Objective To investigate the risk factors for early neurological deterioration (END) in patients with acute middle cerebral artery infarction.Methods From January 2009 to December 2012,81 patients with acute middle cerebral artery infarction completed cerebral angiography admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.END was defined as that the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 or the motor score increased ≥ 1 with in 72 h after admission compared with the baseline score on admission.All the patients were divided into either an END group (26 cases) or a non-END group (55 cases) according to whether the occurrence of END.Univariate factor analysis was used to analyze the differences of the clinical data between the two groups.The grade standard of collateral circulation was assessment with the collateral circulation assessment system of the American Society of Interventional and Therapeutic Neuroradiology/Sociey of Interventional Radiology.Multivariable Logistic regression analysis was used to analyze the risk factors for END after acute middle cerebral artery infarction.Results Compared with the patients in the non-END group,the proportions of age 60 years (65.4％ [17/26] vs.36.4％ [20/55];x2 =5.992,P =0.014),high-sensitivity C-reactive protein level ≥4.0 mg/L (76.9％ [20/26] vs.45.5％ [25/55];x2 =7.080,P =0.008) and diabetes (38.5％ [10/26] vs.16.4％ [9/55],x2 =4.802,P =0.028) in the END group were increased significantly,while the collateral circulation grade was decreased significantly (Z =-3.253,P ＜ 0.01).Multivariable Logistic regression analysis showed that the age ≥60 years (OR,3.412,95 ％ CI 1.075-10.824;P =0.037),high-sensitivity C-reactive protein level ≥ 4.0 mg/L (OR,3.812,95％ CI 1.141-12.740;P =0.030),and collateral circulation grade (OR,2.165,95％ CI 1.241-5.514;P =0.009) were the independent risk factor for END in acute middle cerebral artery infarction.Conclusion The decreased collateral circulation level,age ≥ 60 years and high-sensitivity C-reactive protein≥4.0 mg/L were the independent risk factors for occurring END in acute middle cerebral artery infarction.

Objective To analyze the risk factors of delayed post-polypectomy bleeding ( DPPB) of colonoscopy. Methods The data of 459 patients who underwent colonoscopic polypectomy between January 2014 and May 2017 were summarized, and the risk factors of DPPB were analyzed. Results Among the 459 patients, a total of 572 polyps were removed, and DPPB occurred in 27 patients with 42 polyps. Univariate analysis revealed that gender (male 85. 2%), number of polyps removed (≥3 polyps, 59. 3%), complicated with hyperlipidemia (29. 6%), polyps′diameter (≥10 mm, 66. 7%), morphology (pedunculated, 81. 0%), pathological type ( adenoma, 95. 2%), and excision method ( endoscopic mucosal resection, 90. 5%) were significantly correlated with DPPB ( all P＜0. 05). Logistic regression analysis showed that gender, with hyperlipidemia, number of polyps removed, polyps′ size, and morphology were independent risk factors of DPPB (P＜0. 05). Conclusion The risk factors of DPPB include male, complicated with hyperlipidemia, excision of more than 3 polyps, more than 10 mm in diameter, and pedunculated morphology.

Objective:This study investigated the efficacy and safety of denosumab (DENOS) versus zoledronic acid (ZOL) in the bone disease treatment of newly diagnosed multiple myeloma.Methods:The clinical data of 80 patients with myeloma bone disease (MBD) at the Fifth Medical Center of PLA General Hospital between March 1, 2021 and June 30, 2023 were retrospectively reviewed. Eighteen patients with severe renal impairment (SRI, endogenous creatinine clearance rate<30 ml/min) were treated with DENOS, and 62 non-SRI patients were divided into DENOS (30 patients) and ZOL group (32 patients) .Results:Hypocalcemia was observed in 26 (33%) patients, and 22 patients developed hypocalcemia during the first treatment course. The incidence of hypocalcemia in the non-SRI patients of DENOS group was higher than that in the ZOL group [20% (6/30) vs 13% (4/32), P=0.028]. The incidence of hypocalcemia in SRI was 89% (16/18). Multivariate logistic regression analysis revealed that endogenous creatinine clearance rate<30 ml/min was significantly associated with hypocalcemia after DENOS administration ( P<0.001). After 1 month of antiresorptive (AR) drug application, the decrease in the serum β-C-terminal cross-linked carboxy-telopeptide of collagen type I concentrations of SRI and non-SRI patients in the DENOS group were significantly higher than that in the ZOL group (68% vs 59% vs 27%, P<0.001). The increase in serum procollagen type Ⅰ N-terminal propeptide concentrations of patients with or without SRI in the DENOS group were significantly higher than that in the ZOL group (34% vs 20% vs 11%, P<0.05). The level of intact parathyroid hormone in each group increased after AR drug treatment. None of the patients developed osteonecrosis of the jaw and renal adverse events, and no statistically significant differences in the overall response rate, complete remission and stringent complete remission rates were found among the groups ( P>0.05), and the median PFS and OS time were not reached ( P>0.05) . Conclusions:In the treatment of MBD, DENOS minimizes nephrotoxicity and has strong AR effect. Hypocalcemia is a common adverse event but is usually mild or moderate and manageable.