Urbanization has increased the population density and exposure to environmental risk factors, accelerated changes of people's lifestyles and aggravated population health disparities. A general population cohort in eastern China, Shanghai Suburban Adult Cohort and Biobank (SSACB), was established to understand the incidence and prevalence of chronic and non-communicable diseases, and identify environmental, lifestyle, and genetic risk factors in adults (aged 20-74 years old) living in the suburban of Shanghai, where urbanization process is rapid, and provide evidence for the precise prevention and control of chronic diseases. The cohort study was launched by School of Public Health,Fudan University depended on "Discipline Construction Project Shanghai Peak for Public Health and Preventive Medicine". Four districts in Shanghai, i.e. Songjiang, Jiading, Minhang and Xuhui, were selected. A total of 69 116 permanent residents aged 20-74 years were recruited. Epidemiological investigation, physical examination and laboratory tests were conducted to collect the basic information of the study subjects. Blood and urine samples were collected from them to establish a biobank. An information platform was established, from which the baseline data of the study subjects in electronic medical record system, chronic disease management system, cancer registry, infectious disease reporting system, and death registry can be shared. This paper introduces the design concept, process and future plan of SSACB.

Objective:To formulate the Nursing standards of clinical practice of critical care ultrasonography (referred to as the Standards), so as to provide recommendations for the application of ultrasound in intensive care nursing practice. Methods:Based on the experience of intensive care ultrasound nursing practice and literature research, combined with the consensus recommendations of intensive care ultrasound, the critical care ultrasound study group formed the first draft of the Standards. After expert interview, consensus discussion, two rounds of Delphi expert letter consultation and other methods, the content of the Standards was revised and improved, and the final draft of the Standards was formed. Results:The Standards included four parts, such as basic application of intensive care ultrasound, nursing evaluation standard of intensive care ultrasound guidance, nursing operation process guided by ultrasound and intensive care ultrasound training. Conclusions:The establishment of Standards is scientific and practical, which can provide guidance for nursing practice of clinical operation technology of critical care ultrasonography.

Objective　To analyze the clinical and imaging characteristics of cerebral infarction patients with unilateral middle cerebral artery occlusion (MCAO),and to explore the pathogenesis of cerebral infarction and the related factors of hemorrhage transformation in different parts of MCAO.Methods　A total of 159 MCAO patients with acute cerebral infarction were divided into proximal MCAO group and distal MCAO group according to the location of occlusion.The clinical and imaging characteristics of the two groups were compared,and the independent risk factors of MCAO hemorrhagic transformation (HT) in different locations were analyzed by a multivariate logistics regression analysis method.Results　The proportion of hypertension and hyperlipidemia in proximal MCAO group was higher than that in distal MCAO group (P<0.05),the proportion of atrial fibrillation was significantly lower than that of distal MCAO group (P<0.01).The proportion of atherosclerotic type in proximal MCAO group was higher than that in distal MCAO group(P<0.01).The proportion of infarction involving basal ganglia and hemorrhage transformation (HT) in distal MCAO group was higher than that in proximal MCAO group (P<0.05),binary logistic regression analysis showed that different occlusion location of MCA and whether basal ganglia was involved were independent risk factors for hemorrhage transformation after infarction (P<0.05).Conclusion　Proximal MCAO cerebral infarction is mostly caused by atherosclerotic aorta,while distal MCAO cerebral infarction is mostly caused by cardiogenic embolism.Patients with distal MCAO infarction involving basal ganglia are prone to hemorrhage transformation,which may be related to reperfusion injury.

Objective:To investigate the effect of hemorrhagic transformation (HT) and its different subtypes on the clinical outcome of patients with acute ischemic stroke (AIS).Methods:Patients with AIS within 24 h of onset treated in Henan Provincial People's Hospital from January 2018 to January 2021 were retrospectively enrolled. HT was defined as intracranial hemorrhage found by CT reexamination within 7 d after the onset of AIS, and further divided into hemorrhagic infarction (HI) and parenchymal hematoma (PH) according to the classification standard of European Cooperative Acute Stroke Study (ECASS)-Ⅱ. The modified Rankin Scale was used to evaluate the outcome at 90 d after onset. 0-2 was defined as good outcome and 3-5 were defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcomes. Results:A total of 822 patients were enrolled, including 478 males (58.2%), aged 60.6±10.6 years. The median score of the baseline National Institutes of Health Stroke Scale (NIHSS) was 8 (interquartile range: 6-12). Two hundred and eighty-two patients (34.4%) developed HT and 447 (54.4%) had poor outcomes. Multivariate logistic regression analysis showed that PH-1 (odds ratio [ OR] 2.461, 95% confidence interval [ CI] 1.285-4.712; P=0.007), PH-2 ( OR 5.291, 95% CI 1.178-23.758; P=0.030), blood glucose at admission ( OR 1.063, 95% CI 1.018-1.109; P=0.005) and baseline NIHSS score ( OR 1.124, 95% CI 1.076-1.175; P<0.001) were the independent influencing factors of the poor outcomes. Conclusion:Different HT subtypes have different effects on the outcomes of patients with AIS, among which PH-1 and PH-2 are the independent risk factors for poor outcomes.

Objective:To assess the predictive factors and prognosis of post-stroke seizures.Methods:A total of 315 inpatients with acute anterior circulation cerebral infarction from January 2018 to December 2018 were retrospectively collected, including 95 patients with PSS as observation group and 220 patients without PSS as control group.Clinical characteristics of the patients were recorded, including gender, age, lesion specificity, imaging features, past history, and the time and type of seizures.The Alberta stroke program early CT score (ASPECTS) was used to assess the extent of infarction, the national institutes of health stroke scale (NIHSS) and the modified rankin scale (MRS) were used to assess the severity and prognosis of cerebral infarction.The hemorrhage transformation of cerebral infarction was graded according to the European cooperative acute stroke study Ⅲ(ECASS Ⅲ) classification system.SPSS 21.0 software was used for data analysis.Chi-square test was used for categorical variables and t-test or non-parametric test was used for continuous variables. Results:The observation group had lower ASPECTS scores compared with the control group (5(4, 7), 7 (5, 8)), the presence of atrial fibrillation, hemorrhage transformation, laminar necrosis(LN) and hemosiderin deposition (31.6%, 45.3%, 24.2%, 26.3%) were higher than those of control group (20.9%, 28.2%, 9.1%, 16.4%), and the differences were statistically significant (all P<0.05). In multivariate analysis, ASPECTS score ( OR=0.658, 95% CI=0.556-0.778, P<0.001), hemorrhage transformation ( OR=2.307, 95% CI=1.311-4.059, P=0.004), LN ( OR=2.530, 95% CI=1.250-5.123, P=0.010) and hemosiderin deposition ( OR=2.308, 95% CI=1.201-4.436, P=0.012) were the influencing factors of PSS.Partial secondary generalized seizures was the most common type of seizures, and in this group it accounted for 42.1% (40/95), simple partial seizures and complex partial seizures accounted for 12.6% (12/95)respectively, and generalized seizures accounted for 32.6% (31/95). The mean follow-up time of the two groups was 24.1 months and 24.6 months, respectively.The scores of MRS at the last follow-up and discharge (3(2, 4), 2(1, 4)) of the observation group were better than those of the control group (2(1, 3), 1(1, 3)), and the differences were statistically significant(both P<0.05). Conclusions:PSS after cerebral infarction can affect the prognosis of patients, and the large infarction scope, hemorrhage transformation, LN and hemosiderin deposition are the high risk factors of PSS.

Objective:To observe the clinical and imaging features of cortical laminar necrosis (CLN) after acute cerebral infarction, and to explore its possible mechanism.Methods:Five hundred and three patients were recruited into study with acute anterior circulation cerebral infarction confirmed by magnetic resonance imaging in People′s Hospital of Zhengzhou University from June 2019 to June 2020. They were divided into 24 patients with CLN (CLN group) and 479 patients without CLN (NCLN group). The general information and clinical manifestations of the patients were recorded. National Institutes of Health Stroke Scale (NIHSS) and Montreal Cognitive Assessment Scale (MoCA) scores and cranial magnetic resonance imaging characteristics were compared between the two groups, and the possible mechanism was discussed.Results:After acute cerebral infarction, the incidence of CLN was 4.77% (24/503). CLN group had more cognitive impairment (MoCA total score 15.17±2.67; NCLN group 18.12±2.49) and less neurological impairment (NIHSS total score 6.93±3.63; NCLN group 8.86±3.26),and there were significant differences between the two group ( t=-5.58, t=-2.75; P<0.05). In the CLN group, the proportion of perfusion-weighted imaging showing hyper-perfusion in the laminar necrosis area (increased relative cerebral blood volume) was 87.5% (21/24), while in the NCLN group, the proportion of hyper-perfusion was lower [1.25% (6/479)]. There was statistically significant difference in the perfusion between the two groups (χ2=143.06, P<0.01). In the CLN group, CT angiography or magnetic resonance angiography showed common atherosclerotic stenosis or occlusion of the large intracranial arteries. Conclusion:CLN after cerebral infarction is relatively rare in clinical practice, and its occurrence may be related to local cortical hyper-perfusion.

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

Objective:To investigate the relationship between the expression of DNA methyltransferase 3b (DNMT3b) and the methylation of SEPT9 gene, and their application prospects in the diagnosis and treatment of colorectal cancer.Methods:Seventy-five cases of colorectal cancer and adjacent tissues, 68 cases of colorectal high-grade internal neoplasia tissues (referred to as precancerous tissues) and high-grade internal adjacent neoplasia tissues (referred to as adjacent precancerous tissues) were collected. Pyrosequencing was used to detect the methylationlevel of SETP9. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to examine the mRNA expressionof SEPT9 and immunohistochemistry(IHC) was applied to detect the protein expressions of SETP9 and DNMT3b. Liposome-mediated method was used to transfect DNMT3b siRNA and negative control siRNA into HT-29 cells. Five groups including DNMT3b siRNA 15 nmol/L group, DNMT3b siRNA 30 nmol/L group, negative control siRNA 15 nmol/L group, negative control siRNA 30 nmol/L group and blank control group were set up. Pyrosequencing was applied to determine the methylation level of SEPT9 and mRNA expression of DNMT3b in each group.Results:The methylation rates of SEPT9 gene in colorectal cancer tissues, adjacent tissues, precancerous tissues and adjacent precancerous tissues were (76.8±6.5)%, (14.4±2.6)%, (34.6±5.0)% and (7.4±1.2)%, respectively, which was highest in colorectal cancer tissue ( P<0.001). The relative expressions of SEPT9 mRNA were 0.18±0.03, 0.89±0.41, 0.69±0.41 and 1.01±0.21, respectively, which was lowest in colorectal cancer tissue ( P<0.001), while there were no statistically significant differences in adjacent tissues, precancerous tissues and adjacent precancerous tissues ( P>0.05). The positive rates of SEPT9 protein expression were 12.0% (9/75), 53.3% (40/75), 55.1% (38/69) and 62.3% (43/69), which was lowest in the colorectal cancer tissue ( P<0.001), while there were no statistically significant differences in the adjacent group, precancerous group and adjacent precancerous group ( P>0.016 7). The positive rates of DNMT3b protein expression were 56.3% (45/75), 26.7% (20/75), 46.4% (32/69) and 33.3% (23/69), respectively, which was highest in colorectal cancer tissue ( P<0.001), while without statistically significant difference from the precancerous tissue ( P>0.016 7). Experiments in vitro showed that DNMT3b mRNA expression was lowest in DNMT3b siRNA 30 nmol/L group among five groups and was statistically different from other groups (all P<0.05). Meanwhile, the methylationrate of SEPT9 gene was lowest in this group, but without statistically significant difference from the DNMT3b siRNA 15 nmol/L group ( P>0.05). Conclusions:The expression of DNMT3b is significantly correlated with the methylation level of SEPT9 gene in different stages of colorectal cancer. The high expression of DNMT3b may be an important molecular event before SEPT9 gene methylation and it may have an important potential application value in the diagnosis and treatment of early colorectal cancer.

Objective:To investigate the characteristics of cognitive impairment caused by solitary cerebellar infarction.Methods:From January 2017 to January 2019, 76 inpatients with acute cerebellar infarction treated at our hospital were continuously enrolled as the infarction group and 88 outpatients without cerebral infarction at our hospital during the same period were collected as the control group.The patients in the two groups were evaluated by the Montreal Cognitive Assessment Scales(MoCA)and Mini-Mental State Examination(MMSE)Scale at 14 days, 1 month and 3 months after the onset of solitary cerebellar infarction, respectively.Results:The MoCA and MMSE scores were lower in the infarction group than in the control group at 14 days, 1 month and 3 months after the onset of solitary cerebellar infarction(MoCA: 23.9±6.13 vs.28.1±2.51, 22.6±6.07 vs. 28.2±2.28 and 22.5±6.19 vs. 28.2±2.15, t=5.88, 8.03 and 8.09, P<0.001; MMES: 25.7±4.54 vs.28.3±2.25, 24.9±4.63 vs.28.2±2.14 and 24.6±4.43 vs.28.3±2.16, t=4.74, 5.99 and 6.94, all P<0.001). Cognitive function scores showed that three major recognition domains of visual space and executive function, attention and memory had statistically significant difference between the two groups( P<0.05), and the differences in three recognition domain of naming, calculating force, directional force between the two groups were not statistically significant( P<0.05). Conclusions:There is a clear correlation between cerebellar infarction and cognitive impairment, which is mainly manifested in three aspects of visual space and executive function, attention and memory.The great attention should be paid to screening and intervention on the three aspects in clinical work, which is of great significance for improving the quality of life and prognosis of patients.

Objective:To investigate the association between cerebral hypoperfusion and cognitive function decline in patients with asymptomatic middle cerebral artery stenosis.Methods:Sixty patients with moderate or severe stenosis of middle cerebral artery were diagnosed by magnetic resonance angiography (MRA) in the Department of Neurology, Henan Provincial People′s Hospital from November 2017 to November 2018. All patients were divided into perfusion weighted imaging (PWI) normal group （ n=14）, PWI compensated group ( n=26) and PWI decompensated group ( n=20) according to the results of PWI of magnetic resonance imaging. All patients were assessed for cognitive function using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment scale (MoCA). Results:The cognitive scores of the PWI decompensated group (MMSE score: 19.35±3.26; MoCA score: 16.06±2.59) were significantly lower than the PWI normal group (MMSE score: 26.29±3.12; MoCA score: 24.27±2.85) and the PWI compensated group (MMSE score: 23.78±1.77; MoCA score: 20.69±2.73), and the differences were statistically significant ( F=5.257, 4.134; P<0.05). The visual space and executive ability, language, delayed recall in the PWI compensated group (3.27±0.97, 1.45±0.73, 2.47±1.73, respectively) and the PWI decompensated group (1.96±0.79, 0.97±0.59, 1.49±1.38, respectively) were significantly lower than those of the PWI normal group (4.25±1.29, 2.57±1.24, 3.57±1.51, respectively), and the differences were statistically significant ( F=6.371,5.394,4.989, P<0.05). Patients in the PWI decompensated group had atrophy in the narrow hemisphere. Conclusion:Low cerebral perfusion induced by asymptomatic moderate-to-severe stenosis of the middle cerebral artery is associated with extensive cognitive impairment and local brain atrophy.