Objective To analyze the changes in the disease spectrum of hospitalized patients with neurological diseases in a tertiary hospital in the past 5 years,in order to effectively develop targeted disease prevention and treatment strategies.Methods Collect case data of neurological diseases in a tertiary hospital from January 1,2018 to December 31,2022,and use ICD-10 coding for disease classification,and analyze the disease type,gender,age groups,and other factors.Results A total of 9060 patients with neurological diseases were admitted in the past five years.In 2020,the number of discharged patients affected by the COVID-19 was the smallest,accounting for 15.96% ,and in 2022,the number was the largest,accounting for 24.05% .The number of cases showed an increasing trend.There was no statistically significant difference in the composition of male and female patients;There is a statistically significant difference in the number of cases among patients of different age groups,and the incidence categories are different;The top 10 diseases in the ranking of neurological diseases are:transient ischemic attack,headache,spinal nerve disease,neurological disorders,epilepsy,Parkinson's disease,sleep disorders,paralysis,other brain diseases,hydrocephalus.The distribution of the top 10 diseases by gender has statistical significance.Conclusion The hospital can formulate the diagnosis and treatment technology for different age groups according to the distribution characteristics of disease spectrum,carry out comprehensive prevention and treatment measures for key groups,strengthen the construction of key special-ties and allocate health resources properly.

The formation of learning and memory is regulated by synaptic plasticity in hippocampal neurons. Here we explored how gestational exposure to dexamethasone, a synthetic glucocorticoid commonly used in clinical practice, has lasting effects on offspring's learning and memory. Adult offspring rats of prenatal dexamethasone exposure (PDE) displayed significant impairments in novelty recognition and spatial learning memory, with some phenotypes maintained transgenerationally. PDE impaired synaptic transmission of hippocampal excitatory neurons in offspring of F1 to F3 generations, and abnormalities of neurotransmitters and receptors would impair synaptic plasticity and lead to impaired learning and memory, but these changes failed to carry over to offspring of F5 and F7 generations. Mechanistically, altered hippocampal miR-133a-3p-SIRT1-CDK5-NR2B signaling axis in PDE multigeneration caused inhibition of excitatory synaptic transmission, which might be related to oocyte-specific high expression and transmission of miR-133a-3p. Together, PDE affects hippocampal excitatory synaptic transmission, with lasting consequences across generations, and CDK5 in offspring's peripheral blood might be used as an early-warning marker for fetal-originated learning and memory impairment.

Objective:To evaluate and summary the relevant evidence of emergency target blood pressure management in acute aortic dissection, so as to provide guidance for the evidence-based practice of emergency target blood pressure management.Methods:According to the "6S" evidence pyramid model, the evidence about emergency target blood pressure management of acute aortic dissection in various databases and professional association websites at home and abroad was retrieved, including clinical decision, guidelines, expert consensus, systematic evaluation, randomized controlled trial, cohort study, case series, etc. Two researchers used corresponding literature quality evaluation tools to evaluate the quality of the included literature, extracted and summarized the evidence of the literature above grade B.Results:A total of 22 articles were included in this study, including 6 clinical decisions, 5 guidelines, 7 expert consensus, 1 systematic evaluation, 1 randomized controlled trial, 1 cohort study and 1 case series, forming 37 best evidences, including 9 topics such as target value setting, management strategies, disease observation, medical history collection, monitoring methods, vasoactive drugs, non vasoactive drugs, auxiliary examination, health education.Conclusions:The summarized best evidence provides a reference for emergency medical staff to manage the emergency target blood pressure of acute aortic dissection. It is recommended that emergency medical staff follow the summarized best evidence to formulate an individualized target blood pressure management scheme for patients.

Objective To evaluate the quality of the clinical trial literatures published on the treatment of COVID-19 with TCM, find out the shortcomings and put forward corresponding suggestions, in order to promote TCM against COVID-19. Methods "COVID-19", "New Coronavirus Pneumonia", "TCM", "Chinese Medicine", "Clinical Trial", "Lianhua Qingwen", "Huoxiang Zhengqi", "Jinhua Qinggan", and other keywords were used to search relevant literatures in CNKI and PubMed database. Among the all the screened relevant literatures on the treatment of COVID-19 with TCM, the literature quality was assessed according to evaluation criteria of clinical trial literatures. Results A total of 463 papers related to the treatment of COVID-19 with TCM were obtained. 440 papers on theoretical research on the network pharmacology mechanism of Chinese medicine treatment of COVID-19 were excluded. Among the 23 articles included in the quality analysis, there are 3 randomized controlled studies, 1 multi-center prospective randomized controlled trial, 2 disease case report trials, and 5 uncontrolled single arm studies, 5 controlled trials and 7 retrospective studies. In the period of more than half a year, although many clinical trial documents of TCM for the treatment of COVID-19 have been published, the clinical trial design reflected in most TCM clinical trials were not standardized. There are problems in "randomness and rationality", such as no control group, no randomization design, only case studies, no blinding method in controlling bias, and insufficient objectivity in the evaluation criteria of efficacy. All of these need to be improved. Conclusion The treatment of new coronavirus pneumonia with TCM still requires more and standardized clinical trial verifications and publications to generate strong evidence-based results, such as adding control groups, increasing sample size, and using blinding methods to increase the credibility of clinical trials.

Objective: To investigate the current basic situation of ultrasound machines of ultrasound departments in Shanghai medical institutions, and to provide the basis for making management policy in order to promote medical quality. Methods: Questionnaire surveys about ultrasound machines and service ability including producing countries of ultrasound machines, the number of ultrasound machines, using years of ultrasound machines, yearly workload and the yearly number of patients that each ultrasound machine accepted were made in 2013 and 2018, respectively. Statistical results were compared between the two surveys. Results: Compared with 2013, the share of imported ultrasound machines declined in 2018 (82% vs 91%). Compared with 2013, the number of ultrasound machines in Shanghai medical institutions had increased by 31% in 2018 (2 123 vs 1 617). The occupancy rate of ultrasound machines in tertiary hospitals was the highest (tertiary hospitals 40%, secondary hospitals 25%, primary grade hospitals 20%, and private hospitals 15%). Compared with 2013, the proportion of ultrasound machines that have been used for more than 10 years increased (9% vs 4%), the yearly workload of ultrasound examination had increased by 46% (19.82 million person-time vs 13.59 million person-time). Tertiary hospitals bored the highest proportion of the workload (tertiary hospitals 51%, secondary hospitals 35%, primary grade hospitals 4%, and private hospitals 10%). Currently, the number of ultrasound machines per 10, 000 people in Shanghai was 1.14. The yearly number of patients that each ultrasound machine accepted had increased by 11% (9300 person-time vs 8400 person-time in 2018). Conclusions The scale of ultrasound departments in Shanghai medical institutions has been developing. Brand localization of ultrasound machines is improving. However, the renewal ability of ultrasound machines still needs to be improved. The workload of ultrasound department is getting heavier. Hierarchical diagnosis and treatment is unbalanced.

Objective To investigate the correlation between serum tumor markers levels with the disease condition activity and the tumor occurrence in the patients with rheumatoid arthritis(RA).Methods Serum tumor marker CA199,CA153 levels were de-tected in 35 patients with RA (RA group)and 31 healthy controls(normal control group).ESR and CRP were examined and the disease activity (DA)was assessed by the DAS28 score in the RA group.The serum tumor markers levels and the positive rates were compared between the RA group and the normal control group.The correlation between the serum tumor markers levels with ESR,CRP and DAS28 score was analyzed.Results Serum levels and positives rate of CA199,CA153 in the RA group were higher than those in the control group(P <0.05).The serum CA153 level had a positive correlation with the ESR,CRP and DAS28 score in the RA group(P <0.05),but the serum CA199 level had no significant correlation with them.Conclusion The serum levels and positive rates of CA199 and CA199 could be increased in the patients with RA,moreover the increase of serum CA153 level is corre-lated with DA of RA.Therefore the serum tumor marker CA153 level may be used as one of reference indexes for evaluating the DA in the patients with RA.

Objective To explore the ischemic myocardial perfusion and viability.Methods Ten successful pigs with myocardial infarction model underwent MRI first-pass myocardial perfusion examinations preoperatively and 24 hours,72 hours and one week postoperation.After MRI examinations,the experimental pigs were executed and the samples underwent TTC staining and pathological examination.Results The preoperative myocardial perfusion in the all of the 10 pigs was nomal,but there were myocardial perfusion decrease and defects in 8 experimental pigs after operation,the perfusion curves in the area with perfusion defects had no obvious peak,but there was gradual increase in the end of the performance.The perfusion peak of the area with perfusion decrease was lower than that of normal inferior and lateral myocardial wall(P＜0.05) and the peak perfusion time was delayed compared with that of normal inferior and lateral myocardial wall (P＜0.05).There was myocardial necrosis in the perfusion defects areas that was certified by TTC staining and pathological examination.The intersititial edema and myocardial degeneration could be seen in the perfusion reduced areas.Conclusion MRI fist-pass myocardial perfusion imaging combined with perfusion curve analysis can evaluate the perfusion changes of the regional myocardial microcirculation.

Objective: To establish porcine chronic ischemic myocardium model and to evaluate ultrasonic integrated backscatter(IBS) and Doppler tissue imaging(DTI) in detecting this model. Methods: An Ameroid constrictor was placed around the porcine proximal left circumflex artery. The calibrated average image intensity (%AⅡ), cyclic variation of IBS (CVIB), the subendo-epicardical gradient index (TGI) and the spectrum of left ventricular papillary muscle level short axis view (LVPM-SAM) and apical four chamber view (AP-4CV) were measured at normal state, 2 w, 4 w, 6 w and 8 w after Ameroid placement. Results: Normal %AⅡ, CVIB and TGI were 2.29?0.32,(9.69?2.22)dB and 0.22? 0.08 respectively. After Ameroid placement, the %AII increased gradually, the CVIB decreased gradually, and the decrease was higher in subepicardium than that in subendocardium. The most obvious decrease of TGI occurred from 2 w to 4 w after Ameroid placement and became zero at 8 w(P

Objective To investigate the value of Doppl er tissue imaging (DTI) in detecting chronic ischemic myocardium before and after gene transfer. Methods An Ameroid constrictor was placed around the left circumflex artery of each open-chest pig. After 4 weeks, groupⅠandⅡwere intramyocardially administrated recombinant adenovirus coding for the vascular endothelial growth factors(Ad.VEGF-B) or phosphate buffer(PB). After 4 weeks, their hearts were removed for pathological investigation. Color M-mode, two-dimensional and spectrum DTI of lateral-posterior wall before operation, 2 weeks and 4 weeks after Ameroid placement, 2 weeks and 4 weeks after administration were studied. Results Color of normal myocardium was bright, filling and distinct stratified, and of ischemic myocardium faint, local lost and cloudy stratified. After gene transfer, color filling became better and stratification distinct. Normal V S of apical four chamber view (AP-4CV) was greater than that of left ventricular papillary muscle level short axis view (LVPM-SAM)(P

Objective To observe the perfusion changes of porcine chronic ischemic myocardium before and after gene transfer by myocardial contrast. Methods Ten normal pigs were divided into two groups: groupⅠfor gene transfer(6 pigs) and groupⅡ for control(4 pigs). Myocardial contrasts were performed respectively in basic status, 4 weeks after an Ameroid constrictor was placed around the proximal left circumflex artery (LCX) and another 4 weeks after the replication deficient recombinant adenovirus coding for the vascular endothelial growth factors (Ad. VEGF)was administrated into the regional ischemic myocardium in groupⅠ, and the phosphate buffer(PB) was administrated into similar situs in groupⅡ. The perfusion of above mentioned different blood supply myocardium was observed with HP Sonos 5500 and S4 transducer by myocardial contrast. Results The normal left ventricular myocardial wall was uniformly thick and its perfusion was bright and well filling. The chronic ischemic myocardium was thinned and its echo showed the contrast defect. The echo of the myocardium for gene transfer returned to good, but the echo of the control group remained bad including some bright bits and pieces. Conclusions The blood supply of the porcine chronic ischemic myocardium was ameliorated by gene transfer. The perfusion characters of the different blood supply myocardium can objectively reflect the blood supply status of the myocardium.