significantly increased on the 10th day after treatment(P＜0.05),and the improvement of serum PA and ALB levels of observation group on the 10th day after treatment were significantly better than those of the control group(P＜0.01).Conclusion:Alanyl glutamine combined with octreotide could effectively eliminate or alleviate the symptoms and signs of patients with severe acute pancreatitis,control the inflammatory reaction,improve the level of metabolism,improve the prognosis.

Objective:To determine the content of copper and zinc in tea by flame atomic absorption spectrophotometry and to investigate the influence on the content after leached for different time. Methods:The tea samples were leached for different time by boiling water and then the content of copper and zinc was determinated by flame atomic absorption spectrophotometry. Results:When the leaching time was less than 10 min, the content of copper and zinc increased significantly with the prolongation of the leaching time, while the increase was not obvious when the leaching time was more than 10 min. Copper and zinc showed good linearity in the range of 0.02-0.15 mg/L and 0.05-0.30 mg/L,separately. The recovery was in the range of 98.5%-101.1%for copper and 98.7%-101.2%for zinc with the RSD of 0.8%in copper and zinc (n=9) . Conclusion:The method is suitable to determine the content of copper and zinc in tea. Leaching time can influence the content of copper and zinc in tea significantly.