Pneumonia is one of the common complications after stroke.Stroke-associated pneumonia (SAP) may significantly prolong hospital stay,increase medical costs and mortality.It is a risk factor for affecting stroke outcome.Currently,both European and American guidelines for stroke care are lack of the recommendations of standardized treatment measures for SAP.This article reviews the advances in research on the pathophysiological mechanisms and prevention and treatment of SAP.

Objective To evaluate the effectiveness and safety of ultrasound-enhanced thrombolysis for acute ischemic stroke.Methods Fifty stroke patients with acute middle cerebral artery occlusion were randomly divided into either a ultrasound-enhanced thrombolysis group (recombinant tissue-plasminogen activator [rtPA] +2 MHz ultrasound monitoring for 2 h) or a standard thrombolysis group (rtPA alone).The demographic characteristics,vascular risk factors,blood pressure before treatment,thrombolysis in brain ischemia (TIBI) grade before thrombosis,and vascular occlusion site of the patients were collected.The primary outcome endpoint was the good outcome rate (defined as the modified Rankin Scale score 0-1) at 3 months.The secondary outcome endpoints were complete recanalization at 2 h after thrombolysis,sustained complete recanalization,symptomatic intracerebral hemorrhage,and mortalitY.Results The good outcome rate of the ultrasound-enhanced thrombolysis group at 3 months after treatment was significantly higher than that of the standard thrombolysis group (64％ vs.36％;P=0.011).The sustained complete recanalization rate (40％ vs.8％;P =0.018) and complete recanalization rate (48％ vs.12％;P =0.012) of the ultrasound-enhanced thrombolysis group were significantly higher than those of the standard thrombolysis group,but there were no significant differences in the reocclusion rate (8％ vs.12％;P =0.637),incidence of symptomatic intracerebral hemorrhage (4％ vs.4％;P=1.000),and mortality (4％ vs.4％;P=1.000) compared with the standard thrombolysis group.Conclusions Ultrasoundenhanced thrombolysis can improve the sustained complete recanalization rate,complete recanalization rate,and good outcome rate after using rtPA within 2 h,and it does not increase the risks of symptomatic cerebral hemorrhage and death.It is a safe and effective adjunctive thrombolytic therapy.

Objective To explore the risk factors of and the influence of different hepatitis B virus (HBV) DNA load on paternal vertical transmission of HBV.Methods Totally,161 HBsAg negative women,whose husband was HBsAg positive,attended the antenatal clinics of the Provincial Maternity and Child Health Hospital of Fujian from September 2007 to December 2008 and their newborns were selected,and the epidemiologic information,the duration of being a HBV carrier,the first class HBV family history of the fathers,HBV markers,HBV DNA load,HBsAb of the gravidas,the outcomes of the newborns were all collected.Cord blood was sampled after delivery for HBV DNA quantification and those with HBV DNA load ≥1.0×103 copy/ml were chosen as the case group and those ＜ 1.0×103 copy/ml as control.Results (1) Among the 161 newborns,36 HBV DNA positive cord blood samples were detected,giving a rate of 22.4% (36/161) for paternal vertical transmission of HBV.The HBV DNA positive rate in cord blood was 32.0% (23/72) in HBeAg-positive fathers and 14.6% (13/89) in HBeAg-negative fathers.(2) Univariate analysis showed that HBeAg-positive,HBV DNA positive,first class family history of HBV and the duration of being a HBV carrier of the fathers were risk factors of paternal HBV vertical transmission[X2= 6.892,29.916,29.499 and 23.821,OR = 2.7,5.2,8.3 and 1.4 (P＜0.01)].(3) Multivariate analysis found that paternal serum HBV DNA positive and the first class family history of HBV of the father side were risk factors of paternal vertical transmission of HBV (OR = 11.1,95% CI;4.6-27.1;OR = 17.1,95% CI:3.5-82.6).(4) According to the different serum HBV DNA load of the HBsAg-positive father,7 groups were divided.A dose dependent effect was found that the HBV DNA positive rate of the cord blood increased with the rising of HBV DNA load.No HBV DNA positive cord blood was detected when paternal HBV DNA load was＜1.0×104 copy/ml,while 100% of the cord blood were positive when paternal HBV DNA load≥1.0×108 copy/ml.(5) The average birth weight of the newborns in the two groups was the same (3.3±0.4) kg.And the delivery mode,gestational age at delivery,height and Apgar score of the newborns at 1 minute,neonatal pathological jaundice and other complications had no significant difference between the two groups (P ＞ 0.05).No relationship was found between the neonatal outcomes and the paternal HBV vertical transmission (P＞0.05).Conclusions HBV DNA load in the serum of HBsAg-positive father,and the paternal first class family history of HBV are risk factors of paternal HBV vertical transmission.When the serum HBV DNA load in HBsAg-positive father is≥1.0×107 copy/ml,the possibility of paternal vertical transmission of HBV would increase.

Objective: To observe whether an Xingnaojing 醒脑静 injection could improve the prognosis of patients, by increasing rifampicin penetration through the blood-brain barrier. Methods: Patients with severe tuberculous meningitis were enrolled in this study. The concentrations of Xingnaojing in cerebrospinal fluid and blood in patients treated with Xingnaojing and control were determined by high performance liquid chromatography. The changes in cerebrospinal fluid and the improvement of clinical symptoms and signs, were evaluated two weeks after admission. The long-term prognosis of the patients in the two groups were evaluated by the Glasgow Outcome Scale (GOS). Results: The concentration of rifampicin in cerebrospinal fluid was significantly higher in the Xingnaojing group (1.77±0.17 μg/mL), than in the control group (1.27±0.16 μg/mL, p<0.05). The difference in concentration of rifampicin in the blood was not significant (P>0.05). The short-term effective rate of the Xingnaojing group was 92.5% (37/40), which was significantly higher than that of the control group (80%, 32/40, p<0.05). After 6 months, 75% (30/40) of the Xingnaojing group had good prognosis according to the GOS score, whereas that of the control group was 50% (20/40) showing significantly better long-term treatment effect of the Xingnaojing group compared to the control group (P<0.05). Conclusion: Xingnaojing injection improved rifampicin penetration into the central nervous system. The increase in rifampicin concentration in cerebrospinal fluid improved outcomes in patients with severe tuberculous meningitis.

Objective     To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods     A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results     A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion     There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.