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@#Objective To investigate the changes and correlations of the permeability of blood brain barrier (BBB),the cerebral brain perfusion and the volume of gray matter in patients with asymptomatic carotid artery stenosis (ACAS) by arterial spin labeling (ASL) MRI,dynamic contrast-enhanced (DCE) MRI and artificial intelligence. Methods ASL-MRI,DCE-MRI and three-dimension brain volume (3D-BRAVO) imaging were performed respectively on 40 patients with ACAS,then transferred them to the workstation for image post-processing to obtain cerebral blood perfusion,BBB permeability (which was expressed by volume transport constant Ktrans) and gray matter volume of both side.The above data were statistically analyzed and tested. Results Compared with the contralateral side,the stenosed side had a significant lower cerebral brain perfusion(P<0.001) and higher Ktrans value (P<0.05) in patients with ACAS.The volume of gray matter of the stenosed side was significantly smaller than the contralateral side(P<0.001),there were significant differences between bilateral temporal lobe,frontal lobe,parietal lobe and insular lobe(all P<0.05).Correlation analysis shows there was a negative correlation between Ktrans value and CBF value on the stenosed side (r=-0.334,P<0.05). Conclusion In patients with ACAS,there are lower cerebral brain perfusion and higher BBB permeability in the stenosed side.The increase BBB permeability in the stenosed side in patients with ACAS is related to the decrease in cerebral brain perfusion.
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Objective:To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS).Methods:In this cross-sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2-test, independent sample t-test and Wilcoxon non-parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results:Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm 3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm 3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm 3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm 3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm 3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides ( r=0.427, P<0.01). The attention ( r=0.353) and abstraction ( r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P<0.05). The visuospatial executive ( r=0.187) and language ( r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive ( r=0.386), naming ( r=0.344), language ( r=0.517), abstraction ( r=0.335) and delayed recall ( r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P<0.05). Conclusion:In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them.
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Objective@#To detect varicella-zoster virus ( VZV ) antibody levels among children aged 1 to 12 years in Lu'an City, Anhui Province, so as to provide insights into perfection of the varicella immunization strategy.@*Methods@#Children aged 1 to 12 years were recruited from Lu'an City using the stratified random sampling method from July 2018 to February 2019, and subjects' demographics were collected using questionnaires. The inoculation of varicella vaccines was retrieved through the Anhui Immunization Information Management System or review of preventive immunization certificates, and the serum VZV IgG antibody was detected using enzyme-linked immunosorbent assay ( ELISA ). The seroprevalence and geometric mean concentration of the VZV-IgG antibody were estimated, and the changes of serum the VZV-IgG antibody levels were analyzed at different time intervals following varicella vaccination. @*Results@#Totally 734 children were surveyed, with a mean age of ( 6.94±2.95 ) years, and the subjects included 412 boys ( 56.13% ) and 322 girls ( 43.87% ). There were 514 children ( 70.03% ) with a history of varicella vaccination, including 501 children ( 68.26% ) with one dose of varicella vaccine and 13 children ( 1.77% ) with two doses. There were 297 children ( 40.46% ) positive for VZV-IgG antibody, with seroprevalence of 40.46%, and the GMC of VZV-IgG antibody was 74.97 ( 95%CI: 65.55-85.75 ) mIU/mL. The seroprevalence of the VZV-IgG antibody were 34.55%, 42.91%, and 46.15% among the unvaccinated children and children receiving one dose and two doses of varicella vaccine, with the GMCs of 53.04, 86.31 and 114.46 mIU/mL, respectively. The mean time interval between inoculation of the last dose of varicella vaccine and blood sample collection was ( 5.21±2.79 ) years, and the lowest seroprevalene (31.48%) and GMC of the VZV-IgG antibody (49.96 mIU/mL) were found 4 years after inoculation of varicella vaccine.@*Conclusions@#The serum VZV-IgG antibody level is low among children aged 1 to 12 years in Lu'an City, and the seroprevalence of the VZV-IgG antibody is affected by age and doses of varicella vaccine. A 2-dose schedule of varicella vaccine is recommended for children.
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OBJECTIVE：To provide reference for the development and application of pharmacy popular-science video courseware. METHODS ：Combined with the problems existing in the medication of patients with chronic diseases at the present stage and the key points of medication management ，the theme ，content and form of this popular-science were determined ；the video shooting and production were completed ，and publicity and promotion were carried out. Questionnaire survey was conducted ， and the reception of pharmacy outpatient service in our hospital was counted ；the broadcasting effects of popular-science video were analyzed. RESULTS ：The theme of popular-science video courseware was determined to be self-medication management of patients with chronic diseases at home assisted by pharmacists. Combined with the “five moments ”of medication safety proposed by WHO ， the content included six units as knowing pharmacists ，understanding drugs ，taking drugs ，adding drugs ，checking drugs ，and discontinuing drugs. PPT video was used to explain the contents of each unit ，with an average duration of about 25 min. After the first unit was launched ，a total of 39 327 hits were received within two months. A total of 100 questionnaires were sent out ，97 questionnaires were collected （recovery rate of 97.0％）. Among them ，80（82.5％）thought it helpful to watch the video. Within two months after the broadcast of unit 1 video，the reception volume of pharmacy outpatient department of our hospital （1 160 person times ）increased by 104.2％ compared with the two months in the same period last year （568 person times ），and increased by 18.7％ compared with the two months before the broadcast （977 person times ）；99 patients came to the pharmacy outpatient department to consult because of watching the video ，and 55.6％ of the registered patients consulted the demonstration of video courseware and repeatedly mentioned related problems. CONCLUSIONS ：It is a beneficial exploration for pharmacists to develop popular-science video courseware with the theme of safe and rational drug use. It is the direction for future work to increase the scope of disease types ，target different groups of people or focus on different types of drugs and promot them in various forms.
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@#Abstract Objective To observe the dynamic changes of hippocampus microstructure in patients with cerebral infarction within the territory of the middle cerebral artery (MCA) with cortex involvement,thus exploring the relationship between these changes and the changes in semantic memory function.Methods Twenty-two patients with acute subcortical infarction were assessed for cognitive function,structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) at 1,4,and 12 weeks (W) respectively.A total of 22 gender and age matched subjects were enrolled as healthy controls.Results Bilateral hippocampal volume did not change significantly during the entire follow-up period.Spearman’s rank correlations showed that percent decreases in immediate recall and long-delay recall scores correlated negatively with percent increases in mean diffusivity (MD) values in the ipsilateral hippocampus (immediate,rs=0.683,P=0.006; long-delay,rs=-0.602,P=0.013).Conclusion In patients with cerebral infarction within the territory of the MCA with cortex involvement,the microstructural integrity of the hippocampus may be damaged before the macrostructure changes,and these changes may be related to the decline of semantic memory.
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@#Objective To investigate the clinical features and prognosis of anterior circulation cerebral infarction secondary to cervical artery dissection.Methods Sixty one patients with cervical artery dissection (CAD) secondary to anterior circulation cerebral infarction treated in Department of Neurology of North Jiangsu People’s Hospital from January 2016 to December 2020 were included consecutively.And 67 patients with large artery atherosclerosis (LAA) cerebral infarction complicated with moderate to severe carotid artery stenosis who were hospitalized at the same time were enrolled for comparison.The clinical data and prognosis between the two groups were compared.Results Unifactorial analysis showed that the average age of CAD cerebral infarction group was younger,the incidence of head and neck pain and monocular amaurosis was higher,the proportion of massage trauma fatigue history was higher,the incidence of hypertension and smoking history was higher in LAA cerebral infarction group.The comparison of the two hematologic examinations showed that the erythrocyte count was higher in the CAD cerebral infarction group,and the D-dimer,cholesterol,glycated hemoglobin,and uric acid values were higher in the LAA cerebral infarction group.Binary logistic regression analysis showed that the history of massage trauma fatigue was more correlated with CAD cerebral infarction,while older age and smoking history were more correlated with LAA cerebral infarction.The improvement of NIHSS scores during hospitalization in the CAD cerebral infarction group was more significant than that in the LAA cerebral infarction group,and the difference was statistically significant.There were no significant differences in 90 day prognosis,mortality,and reinfarction rate within 6 months between the two groups.Conclusion The correlation between the history of massage trauma and fatigue and CAD cerebral infarction was greater,and the correlation between the older age and smoking history and LAA cerebral infarction was greater.The improvement of NIHSS score in CAD cerebral infarction group during hospitalization was more obvious than that in LAA cerebral infarction group,which was statistically significant.There were no significant differences in 90 days prognosis,mortality and 6 month reinfarct rate between the two groups.
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Objective To investigate the effects of the multidisciplinary cooperative management intervention model on the self‐management efficacy of patients with ileostomy irritant dermatitis. Methods Among the patients with irritative dermatitis in the ileostomy section of the Anorectal Surgery and Ostomy Clinic of Hwamei Hospital, the Chinese Academy of Sciences, 72 patients, who visited the clinic from August 2016 to August 2018, met the inclusion criteria and were finally included in the study. According to the random number table method, 36 patients each were assigned to the control and observation groups respectively. There were no significant differences in age, sex and education between the two cohorts. The control groups were compared. The control group was treated with routine nursing methods. The observation group underwent multidisciplinary nursing intervention that was based on the routine measures of the control group. The Chinese version of the cancer self‐management efficacy was used as the questionnaire survey that was administered before and after treatment. The results were compared and analyzed between the patient groups. The independent sample t‐test was used to compare the results between the groups, and the paired sample t‐test was used for intra‐group comparisons. Results After intervention, the total scores of self‐management efficacy and positive attitude, self‐decompression and self‐decision scores were higher in the observation group than in the control group (t=4.192, 3.095, 4.123, 2.267, P<0.05). The scores of self‐administration efficacy and each dimension of the two groups were higher than those before intervention, and the difference was statistically significant (P<0.01). After the intervention, 3 patients (10.0%) in the observation group with recurrent dermatitis and 13 patients (43.3%) in the control group. The recurrence rate of the observation group was significantly lower than that of the control group (χ2= 8.357, P<0.05). Conclusion Multidisciplinary cooperative management can improve the self‐management efficacy of patients with irritating dermatitis and reduce the incidence of this condition.
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The occurrence,development and reperfusion treatment of ischemic stroke may damage the structure and function of the blood-brain barrier,leading to increased permeability of the blood-brain barrier,and then having cerebral edema or hemorrhagic transformation,and finally resulting in poor outcome.Quantitative assessment of blood-brain barrier permeability is now available.This article reviews the assessment methods of blood-brain barrier permeability and their application in patients with ischemic stroke.
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Objective To investigate the influence of moderate to severe leukoaraiosis (LA) in prognoses of acute ischemic stroke patients after endovascular treatment.Methods From January 2017 to December 2018, 60 patients with acute ischemic stroke due to anterior circulation large vessel occlusion underwent endovascular treatment and obtained complete vessel recanalization in our hospital were evaluated for degrees of LA severity according to head CT scan and van Swieten scale (2-4 scores were defined as moderate-severe LA). According to modified Rankin scale (mRS) scores 90 d after treatment, the patients were divided into poor prognosis group and good prognosis group. Univariate analysis was used to compare the differences of influencing factors of the two groups. Multivariate Logistic regression analysis was further used to explore the influence of moderate to moderate-severe LA in poor prognosis of patients after endovascular treatment.Results Of the 60 patients, 18 did not have LA, 19 had mild LA, and 23 had moderate-severe LA; 32 had poor prognosis and 28 had good prognosis. Univariate analysis showed that the patients from the poor prognosis group had significantly higher proportion of moderate-severe LA (59. 4％ [19/32]vs. 14.3％ [4/28]), significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores ([23.4±10.1]vs. [14.7±7.0]), significantly higher baseline diastolic blood pressure ([87.5±18.9] mmHgvs. [78.3±15.1] mmHg), significantly higherproportion of patients with hypertension history (68.8％ [22/32]vs. 42.9％ [12/28]), and statistically older age ([70.6±9.4] yearsvs. [61.3±12.5] years) than the patients from the good prognosis group (P<0.05). On multivariable Logistic regression analysis, the presence of moderate-severe LA (OR=5.032, 95％CI: 1.026-24.679,P=0.046) and baseline NIHSS scores were independent risk factors for poor prognosis of patients after endovascular treatment.Conclusion Patients with acute ischemic stroke accompanied with moderate-severe LA are more likely to have poor prognosis after endovascular treatment.
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In recent years,studies have shown that inflammation is an important factor in secondaryischemic injury.The exploration of the related mechanisms of the occurrence of inflammation has become ahot spot in the field of cerebral ischemia.Toll-like receptor 4 (TLR4) signaling pathway is one of theclassical inflammatory pathways.Studies have shown that TLR4 is involved in the early inflammatoryresponse after cerebral ischemic injury and the late nerve repair.This article reviews the research progress ofthis signaling pathway in cerebral ischemia injury,so as to seek a therapeutic target against inflammatoryinjury caused by cerebral ischemia through the analysis of its potential research direction.
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Objective To investigate the value of high-resolution magnetic resonance imaging (HR-MRI) for assessing the plaque stability as well as the risk factors for unstable plaque and severe stenosis in patients with symptomatic carotid stenosis.Methods The patients with symptomatic carotid stenosis were enrolled.HR-MRI was use to evaluate carotid plaque compositions and identify the stability of plaques.The carotid plaques from the patients underwent carotid endarterectomy were collected for pathological examination.The consistency of the preoperative HR-MRI and the postoperative pathological findings were compared.The clinical data of all patients were collected and the risk factors for the stability of carotid plaques and the severity of vascular stenosis were analyzed.Resulls A total of 219 patients with symptomatic carotid stenosis (stenosis ＞ 50％) who underwent HR-MRI were enrolled.Among them,102 patients (46.6％) had stable plaques and 117 (53.4％) had unstable plaques;118 (53.9％) had moderate stenosis and 101 (46.1％) had severe stenosis.Thirty-fiwe patients received carotid endarterectomy,HR-MRI showed that the plaque in 19 (54.3％) of them were instable,and pathological examination showed that the plaque in 20 (57.1％) cases were instable,and both were highly consistent (κ =0.942,P ＜ 0.001).The proportions of male (P =0.007),hyperlipidemia (P =0.013),smoking (P ＜0.001),as well as the levels of total cholesterol (P =0.001),low-density lipoprotein cholesterol (P ＜0.01),and fasting blood glucose (P =0.001) in the unstable plaque group were significantly higher than those in stable plaque group.Multivariate logistic regression analysis showed that male (odds ratio [OR] 2.33,95％ confidence interval [CI] 1.08-5.04;P=0.032),smoking (OR 3.45,95％ CI 1.67-7.14;P=0.001),and higher fasting blood glucose level (OR 1.26,95％ CI 1.07-1.48;P =0.006) were the independent risk factors for unstabke plaque.All the data did not show any significant difference between the moderate stenosis group and the severe stenosis group.Conclusions HR-MRI accurately assessed the plaque stability in patients with symptomatic carotid stenosis.Sex,smoking,and fasting blood glucose level were the independent risk factors for carotid artery unstable plaque.
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Symptomatic carotid stenosis is closely associated with ischemic stroke,its treatment strategies include risk factor control,medical therapy,and revascularization.This article reviews and summarizes the clinical research of treatment methods in recent years,such as symptomatic carotid stenosis related antiplatelet therapy,antihypertensive treatment,lipid-lowering therapy,carotid endartereetomy and stenting,as well as the treatment strategies recommended by the guidelines.
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Objective To study factors used to predict 30-day mortality and favorable outcomes to intracerebral hemorrhage (ICH) in young adult subjects and to estimate the reliability of these predictors.Methods Data of 175 acute ICH patients selected from 201 patients admitted to our hospital from 2008 to 2011 were reviewed retrospectively.Patients were assessed with Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) and routine laboratory examinations after admission.Independent predictors of 30-day mortality or good outcome (modified Rankin score,0-2) were identified by stepwise logistic regression.Results There were 90 male and 85 female,and 142 survivals and 33 deaths.The modified Rankin score (mRS) of survival group was ＜6 and mRS =6 in death group,and mRS ＜3 in good outcome group and mRS ＞ or =3 in poor outcome group.Independent factors for 30-day mortality were hypertension (P =0.023) or hyperglycemia (P =0.007),infra-tentorial ICH (P =0.000),large ICH volume (P =0.008),low Glasgow Coma Scale (GCS) scores (P =0.000),high white blood cell count (P =0.000),higher blood glucose level (P =0.039) and prothrombin time (PT) (P =0.001) after admission.Independent factors for 30-day good outcome were younger age (P =0.001),normal blood pressure (P=0.010) or absence of hyperglycemia (P=0.028),lower NIHSS scores (P=0.000),small ICH volume (P =0.000),low white blood cell (WBC) count (P =0.000),lower blood glucose level (P =0.012) or lower systolic blood pressure (SBP) level (P =0.000) at admission.The NIHSS score and GCS score were excellent predictors,while the SBP level,WBC count and ICH volume were fine predictors.Conclusions Overall prognostic factors should be integrated to get high reliabilities for predicting the outcomes of ICH in young people.
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Objective To evaluate the value of the differential diagnosis of peripheral pulmonary cancer using contrast-enhanced ultrasound (CEUS).MethodsTotally 59 patients selected with peripheral pulmonary lesions(27 primary lung cancer and 32 non-lung cancer cases including 12 pulmonary abscess,19 tuberculosis and 1 hemangioma subjects)were examined by traditional gray-scale sonography and color Doppler flow imaging (CDFI),the lesions shape,borders,echo characteristic and blood flow were recorded first,and then the contrast enhancedsonographicstudies were performed.The process of contrast enhancement and regression was observed and the parameters were quantitative analyzed by acoustic quantification analysis software (ACQ).Finally,surgery or biopsy were conducted.Results CEUS had higher detection rates of blood flow signals than CDFI( P ＜0.001 ).There were significant differences (P ＜ 0.01) between the primary lung cancer group and the non-lung cancer group regarding parameters peak intensity ( PI ) and enhanced intensity ( EI ).By drawing the ROC curve and obtaining the area under the curve:a cut-off value＞15.7 dB of PI in assessing lung cancer had higher sensitivity and specificity (66.7 ％,81.2％).A cut-off value＞ 10.77 dB of EI in assessing lung cancer had higher sensitivity and specificity (81.5％,68.8％).Conclusions CEUS is helpful to identify necrotic tissue in biopsy and improving the biopsy positive rate.The parameters of PI and EI can help to identify the primary lung cancer with the Nonlung cancer.
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Objective To investigate the relation between anormalities of fetal abdominal great vessels and heterotaxy, the clinical significance of screening fetal heterotaxy by the abnormalities of fetal abdominal great vessels. Methods 6532 fetuses from our hospital were scanned and the fetuses with abdominal great vessels abnormalities were included. Parameters of fetal growth, abdominal great vessels and anatomical survey were detected. Results Forty-five cases (0.7%) of fetal abdominal great vessels abnormalities were detected prenatally. Forty-two cases were confirmed postnatally, including 35 cases of heterotaxy syndrome and 7 cases of situs inversus totalis and 3 cases missed. The incidences of the abnormal fetus,heterotaxy syndrome and situs inversus totalis of the fetuses with abnormal abdominal great vessels were higher than that of the fetuses with normal abdominal great vessels, the differences were statistically significant( P＜ 0.001). The incidence of both type Ⅰ and type Ⅱ of the heterotaxy syndrome were significantly higher than that of type Ⅳ (P＜0.001). There was a high incidence of left isomerism in abnormal type Ⅰ and of right isomerism in abnormal type Ⅱ , the differences were statistically significant (P＜ 0.001). Conclusions Abnormal great vessels abnormalities have strong relations to heterotaxy and situs inversus which can be used as effective and simple indicator in screening heterotaxy syndrome.
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Objective To investigate the effectiveness of entropy in measuring the level of sedation during target controlled infusion (TCI) of propofol in patients of different ages. Methods Twenty-nine ASA Ⅰ-Ⅱ patients undergoing elective surgery under general anesthesia were divided into two age groups: Ⅰ adult group (20-64 yr) (n = 16) and Ⅱ the aged group (65-85 yr) ( n = 13). The patients were unpremedicated. The level of sedation was assessed using OAA/S scale. Propofol was given by TCI. The effect-site concentration (Ce) of propofol was set first at 1 ?g?ml-1 and then increased step by step by 0.5 ?g?ml-1 every 60 seconds until Ce reached 6 ?g?ml-1. Response entropy ( RE), state entropy ( SE), BP, HR, SpO2 were monitored and recorded at each Ce, before intubation, and immediately and 1, 2, 3, 4, 5, 10 min after intubation. The predictive performance of entropy was evaluated by prediction probability (Pk) .Results The two groups were comparable with respect to sex (M/F ratio), body weight and body weight index (kg?m-2). The RE and SE values decreased as Ce increased. The difference between RE and SE was also reduced. In adult group when Ce reached 2.0 ?g?ml-1, the RE and SE values were lower than the baseline values ( P