Objective:To analyze plaque characteristics of non-culprit coronary lesions with cholesterol crystals in patients with acute myocardial infarction(AMI) by using optical coherence tomography(OCT). We also investigated the potential association between cholesterol crystals with plaque rupture and healed plaque at non-culprit segment.Methods:This study was a retrospective cohort study. Between January 2017 and December 2017, patients with AMI who underwent 3-vessel OCT imaging were included in this study. Patients were divided into two groups according to the presence or absence of cholesterol crystals at the non-culprit lesions. All patients underwent coronary angiography and OCT examination, and non-culprit plaque characteristics were compared between the two groups. The generalized estimating equation log-binomial multirariate regression model was used to assess the relationship between non-culprit lesions with cholesterol crystals and plaque rupture and plaque healing. The follow-up data collection ended in October 2023. Kaplan-Meier survival curves were plotted, and log-rank tests were used to compare the cumulative incidence of major adverse cardiovascular events between the two groups.Results:A total of 173 AMI patients were included (aged (56.8±11.6) years; 124 men (71.7%)). Among 710 non-culprit lesions identified by OCT, there were 102 (14.4%) in cholesterol crystals group and 608 (85.6%) in non-cholesterol crystals group. Compared with non-culprit lesions without cholesterol crystals, those with cholesterol crystals had smaller minimum lumen diameter, severer diameter stenosis, and longer lesion length (all P<0.01). The prevalence of plaque rupture (17.6% (18/102) vs. 4.9% (30/608), P=0.001) and thin-cap fibroatheroma (31.4% (32/102) vs. 11.5% (70/608), P<0.01) was higher in the cholesterol crystals groups than in the non-cholesterol crystals group. In addition, vulnerable plaque characteristics such as (44.1% (45/102) vs. 25.8% (157/608), P<0.01), macrophages were more frequently observed in non-culprit lesions with cholesterol crystals. The generalized estimating equation log-binomial multivariate regression analyses showed that non-culprit cholesterol crystals were positively correlated with healed plaque ( OR=1.583, 95% CI: 1.004-2.495, P=0.048). Conversely, cholesterol crystals were not associated with plaque rupture ( OR=1.632, 95% CI: 0.745-3.576, P=0.221). The follow-up time was 2 142 (1 880, 2 198) days. Non-culprit cholesterol crystals were not related to the major adverse cardiovascular events in patients with AMI (log-rank P=0.558). Conclusions:Among AMI patients, non-culprit lesions with cholesterol crystals presented with severer luminal stenosis and increased plaque vulnerability. The presence of non-culprit cholesterol crystals was associated with rather than plaque rupture.

Objective:To evaluate the effect of ozone preconditioning on splenic natural killer (NK) cells in septic mice.Methods:Twenty-four SPF-grade male C57BL/6 mice, aged 6-8 weeks, weighing 18-22 g, were divided into 4 groups ( n=6 each) according to the random number table method: control group (group C), lipopolysaccharide (LPS)group, ozone+ LPS group (O 3+ LPS) and air+ LPS group (Air+ LPS). The sepsis was induced by intraperitoneal injection of LPS 10 mg/kg. Ozone preconditioning was started at 5 days before developing the model: ozone 1 mg/kg was intraperitoneally injected once a day for 5 consecutive days, the equal volume of air was injected in Air+ LPS group. The survival was observed within 72 h after LPS injection, and sepsis score and ear temperature (once every 2 h, an average was calculated) were recorded. The posterior orbital venous blood samples were taken at 6 and 24 h after LPS injection for determination of serum interferon-γ (IFN-γ) and interleukin-10 (IL-10) concentrations using enzyme-linked immunosorbent assay. The spleen was then taken, and a single cell suspension of the spleen was prepared for measurement of the percentage of NK cells in the spleen by flow cytometry. Results:Compared with C group, the ear temperature, sepsis score and 72-h survival rate were significantly decreased, serum IFN-γ and IL-10 concentrations were increased at each time point after LPS injection, and the percentage of splenic NK cells was increased at 6 h after LPS injection and decreased at 24 h after LPS injection in LPS, Air+ LPS and O 3+ LPS groups ( P<0.05). Compared with LPS group, the ear temperature, sepsis score and 72-h survival rate were significantly increased, serum IFN-γ concentrations were decreased at each time point after LPS injection, serum IL-10 concentrations were increased at each time point after LPS injection, and the percentage of splenic NK cells was decreased at 6 h after LPS injection and increased at 24 h after LPS injection in O 3+ LPS group ( P<0.05), and no significant change was found in the parameters mentioned above in Air+ LPS group ( P>0.05). Conclusions:The mechanism by which ozone preconditioning reduces sepsis may be related to reduction of inflammatory responses and regulation of splenic NK cell levels in septic mice.

【Objective】 To explore whether the effect of functional electrical stimulation combined with respiratory training on patients with mechanical ventilation is superior to that of single lung rehabilitation scheme. 【Methods】 We selected 90 patients with mechanical ventilation hospitalized in the central ICU of our hospital from March 2018 to October 2019 and randomly assigned them into the functional electrical stimulation group (30 cases), respiratory function training group (30 cases), and the combined rehabilitation group (functional electrical stimulation combined with respiratory training) (30 cases). The treatment time in the three groups was 40 minutes each time. The treatment was given once a day, 6 times a week, and lasted for 2 weeks. B-ultrasound was used to measure the changes of the diaphragm and calculate the score of diaphragm thickening. The success rate of weaning, incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, and length of stay in ICU can be quantified according to the clinical nursing records. 【Results】 There were significant differences in the success rate of weaning, incidence of VAP, time of mechanical ventilation, and length of ICU stay in the three groups. However, the success rate of weaning, incidence of VAP, time of mechanical ventilation, and the length of ICU stay in the combined rehabilitation group were better than those in the other two groups (P<0.05). 【Conclusion】 The effect of functional electrical stimulation combined with respiratory training on patients with mechanical ventilation is significantly better than that of single lung rehabilitation scheme. The former one is superior to the single rehabilitation scheme in improving the success rate of weaning, increasing the activity of diaphragm, shortening the time of mechanical ventilation, and the length of stay in ICU.

The cholinergic anti-inflammatory pathway (CAP) is an important neuroimmunomodulatory mechanism that innervates the spleen through vagus nerve efferent and splenic nerve relay, and acts on macrophages by transforming adrenergic stimulation into cholinergic signal by spleen T cells, which plays an anti-inflammatory effect, and maintains the balance of inflammatory response. Due to the critical role of the imbalance of pro-inflammatory and anti-inflammatory responses in the physiological process of sepsis, regulating the activity of the CAP has become an important focus in the treatments of sepsis. Based on the understanding of the CAP, vagus nerve stimulation, drug agonists mimicking cholinergic signals, and acupuncture are currently applied in the research and exploration of sepsis treatment. This article summarizes the recent progress and prospects of the CAP mechanism, biological effects, and application in sepsis treatment.

Objective:To investigate whether idebenone can improve behavioral disorders in mice with Parkinson disease (PD) by increasing PHB2 mediated mitophagy.Methods:In the first small experiment, thirty mice were randomly divided into normal control group, model group and treatment group according to the random number table method, with 10 animals in each group.The aim of this study was to observe the effect of idebenone on the behavior of Parkinson disease model mice. In the second experiment, 20 mice were randomly divided into blank control group, MPTP group, shRNA-PHB2 group and shRNA-PHB2+ MPTP group, with 5 mice in each group. The changes of tyrosine dehydrogenase (TH) in brain tissue were detected by immunofluorescence assay. In the third experiment, 30 mice were randomly divided into blank control group, shRNA-PHB2 group, MPTP+ idebenone group, shRNA-PHB2+ MPTP group, shRNA-PHB2+ idebenone group and shRNA-PHB2+ MPTP+ idebenone group, with 5 animals in each group. The aim of this study was to investigate the effect of idebenone on mitochondrial autophagy in mouse brain.C57BL-6 mice were intraperitoneally injected with MPTP to establish the animal model of chronic PD. Then 200 mg / kg idebenone was given by gavage for 21 days. And the expression of PHB2 in brain was inhibited by microinjection of adeno-associated virus 9 (AAV9) shRNA inhibin 2(PHB2) into lateral ventricle. The behavioral changes of the PD mice were detected by Morris water maze, and the changes of tyrosine dehydrogenase (TH) induced by inhibiting PHB2 were detected by immunohistochemistry. The protein expression of LC3 and PHB2 in substantia nigra of midbrain was detected by Western blot.The data were analyzed by GraphPad 7.0 and SPSS 22.0.Results:(1) In the water maze test data of the first small experiment, the repeated measurement ANOVA showed that the group-time interaction effects of latency of mice from 1 to 7 days were significant ( Ftime×group=20.51, P<0.05). Simple effect analysis showed that on the 5th, 6th and 7th day, the incubation period of the treatment group was significantly shortened (all P<0.05). Univariate analysis of variance showed that on the 7th day of the test, the differences between the control group and the model group, the model group and the treatment group, the control group and the treatment group were all statistically significant( t=-49.95, -21.81, 28.14; all P<0.01). In the third small experiment, repeated measurement analysis of variance showed that the interaction between time and group was significant ( Ftime×group=42.11, P<0.01). Simple effect analysis showed that compared with MPTP+ idebenone group, the latency of shRNA-PHB2+ MPTP+ idebenone group was significantly prolonged (all P<0.05). There were no significant difference between shRNA-PHB2+ MPTP+ idebenone group and shRNA-PHB2+ MPTP group except the 4th day ( P<0.05). On the 7th day, compared with MPTP+ idebenone group, the residence time of shRNA-PHB2+ MPTP+ idebenone group was significantly increased ( t=-34.36, P<0.001), but there was no significant difference between shRNA-PHB2+ MPTP group and shRNA-PHB2+ MPTP+ idebenone group ( t=2.94, P>0.05). (2)The results of immunofluorescence experiment showed that the relative expression of TH in the control group, model group, shRNA-PHB2 group and shRNA-PHB2+ MPTP group were (41.03±3.01), (24.20±4.18), (38.39±3.31) and (13.12±2.65), respectively. Compared with the control group, the expression of TH in the midbrain of the MPTP group was significantly down-regulated, the difference was statistically significant( t=7.98, P<0.01). Compared with the MPTP group, the expression of TH in shRNA-PHB2 group was down regulated ( t=-6.73, P<0.05). (3) Western blot results showed that the relative expression of LC3 in midbrain tissue of control group, shRNA-PHB2 group, MPTP+ idebenone group, shRNA-PHB2+ MPTP group, shRNA-PHB2+ idebenone group and shRNA-PHB2+ MPTP+ idebenone group were (0.86±0.07), (0.77±0.08), (0.42±0.05), (0.21±0.05), (0.66±0.09) and (0.27±0.07). The relative expression of PHB2 were (1.13±0.14), (0.56±0.11), (1.08±0.14), (0.27±0.07), (0.68±0.14) and (0.24±0.10). Compared with MPTP+ idebenone group, the relative expression of LC3 and PHB2 in shRNA-PHB2+ MPTP+ idebenone group was significantly decreased ( F=1.96, P<0.01). Conclusion:Idebenone can increase the level of mitophagy in PD mice through PHB2, thus improving the behavioral disorder.

Objective To investigate the difference of styrofoam and breast carrier in postposition fixation of intensity-modulated radiotherapy after breast conservative surgery for breast cancer patients.Methods From February 2018 to August 2018,tweenty-four patients with breast cancer in Sun Yet-Sen Memorial Hospital of Sun Yet-sen University were selected for this study,who underwent hypofactionationed radiotherapy after breast conservative surgery with total dose 42.56 Gy/16Fractions.They were randomized into styrofoam test group and breastcarrier control group.Cone beam CT as used to record the positioning error under the directions of left and right (x),head and foot (y),abdomen and back (y) within two groups at the first,third,fifth,seventh,eleventh time before irradiation.Furthermore,the PTV extension margin was calculated and the positioning time of two groups was recorded.Two sets of pendulum errors were analyzed by independent sample T-test,and the outspread value of inter-fractional set up error of the PTV was calculated.Results The errors of the test group and the control group in the direction of x,y,z were as follows:(2.36±1.89) and (2.56±2.05) mm (P=0.49),(1.76± 1.78) and (3.28±2.79) mm (P＜0.05),(1.47± 1.49) and (1.73± 1.81) mm (P=0.28).The extension values of inter-fractional set up error of CTV to PTV were 2.97,2.92,2.21 mm and 3.41,4.09,2.59 mm respectively.The time of single positioning was (3.4± 1.1) and (5.5 ± 3.1) min respectively (P=0.01).Conclusion Styrofoam has better positioning accuracy and efficiency compared with breast carrier.

Objective: To compare the clinical effects of two different skin preparation methods for infant craniocerebral surgery. Methods: Totally 120 infants who were going to receive craniocerebral surgery were divided into two groups by random number table, 60 cases in the observation group and 60 cases in the control group. The scalp of both groups was cleaned with moisturizing oil every day from 3 days before operation. On 1 day before operation, the observation group used electric shaver to shave off all hair on the head, and then rinsed with warm water. The control group was treated with skin preparation knife to shave all the hair under soap water lubrication and rinse with warm water. The skin injury rate, incision infection rate and pain score of the two groups were evaluated. Results: The incidence of skin injury and incision infection were 0 and 1.7% (1/60) in the observation group, 18.3% (11/60) and 13.3% (8/60) in the control group, respectively. There were significant differences between the two groups (χ²= 12.110, 5.886, all P < 0.01 or 0.05). The median score of pain in the observation group was 0 (Q₁:0, Q₃:0), while 1.5 (Q₁:1, Q₃:2) in the control group, and there were significant differences between the two groups (Z= 3.286, P < 0.01). Conclusion Electric shaver is superior to skin preparation knife in shaving hair of infants. It not only reduces the incidence of head skin injury, incision infection and pain in the process of skin preparation, but also reduces the incidence of incision infection after craniocerebral surgery in infants. It is worth popularizing.

Since the anti-N-methyl-D-aspartate receptor (NMDAR) antibody was discovered in 2007, over 10 kinds of antibodies related to autoimmune encephalitis (AE) has been identified.Thus, more formerly undiagnosed encephalitis can be confirmed now.At the same time, with the deepening of AE research, the understanding of the etiology, antibody production mechanism and pathogenic mechanism of AE is getting clear.This paper introduces the etiology, antibody production mechanism and pathogenic mechanism of AE, and elaborates the guiding role in relevant research findings in the diagnosis and treatment of AE.

Objective: To preliminarily investigate the difference of position fixation accuracy between polyurethane styrofoam and vacuum negative pressure pad in intensity-modulated radiation therapy (IMRT) after radical mastectomy for breast cancer. Methods: Forty breast cancer patients, who received breast-conserving surgery followed by hyper-fractionated IMRT of the whole breast (42.56 Gy for 16 times) in our hospital between 2017 and 2018 were recruited and randomly divided into the polyurethane styrofoam group and vacuum negative pressure pad group. Before IMRT treatment, the anterior and lateral films of patients were taken with kilovoltage digital radiographs (KVDRs) by Varian Trilogy machine-borne OBI KV image verification system. The KVDRs images were matched with the DRR images reconstructed by the planned system to obtain the setup errors in the left and right, head and foot, and ventral and back directions between two groups. Each patient was verified for 10 times to obtain 400 sets of data. The independent sample t-test was adopted to analyze the setup errors between two groups. The external expansion value of graded setup errors from clinical target volume (CTV) and planned target volume (PTV) was calculated. Results: The setup errors in the left and right, head and foot, ventral and back directions between the styrofoam fixation and vacuum pad groups were (1.63±1.29) mm and (1.83 ±1.61) mm (P=0.18), (1.46±1.51) mm and (2.26±2.03) mm (P=0.00), and (1.30±1.35) mm and (1.91±1.67) mm (P=0.00), respectively. The external expansion values of setup errors from CTV to PTV were 2.19 mm, 2.51 mm, 1.57 mm and 2.40 mm, 3.97 mm and 2.63 mm, respectively. Conclusion Both two fixation methods meet the clinical requirements. However, the setup accuracy and reproducibility in the polyurethane styrofoam group are better than those in the vacuum negative pressure pad group.