BackgroundInvasive vagus nerve stimulation therapy has been approved for the adjunctive treatment of treatment-resistant depression， which may contribute to the anti-inflammatory properties of vagus nerve stimulation （VNS）， whereas the efficacy of non-invasive transcutaneous cervical vagus nerve stimulation （tcVNS） in treating major depressive disorder （MDD） and its impact on plasma inflammatory factors remain unclear. ObjectiveTo observe the effect of escitaloprom combined with tcVNS on the status of depression， anxiety and sleep quality as well as the plasma levels of interleukin-6 （IL-6） and interleukin-10 （IL-10） in MDD patients， in order to provide references for the recovery and treatment of MDD patients. MethodsFrom August 21， 2019 to April 17， 2024， 45 patients who met the diagnostic criteria for MDD in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from the psychosomatic outpatient clinic of the First Affiliated Hospital of Air Force Military Medical University. Subjects were divided into study group （n=23） and control group （n=22） using random number table method. All patients were treated with escitalopram. On this basis， study group added a 30-minute tcVNS therapy once a day for 4 weeks. While control group was given corresponding sham stimulation， and the duration of each stimulation lasted 30 seconds. Before and after 4 weeks of treatment， Hamilton Depression Scale-17 item （HAMD-17） was used to assess depressive symptoms， and HAMD-17 anxiety/somatization subfactor and insomnia subfactor were used to assess patients' anxiety/somatization symptoms and sleep quality. Levels of plasma IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay （ELISA）. ResultsThe generalized estimating equation model yielded a significant time effect for HAMD-17 total score， anxiety/somatization subfactor score and insomnia subfactor score in both groups （Wald χ²=315.226， 495.481， 82.420， P<0.01）. After 4 weeks of treatment， HAMD-17 total score and anxiety/somatization subfactor score of study group were lower than those of control group， with statistically significant differences （Wald χ²=4.967， 32.543， P<0.05 or 0.01）， while no statistically significant difference was found in the insomnia subfactor score between two groups （Wald χ²=0.819， P=0.366）. Significant time effects were reported on plasma IL-6 and IL-10 levels in both groups （Wald χ²=21.792， 5.242， P<0.05 or 0.01）. Compared with baseline data， a reduction in plasma IL-6 levels was detected in both groups （Wald χ²=22.015， 6.803， P<0.01）， and an increase in plasma IL-10 levels was reported in study group （Wald χ²=5.118， P=0.024） after 4 weeks of treatment. ConclusionEscitalopram combined with tcVNS therapy is effective in improving depressive symptoms， anxiety/somatization symptoms and sleep quality in patients with MDD. Additionally， it helps reduce plasma IL-6 levels and increase IL-10 levels. ［Funded by Shaanxi Provincial Key Research and Development Program-General Project （number， 2023-YBSF-185）， www.clinicaltrials.gov number， NCT04037111］

Objective To explore the efficacy of superior hypogastric nerve block(SHNB)for alleviating pain after uterine artery embolization(UAE).Methods Twenty-five patients with hysteromyoma who underwent UAE were retrospectively enrolled.The patients were divided into SHNB group(n=11)and non-SHNB group(n=14,receiving peripheral intravenous analgesia)according to analgesia methods.The technique success rate and complication of SHNB were recorded.The maximum score of numeric pain-rating scale(NRS),the total dose of opioid consumption after UAE and the interval time between UAE completed to the first additional use of opioid were compared between groups.Results No significant difference of patient's age,body mass nor the maximum diameter of hysteromyoma was found between groups(all P＞0.05).The technique success rate of SHNB was 100%(11/11).No complication such as lower limb radiating numbness,intravascular injection,intraperitoneal hemorrhage nor peritonitis occurred.The maximum score of NRS after UAE and the total dose of opioid consumption after UAE in SHNB group were both significantly lower,while the interval time between UAE completed to the first additional use of opioid in SHNB group was significantly longer than those in non-SHNB group(all P＜0.001).Conclusion SHNB was effective for alleviating pain and reducing required dosage of analgesic medications after UAE in patients with hysteromyoma.

Objective:To investigate the effect of tumor necrosis factor-α (TNF-α) on the differentiation of orbital fibroblasts (OF) in thyroid-associated ophthalmopathy (TAO) and its regulation mechanism.Methods:Six patients (six eyes) diagnosed with TAO were collected in Tianjin Medical University Eye Hospital from December 2019 to August 2020.Adipose connective tissue was collected during the orbital decompression surgery.OF was isolated and cultured using the tissue block method and vimentin was identified by immunofluorescence.Lipogenic differentiation of OF was induced and identified by oil red O staining.Complete culture medium containing 0, 0.1, 1.0 and 10.0 μg/L TNF-α was used to induce the dedifferentiation of orbital mature adipocytes.Primary culturing cells, 14-day differentiation cells and 20-day dedifferentiation cells were collected.The relative mRNA expression levels of peroxisomal proliferation-activated receptor (PPARγ), extracellular regulatory protein kinase1 (ERK1), ERK2 and fat-coated protein1 (perilipin1) were detected by real-time fluorescent quantitative PCR.The relative protein expression levels of PPARγ, P-ERK1/2 and perilipin1 were detected by Western blot.Results:Human TAO-derived OF were successfully cultured in vitro, spindle-shaped or polygonal, tightly arranged in a vortex pattern, and immunofluorescence staining for vimentin was positive.After OF adipogenic differentiation, lipid droplet structures could be seen in the cytoplasm of some cells, and the stained lipid droplet structures in the cytoplasm could be seen by oil red O staining, which confirmed that the cells obtained after differentiation were adipocytes.Dedifferentiation of adipocytes was induced by 0.1, 1.0, and 10.0 μg/L TNF-α.With the extension of induction time, the volume of lipid droplets in the cytoplasm and the number of cells containing lipid droplets decreased.Lipid droplets disappeared in the cytoplasm on the 20th day of dedifferentiation, and the cells became long spindle-shaped and tightly arranged, dedifferentiated into fibroblast-like cells.Real-time fluorescence quantitative PCR detection results showed that the relative expression levels of PPARγ, ERK1, ERK2 and perilipin1 mRNA in 14-day differentiation group were 4.26±0.09, 2.01±0.09, 3.23±0.10 and 8.69±0.33, respectively, which were significantly higher than 1.00±0.09, 1.05±0.19, 1.00±0.10 and 1.05±0.07 in primary group, and 1.06±0.03, 1.15±0.11 and 6.27±0.09 in 20-day dedifferentiation group (all at P<0.05). Western blot analysis showed that the expression levels of PPARγ, ERK1/2 and perilipin1 proteins in 14-day differentiation group were 1.07±0.03, 1.00±0.03 and 1.13±0.02, respectively, which were significantly higher than 0.37±0.02, 0.29±0.02 and 0.00±0.00 in primary group, and 0.20±0.02, 0.38±0.06 and 0.00±0.00 in 20-day dedifferentiation group (all at P<0.001). Conclusions:TNF-α has a dedifferentiation effect on TAO orbital adipocytes.The mechanism may be related to the downregulation of ERK1/2-PPARγ-perilipin1 signaling pathway.

Objective:To investigate the association between door-in-door-out time (DIDO) and clinical outcome of patients with acute large vessel occlusion stroke (AIS-LVO) of anterior circulation after early endovascular therapy (EVT).Methods:The patients with AIS-LVO of anterior circulation who received EVT in the advanced stroke center of the Yijishan Hospital of Wannan Medical College from February 2019 to December 2021 were retrospectively analyzed. The baseline characteristics, time metrics and clinical outcomes were collected. DIDO was defined as the duration of time from arrival to referral at the primary stroke center, and the primary outcome was favorable clinical outcome, as evaluated by a modified Rankin Scale score of 0 to 2 at 3 months after EVT. Univariate and multivariate regression analysis was used to explore the relationship between DIDO and early endovascular treatment clinical outcomes in patients with AIS-LVO.Results:A total of 320 patients [aged (69.6±10.2) years] were enrolled. The baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program early CT score were 14 (11, 18) and 8 (7, 9). The DIDO time was 76 (50, 120) minutes. DIDO was not an independent correlation factor for clinical outcomes in patients with EVT in the overall population. However, in patients receiving early EVT (onset-to-reperfusion≤300 minutes), DIDO ( OR=1.030, 95% CI 1.001-1.059, P=0.041) was an independent correlating factor of clinical outcome in patients with EVT. According to the receiver operating characteristic curve, the DIDO cutoff of 74.5 minutes can be used as an important indicator of prehospital delay in referral to EVT for large vascular occlusion stroke. Door to computed tomography time ( OR=1.393, 95% CI 1.212-1.601, P<0.001) and computed tomography to transfer time ( OR=1.386, 95% CI 1.220-1.575, P<0.001) were factors associated with DIDO≤74.5 minutes in a multivariate analysis in this time frame. Conclusions:In transferred patients undergoing EVT early, DIDO has a signifificant impact on clinical outcome. DIDO can be used as an important quality control indicator to evaluate the referral process for patients with AIS-LVO.

Objective:To investigate the clinical efficacy of extreme lateral interbody fusion (XLIF) in comparison with traditional posterior lumbar fusion in the treatment of lumbar infectious diseases.Methods:A retrospective study was conducted to analyze the clinical data of 30 patients with lumbar infectious disease who had been treated at Department of Spinal Surgery, The Third Hospital of Hebei Medical University from May 2017 to November 2019. There were 18 males and 12 females with an age of (53.3 ± 12.5) years. According to surgical procedures, the patients were divided into group A of 13 cases subjected to XLIF and group B of 17 cases subjected to posterior radical debridement plus lumbar fusion plus internal fixation. The 2 groups were compared in terms of demographic data like age and gender, intraoperative indexes, intervertebral fusion rate, and complications, as well as visual analogue scale (VAS) and Oswestry disability index (ODI) at 3, 6, and 12 months after operation.Results:There was no statistically significant difference between the 2 groups in the general clinical data before operation, showing comparability ( P>0.05). The operation time in group A was significantly shorter than that in group B [(88.5 ± 13.6) min versus (124.1 ± 15.4) min], and the intraoperative blood loss in group A significantly less than that in group B [(66.9 ± 18.4) mL versus (461.8 ± 150.6) mL] ( P<0.05). The VAS and ODI at 3, 6, and 12 months after operation in both groups were significantly lower than those before operation ( P<0.05). The VAS and ODI at 3 months after surgery in group A [2 (2, 2) points and 15.2% ± 5.0%] were significantly lower than those in group B [3 (2, 3) points and 19.5% ± 6.2%] ( P<0.05). There was no significant difference in the fusion rate between groups A and B at 12 months after operation (13 versus 16) ( P>0.05). Postoperatively, left thigh numbness and weakness was reported in 1 case in group A while 2 cases of cerebrospinal fluid fistula and 1 case of poor wound healing were observed in group B, showing no significant difference in the incidence of complications between the 2 groups ( P>0.05). Conclusion:Compared with the traditional posterior lumbar surgery, XLIF demonstrates advantages of less intraoperative blood loss, less tissue damage, shorter operation time, faster postoperative recovery in the treatment of lumbar infectious diseases with no obvious intraspinal abscess or nerve compression.

Objective:To explore the application effect of intelligent nursing information system in health education for patients with brain glioma.Methods:Using the convenient sampling method, a total of 100 patients with brain glioma who were admitted to Beijing Tiantan Hospital, Capital Medical University from December 2018 to December 2019 were selected as the research objects. According to the random number table method, they were divided into the observation group and the control group, with 50 cases in each group. The control group adopted the conventional model for health education, while the observation group adopted intelligent nursing information system for health education. The cognition level of disease, quality of life and nursing satisfaction were compared between the two groups.Results:The cognition level of disease, quality of life and nursing satisfaction of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of intelligent nursing information system in health education for patients with brain glioma can improve cognition level of disease and nursing satisfaction of patients and improve the quality of life of patients so as to provide a new health education model for clinical nursing work.

Objective: To compare the clinical effects between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by Microendoscopic discectomy (MED) and Quadrant for the treatment of degenerative lumbar spinal stenosis (DLSS). Methods: All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were reviewed. According to the surgery method, all cases were divided into MED group (27 cases) and Quadrant channel group (32 cases). All patients were followed up for an average of 18.5 months (11-29 months). Comparison was made on the operative time, intraoperative blood loss, postoperative drainage, postoperative time in bed, postoperative creatine kinase (CK), fusion rate and the degree of muscle fibrosis shown in MRI, as well as visual analogue scale (VAS)score and Oswestry dysfunction index (ODI) score in two groups. Results: The duration of operation in MED group was significantly longer than that in Quadrant group (161.7±22.4 min vs. 145.6±19.4 min, t=4.541, P<0. 01), but less intraoperative blood loss (138.1±26.9 ml vs. 155.6±21.5 ml, t=-2.724, P< 0. 01) and shorter time in bed after surgery (2.3±0.7 d vs. 3.5±1.1 d, t=-4.564, P<0.01). Compared with Quadrant group, CK levels were risen slightly on the first and third postoperative day (P<0.01). CK on the fifth postoperative day in both groups returned to normal. VAS score of lower back pain in MED group was lower than that in Quadrant group on the third day and twelfth month after operation (P<0.05). After 3 months, there was no significant difference in VAS score and ODI between the two groups (P>0.05). ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was88.9%(24/27) in MED group and 93.8%(30/32) in Quadrant channel group. There was no statistical difference in fusion rate of two groups. 10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation. The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured. Muscle atrophy of lower back muscle was lighter in MED group (0.12±0.05 vs. 0.22±0.04, t=-2.428, P<0.05). For intraoperative and postoperative complications, 1 case of dural sac rupture occurred in both groups. Gelatin sponge immediately with fibrin glue was used for plugging up, no postoperative cerebrospinal fluid leakage was found. In Quadrant channel group, 1 case had less blood supply of skin incision edges and epidermal necrosis while the other case had fat liquefaction. Conclusion Compared with the aid of Quadrant, MIS-TLIF assisted with MED had less blood loss, less trauma and faster recovery and could reduce the incidence of postoperative incision complication.

Objective To explore the surgical technique and clinical effect of percutaneous lumbar endoscopic surgery for central disc herniation.Methods From February 2010 to April 2014,69 consecutive patients (36 males and 33 females) with central lumbar disc herniation underwent percutaneous endoscopic surgery were included in the study.The average age was 31.33±8.27 years,ranging from 16 to 56 years.All operations were performed by increasing the initial puncture angle.First enter the intervertebral space through the ventral nerve root,and then move the guide rod tip step by step to the top of the protrusion.Operative time,intraoperative blood loss and complications were recorded.Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) were followed up before surgery,immediately after surgery,3,12,24 months after surgery.The MacNab criteria were used to evaluate the efficacy at the last follow-up.During the follow-up period,X-ray,CT and MRI were performed to observe the instability and recurrence of the operative segment.Results All of the disc herniations were successfully removed without conversion to open surgery or revision.All patients were followed up for more than 24 months.The VAS scores of low back pain and leg pain were significantly lower than those before operation immediately,3 months,12 months and 24 months after operation (P＜0.01).The JOA score was significantly higher in monthly follow-up (P＜0.01),and ODI was significantly improved in 3 months and 24 months after operation (P＜ 0.01).There were 22 excellent cases (31.88％),44 good cases (63.77％),3 cases (4.35％) during the final follow-up,and the excellent and good rate was 95.65％.Dural sac injuries occurred in 1 patient and discharged from hospital in 2 weeks of symptomatic treatment.Lumbar instability and operative segment recurrence were not found during the follow-up period (2 years).Conclusion The improvement of the puncture angle and the technique innovation of the guide rod moving from intervertebral space to intraspinal canal step by step can effectively reduce the nerve root stimulation and injury during the puncture and the placement of the working passage,and significantly improve the clinical efficacy of percutaneous lumbar endoscopy in the treatment of central lumbar disc herniation.Microscopic management of the posterior longitudinal ligament can effectively reduce the recurrence rate and has no significant impact on spinal stability.

Objective To investigate the efficacy and safety of levosimendan on patients with acutely decompensated heart failure (ADHF).Methods A prospective randomized and controlled study was carried out from June 2013 to June 2014.Patients were randomly divided into levosimendan group and dobutamine group,with 60 patients in each group.All patients received an intravenous infusion of levosimendan or dobutamine for 24 hours.Brain natriuretic peptide (BNP),stroke volume (SV) and left ventricular ejection fraction (LVEF) were measured.The cardiovascular mortality,rehospitalization rate,the composite endpoint differences and the incidence of adverse events were compared between two groups in 1,3,6 months after treatment.Comparisons between two groups were made using Student t-test or one-way ANOVA.Statistical analysis was performed using SPSS 17.0 software and a P value of ＜ 0.05 was considered statistically significant.Results There was no significant difference in the basic characteristics between two groups.Compared with baseline level,the plasma BNP levels,SV and LVEF were improved at 24 h in both groups (P ＜ 0.05).The cardiac function indexes were better in levosimendan group than in dobutamine group at 24 h [BNP (1147±407) pg/mL vs.(1 502±501) pg/mL,SV (60.9±9.6) mL vs.(57.3±10.3) mL,LVEF (31.6±6.0)％ vs.(28.8±5.1)％,P＜0.05].One month later,the cardiac function indexes were still better in levosimendan group than baseline [BNP (796 ± 296) pg/mL vs.(1 951 ±692) pg/mL,SV (64.6±9.5) mL vs.(52.2±9.1) mL,LVEF (33.4 ±5.8)％ vs.(25.7 ± 6.1) ％,P ＜ 0.05].After l months of treatment,the composite endpoint in levosimendan group was significantly lower than dobutamine group (5％ vs.16.3％,P =0.043).There was a downward trend of mortality and rehospitalization rate in levosimendan group in six months follow-up (P ＞ 0.05).The incidence of side effects was no statistically significant between groups (both were 13.3％).Conclusions Levosimendan is superior to that of dobutamine in improving the hemodynamic status and prognosis in ADHF patients,and the adverse reaction of levosimendan is less.

The varicela-zoster virus(VZV) infection causes central vasculopathy,and then leads to stroke onset. This article review s the correlation betw een VZV infection and stroke onset in order to conduct a comprehensive assessment of patients w ith VZV infection, thereby reducing the risk of stroke after VZV infection.