objective To observe the influence of hemodynamic changes caused by extracranial carotid stenosis on the plaque stability, and analyze the relationship of cerebral infarction classification,criminal artery stenosis degree and plaque stability to offer evidence for evalu-ating nosogenesis,clinical diagnosis,treatment and prevention of cerebral infarction. Methods CDFI,CTA were performed in 168 patients with acute cerebral infarction,some moderate and severe and occlusive carotid artery which were demonstrated by CTA and CDFI were further checked by DSA during convalescence. Totally 168 acute cerebral infarction patients were divided into 5 groups based on the criminal artery stenosis degree. To evaluate the plaque stability and flow field changes with CDFI and CTA,OCSP clinical classification and brain image clas-sification were finished according to CTA. Patients were classified into 4 subtypes,namely cortical infarction,basal ganglion infarction,corona radiata infarction and posterior infarction,according to the lesion distributions. Observe the changes of flow field and stability of plaque,and compare the relationship between different degree of stenosis and the classification of lesion of infarction. Results Among the 168 criminal arteries,there was 17. 9% of normal,22. 6% of mild stenosis,30. 9% of moderate stenosis,14. 8% of severe stenosis,and 14. 3% of occlu-sion,and the moderate stenosis proportion was the highest. When the stenosis degree was over 50%,it may lead to the changes of flow field, speeding up of blood flow,forming of turbulent flow,and increasing of plaque instability in which lipid plaque and admixture plaque was the highest. PACI is the commonest in all moderate groups. Admixture plaque is usually seen in severe stenosis and occlusion, while fibrous plaque is usually seen in mild stenosis. Conclusion Moderate carotid stenosis may lead to the increase of plaque instability as a result of the changes of flow field,and it may prone to artery-artery embolization.

Objective To analyze the imageological characteristics of intracranial vascular multiple stenosis aneurysms and to e-valuate the influence of cerebral vascular stenosis caused hemodynamic change on the aneurysm occurrence .Methods The clinical data of 30 inpatients with intracranial arterial multiple stenosis aneurysms diagnosed by CTA and DSA ,who were hospitalized due to ischemic cerebrovascular disease in the neurology department of 251 Hospital of Beijing Military Region from January 2007 to May 2012 ,were retrospectively analyzed and taken as the observation group ;contemporaneous 30 cases of aneurysm without in-tracranial and extracranial arterial stenosis admitted to the neurosurgery department were taken as the control group .The gender , age of onset ,number of aneurysms ,whether or not complicating hypertension ,diabetes ,smoking ,hyperlipemia ,plaque of extracrani-al carotid artery ,ischemic stroke and cerebral arterial abnormal development were compared between the two groups .The Logistic single factor and multi-factor correlation analysis was adopted to evaluate the correlation between the aneurysm occurrence with the hemodynamic changes caused by atherosclerotic stenosis .Results Cystic multiple aneurysms were common in the observation group ,which was up to 4 in number ,the age was more than 60 years ,the majority was complicated by hypertension ,diabetes ,hyper-lipemia ,cerebral stroke ,plaque of extracranial carotid artery and intracranial arterial multiple stenosis were common .Aneurysms mostly occurred in intracranial artery with severe stenosis .The gender differences were unobvious .The control group was domina-ted by young patients .Single aneurysm was more common without intracranial artery multiple stenosis .The occurrence rate of ca-rotid arterial plaque and cerebral stroke was lower .The partial patients had smoking ,hyperlipidemia and hypertension .The Logistic regression analysis between the two groups showed that ischemic stroke ,cerebral arterial development abnormality and atheroscle-rosis plaque of extracranial carotid artery had significant correlation .Conclusion The aneurysm occurrence is related with cerebral arterial atherosclerotic stenosis ,which becomes the important factor leading to aneurysm formation and should arouse attention to conduct early diagnosis and early treatment .

The research aimed to investigate the therapeutic effects and mechanisms of Opuntia dillenii Haw polysaccharide (OPS) on atherosclerosis of rats. First atherosclerotic rat models were established by high-fat and high-calcium diet. Thirty days later, the rats were treated with low dosage of OPS (0.2 g x kg(-1) x d(-1)) or high dosage of OPS (0.4 g x kg(-1) x d(-1)) by intraperitoneal injection for 60 days continuously. At the end of treatment, thoracic aorta rings were prepared and vasorelaxation of rat thoracic aorta in different experiment groups were determined by using 620M multi wire myograph system in vitro. Blood and livers of rats were collected. Then plasma levels of total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL) of rats were separately determined using whole automatic biochemical analyzer; protein level of hepatic apolipoprotein B (ApoB) and that of hepatic diglyceride acyltransferase (Dgat1) were measured by Western Blot technique. Results showed that the ability of rat thoracic aorta to relax decreased markedly in the model group compared with that in the normal group, and significant differences existed in vasorelaxation ratios induced by different concentrations of carbamylcholine chloride (Carb) between these two groups (P < 0.01). After OPS treatment, the ability of rat thoracic aorta to relax improved markedly, the vasorelaxation ratios induced by Carb at 5 and 10 μmol x L(-1) were respectively 0.34 ± 0.08 and 0.62 ± 0.15 in the group treated with low dosage of OPS, while the ratios induced by Carb at 1 and 5 μmol x L(-1) were respectively 0.54 ± 0.08 and 0.98 ± 0.02 in the group treated with high dosage of OPS, which were all significantly different with those in the model group (P < 0.01). Plasma contents of TC, TG and LDL reduced significantly by the treatments both with low and high dosages of OPS compared with those in the model group (P < 0.01). Protein level of hepatic ApoB and that of hepatic Dgat1 decreased significantly after the treatment with high dosage of OPS compared with those in the model group (P < 0.01). These results indicate that OPS can markedly improve the vasorelaxation of thoracic aorta of atherosclerotic rats and has significant anti-atherosclerotic effect; inhibiting the expression of ApoB and Dgat1 and thus decreasing the amounts of TC, LDL and TG serving as one of the molecular mechanisms of its antiatherosclerosis effect.

Objective: To explore the effects of cardiac resynchronization therapy (CRT) in patients with dispersion of re-polarization and ventricular arrhythmia.
Methods: A total of 86 consecutive patents with CRT implantation were enrolled. According to weather absolute value of LVEF increased≥10% from baseline at 6 months after CRT implantation, the patients were divided into 2 groups: Response group and Non-response group,n=43 in each group. Dispersion of re-polarization indexes as QRS duration, QTc interval, TpTe interval and the events of ventricular arrhythmia were compared between 2 groups at different time points after CRT.
Results:①In Response group, compared with pre-operation, QRS duration and TpTe interval were shorter at 1 year and within 24h after CRT implantation, allP<0.05, while the above indexes were similar in Non-response group, allP>0.05.②During 1 year after CRT implantation, the incidences of PVCs and PVC runs in Response group were much less than those in Non-response group, for lgPVCs: (1.78 ± 0.77) vs (2.73 ± 0.61), for lgPVC runs: (0.64 ± 0.48) vs (1.98 ± 0.72),P<0.05.③Multi liner regression analysis demonstrated that TpTe interval within 24h after CRT implantation was an independent predictor for both lgPVCs: (B=0.143, OR=1.154,P=0.001) and lgPVC runs: (B=0.122, OR=1.047,P=0.001).
Conclusion: CRT ventricular reverse remodeling may reduce dispersion of re-polarization and the risk of ventricular arrhythmia, therefore improve the prognosis in relevant patients; TpTe interval within 24h after CRT had the predictive value for ventricular arrhythmia.

Objective To discuss the application of transanal placement of ileus tube in treatment of colonic obstruction in left colorectal cancer.Methods Thirty-two patients with left malignant colorectal obstruction were divided into ordinary colonoscope group (16 cases) and superslim endoscope group (16 cases) by random digits table.The catheter success rate,catheter operating time and exposure to X-ray time was compared between two groups.Results Fifteen cases were successful and 1 case was failed in ordinary colonoscope group.Thirteen cases were successful and 3 cases were failed in superslim endoscope group.There was no significant difference in the catheter success rate between two groups (x2 =1.143,P =0.285).The catheter operating time was (42 + 15),(20 +6) min in ordinary colonoscope group and superslim endoscope group,and there was significant difference between two groups (t =3.895,P =0.005).The exposure to X-ray time was (20 + 12),(5 + 2) min,and there was significant difference between two groups (t =-3.596,P =0.007).Conclusion Transanal placement of ileus tube is more successful and convenient by superslim endoscope combined with anesthesia than by ordinary colonoscope.

Objective To analyze the epidemiology and clinical characteristics of the children with measles. Methods Retro-spectively analyzed methods were applied to analyze the timing, and season of the break, age distribution, clinical manifestations and major complications of 3431 children with measles (<12 years) in the Second Hospital of Nanjing from 2008 to 2015. Results It found that there was a peak incidence of measles in children each in 2009, 2013, and 2015 , peaking in March to May. Onset age of measles mainly within the first year of life, and incidence increased with age within the first 8 months. Typical clinical manifestations are mainly fever, rash, cough, and catarrhal symptoms. The main complications of measles were pneumonia, laryngitis and heart failure. Conclusions Early diagnosis and effective treatment of the children with measles needs to be strengthened.

Objective To understand the clinical nutritional status and malnutrition risk factors of Parkinson's disease (PD) patients and construct their risk scoring system.Methods A total of 221 patients with PD admitted to our hospital from January 2015 to January 2019 were enrolled. The nutritional status of the patients was assessed by Mini Nutrition Assessment (MNA), and according to the MNA scores, these patients were divided into well-nourished groups (n=176) and malnourished group (including patients having malnutrition and malnutrition risk,n=45). Single factor analysis and Logistic regression analysis were used to analyze the risk factors; their scoring systems were constructed and Hosmer-Lemeshow goodness of fit test was used. Accuracy and discrimination of evaluation scoring systems were evaluated by area under receiver operating characteristic (ROC) curve.Results A total of 45 patients (20.36％) had malnutrition or risk of malnutrition. Multivariate regression analysis suggested that the course of disease≥9 years, motor symptoms (unified PD rating scale Ⅲ scores≥54), Hoehn-Yahr (H-Y) staging≥4, daily levodopa equivalent dose≥600 mg, scores of non-motor symptom scale (NMSS) scores≥101, and quality of life (39-item PD questionnaire scores≥81) were independent risk factors for malnutrition in PD patients (P<0.05). The constructed risk scoring system scored from 0 to 30, and Hosmer-Lemeshow goodness of fit test were:&chi;2=6.259,P=0.618; the area under ROC curve was0.830 (95％CI: 0.801-0.860); when the predicted score was 14, Yoden index was the largest (0.517), and the sensitivity and specificity were 75.70％ and 76.00％, respectively.Conclusion sPD patients have a high risk of malnutrition or malnutrition. The risk scoring system based on risk factors has high predictive ability and discriminating ability, and can be used as an important tool for malnutrition risk assessment in PD patients.

Objective To analyze the biochemical characteristics and clinical characteristics of heart failure patients with intermediate ejection fraction.Methods From June 2012 to June 2017,nine hundred and thirty patients with heart failure who were hospitalized and treated in Beijing Anzhen Hospital were selected.According to left ventricular ejection fraction (LVEF),the patients were divided into heart failure with reduced left ventricular ejection fraction group (LVEF＜40％),heart failure with midrange left ventricular ejection fraction group (LVEF 40％-49％) and heart failure with preserved left ventricular ejection fraction group (LVEF ≥ 50％).The number of cases of acute heart failure and chronic stable heart failure was recorded.The general patient information (gender,age,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),NYHA classification) laboratory test results (Brain Brain natriuretic peptide (BNP)) and echocardiography (left ventricular end-diastolic diameter (LVEDD),left atrium diameter (LAD),septal thickness (interventricular septum thickness,IVSD),left ventricle posterior wall thickness (LVPWT) were collected.Results The proportion of patients with acute heart failure in the midrange left ventricular ejection fraction heart failure was similar to the heart failure with reduced left ventricular ejection fraction (38.0％ (35/92) vs.45.4％ (210/463),P＞0.05),but significantly higher than the heart failure with preserved left ventricular ejection fraction (38.0％ (35/92) vs.10.4％(210/463),P=0.000).The proportion of NYHA class IV patients in the heart failure with midrange left ventricular ejection fraction was lower than the heart failure with reduced left ventricular ejection fraction(10.9％(10/92) vs.24.6％(114/463),P=0.000),and higher than the heart failure with preserved left ventricular ejection fraction (10.9 (10/92) ％ vs.2.9％ (11/375),P =0.000).Left atrial diameter,left ventricular end diastolic diameter in the heart failure with reduced left ventricular ejection fraction were maximum ((47 ± 8) mm,(67.3 ± 9.0) mm),the heart failure with midrange left ventricular ejection fraction were medium ((44 ± 7) mm,(60.0 ± 7.5) mm),the heart failure with preserved left ventricular ejection fraction were minimum((42±7) mm,(41.7±6.1)mm),and the difference between the three groups was statistically significant (F =44.200,F =648.426,P ＜ 0.05).Conclusion Some biochemical and echocardiographic features of heart failure with midrange left ventricular ejection fraction patients are located between heart failure with reduced left ventricular ejection fraction and heart failure with preserved left ventricular ejection fraction.The LVEDD is significantly increased in heart failure with midrange left ventricular ejection fraction and heart failure with reduced left ventricular ejection fraction group.The ventricular remodeling in heart failure with midrange left ventricular ejection fraction is similar to that of heart failure with reduced left ventricular ejection fraction.

Objective To evaluate the prevalence of cryptococcal antigenemia and explore the related cryptococcal lesions in hospitalized human immunodeficiency virus ( HIV )-infected patients . Methods Medical records of 517 HIV-infected patients ,including patients'age ,sex ,clinical features , previous medical history ,laboratory tests ,chest CT ,treatment and the response to treatment ,in the Second Hospital of the Nanjing between January 2016 and February 2018 were retrospectively analyzed . The serum cryptococcal antigen (sCrAg) was detected by lateral flow immunoassay .The &chi;2 test or Fisherexact test was used to perform the statistical analysis .Results Among 517 HIV-infected cases ,51 were sCrAg positive ,of whom 96 .1％ (49 cases) were men .The cases with CD4+ T lymphocyte count <100 × 106 cells/L accounted for 66 .2％ (342 cases) ,while 90 .2％ (46 cases) in sCrAg-positive patients showed CD4+ T lymphocyte count < 100 × 106 cells/L with statistical significance (&chi;2 = 14 .6 , P< 0 .01 ) . Multivariable analysis revealed that CD4+ T lymphocyte count <100 × 106 cells/L was independent risk factor for cryptococcal antigenemia (OR= 4 .7;95％ CI:1 .8 -12 .5 , P< 0 .01) .Clinical cryptococcal diseases were found in 76 .4％ (39/51 ) of patients with cryptococcal antigenemia , and cryptococcal meningitis (CM) ,pulmonary cyptococcosis (PC) and cryptococcal septicemia were found in 56％ (28/50) ,52 .9％ (27/51) and 44 .4％ (16/36) of the patients ,respectively .Cryptoccal disease was not identified in 21 .6％ (11/51 ) of the patients with cryptococcal antigenemia (isolated cryptococcal antigenemia) .The median (range) sCrAg titers of the patients with and without CM were 1:1280 (1:10-1:2560) and 1 :15 (1:2-1:2560) ,respectively (P<0 .01) .The proportion of CM in patients with sCrAg titers ≤1:5 ,1:10 -1:320 and ≥1:640 were 0 (0/10) ,50％ (10/20) and 90％ (18/20) , respectively .When cryptococcal infection was restricted to the lung ,87 .5％ (7/8) of the patients had sCrAg titers ≤1:20 .30％ (3/10) of the patients with sCrAg titers ≤1:5 had PC .The median (range) sCrAg titers of the patients with cryptococcal septicemia and with isolated cryptococcal antigenemia were 1:1280 (1:10 -1:2560 ) and 1:5 (1:2 -1:320 ) , respectively . Conclusions T he prevalence of cryptococcal antigenmia is high in hospitalized HIV-infected patients . Most patients with cryptococcal antigenemia have developed cryptococcal diseases .The sCrAg titer in HIV patients may ,in some extend , predicts the condition of cryptococcal infection .sCrAg titers ≥ 1:640 are strongly suggestive of CM . Patients with sCrAg titers ≤1:5 seems unlikely to have CM or cryptococcal septicemia ,however ,clinician should still be alarmed of possible PC .

ObjectiveTo investigate the infection and genotypes of Wolbachia in Aedes albopictus. MethodsAdult and larval samples of Aedes albopictus were collected from different residential and wild areas from 2020 to 2021， Wolbachia surface protein （wsp） gene was amplified and genotyped for wAlbA and wAlbB by PCR， and sequenced for phylogenetic analysis. The difference of detection rate among different habitats， male and female adult mosquitoes， adult and larvae was compared by χ² analysis. ResultsThe detection rate of Wolbachia in adult and larvae of Aedes albopictus were 43.5% （77/177） and 70.4% （190/270）， respectively， with a statistically significant difference （χ²=32.086，P<0.001）， and wAlbA and wAlbB were mainly detected together. The detection rate of Wolbachia in female and male Aedes albopictus were 50.7% （76/150） and 3.7% （1/27）， respectively， with a statistically significant difference（χ²=20.533，P<0.001）. The detection rate of adult Aedes albopictus in Songjiang wild area， residential area and Hongkou residential area were 91.7% （55/60）， 18.8% （22/117） and 41.7% （30/72）， respectively， with a statistically significant difference （χ²=54.322，P<0.001）. Genotyping and phylogenetic analysis showed that adult and larvae of Aedes albopictus infected with Wolbachia were mainly wAlb A and wAlb B. In addition， some sequences formed clades independently， and the genetic distance from other sequences was relatively large. ConclusionInfection of Wolbachia in Aedes albopictus is relatively common in Songjiang District. The main genotypes are wAlb A and wAlb B and there may be other subtypes， which are worthy of further exploration and research.