Objective To analyze the clinical determination and mechanism of poststroke dementia.Methods 186 consecutively hospitalized patients who at admission after stroke,completed clinical valuation of neural-functional defect and intelligence assessments,and head CT scan.Their intelligene performances were assessed again after three months .Results Frequency of poststroke dementia was 32 5% .Poststroke dementia was related to age,level of education,residential area,hypertension ,hyperlipidemia,the location and severity of stroke,history of coronary heart disease and diabetes.But it unrelated to sex,smoking,alcohol drinking and type of stroke.Conclusions Dementia is frequently occurred after stroke,and multiple risk factors contribute to its occurrence

Objective To explore the relationship between the intelligence condition and the content of ?-aminobutyric acid (GABA) in cerebrospinal fluid (CSF) in epileptic patients.Methods We measured the Intelligence Quotient (IQ) of 40 cases of epileptic patients by using the Wechsler Intellectual Scaled, and tested their CSF-GABA contents by using HPLC.At the same time, factors which might have influence on patient’s IQ were analysed.Results In the 40 cases of epileptic patients, there were 14 cases of patients with FIQ≤89, and occupied 35%.The intelligence condition of epileptic patients was positive relation with the contents of CSF-GABA, education background and patterns of seizure,but was negative relation with the patient's age. Among all factors, content of CSF-GABA was very significant relationship with VIQ, PIQ and FIQ (P

AIM:To investigate whether ginsenoside Rg1 attenuates high-fat diet ( HFD)-induced non-alcoho-lic fatty liver disease ( NAFLD) by improving β-oxidation.METHODS: SD rats ( n=60) were randomly divided into control group ( CON ) , HFD group, low-dose, medium-dose and high-dose ginsenoside Rg1 groups ( LDG, MDG and HDG) and positive drug ( sodium ursodeoxycholate) treatment group ( PDT) .High-fat diet was given for 8 weeks to suc-cessfully establish an NAFLD model.The animals were treated with the appropriate medications for 4 weeks and 8 weeks af-ter modeling, and sacrificed to collect the liver tissues for observing the pathologic changes with HE staining and for detec-ting liver functions and lipid levels.The expression of hepatic acyl-CoA synthetase 1 (CoASH1), carnitine acyltransferase I (CATI) and acyl-CoA oxidase 1 (ACOX1) at mRNA and protein levels was determined by RT-PCR and Western blot-ting.RESULTS:After 4-week treatment, the fatty infiltration of the liver tissues in PDT group, LDG group and MDG group was not attenuated except HDG group.After 8 weeks of treatment, a small number of fat particles was observed in PDT group and LDG group, while no infiltration of lipid droplet was found in MDG group and HDG group.Compared with HFD group, the levels of AST, ALT, AKP, TC, TG and LDL-C were significantly decreased after 4-week treatment in PDT group, LDG group, MDG group and HDG group (P<0.05), these indexes were further reduced after 8-week treatment. After 4-week treatment, HDL-C was significantly increased in the 4 treatment groups and almost restored to the level of CON group after 8-week treatment.The levels of CoASH1, CACTI and ACOX1 in the liver tissue of the 4 treatment groups were significantly increased after 4-week treatment (P<0.05) and much improved after 8-week treatment, and those in MDG group and HDG group were better than those in PDT group (P<0.05).CONCLUSION:Ginsenoside Rg1 regulatesβ-oxidation-related enzymes to improve the fat metabolism, thus playing a therapeutic role in liver injury in the rats with NAFLD.

Objective Study the concentration of the hepatocyte growth factor(HGF) the expression product of recombinant human hepatocyte growth factor naked plasmid ,and whether the body generates immune responseafter wsing HCF. Methods Selected 21 patients with severe ischemic disease of lower extremity (Rutherford classification 4-6 class) , after signing the informed consent and divided them into four dosage groups( 4 mg, 8 mg, 12 mg and 16 mg) random.In each group the dosage was the lower limbs partly intramuscular injection following the feeding artery in experimental stage Dl and D15. The plasma samples were collected to determine the HGF concentration in Dl ( before administration), D8, D15 ( before administration) , D21, D59, and the HGF-antibody concentration in Dl, D15, D28, D59, D91. Results (1)The concentrations of HGF in the subjects ranged from 216 pg/mL to 1189.75 pg/mL.(2) HGF-antibodies were not dectected in the subjects' plasma. Conclusions After using recombinant human HGF naked plasmid through intramuscular injection, the concentration of HGF expression product in subjects' peripheral blood does not have abnormally changed and using the drug the human body immune response does not generate.

Objective To investigate the effect of leptin on endoplasmic reticulum stress related protein after focal cerebral ischemia in rats. Methods Ischemia was induced by occluding the middle cerebral artery in rats brain using the filament occlusion method. Forty SD rats were randomly divided into sham operation group, cerebral is-chemia group and leptin-preconditioning group. Leptin was injected subcutaneously before occlusion of blood vessel. Longa 5 score neurological function scale, body weight and brain edema changes were measured 6 hours after MCAO, and the brain was removed to detect the endoplasmic reticulum marker protein: glucose-regulated protein 78 (GRP78) and C/EBP-homologous protein (CHOP) by immunohistochemical method. Results There was no difference in the body weight changes between leptin-preconditioning group and ischemic group. In the leptin-preconditioning group, the neurological function score (1.90±0.31 vs. 2.50±0.52, P<0.05) and the degree of brain edema (3.60±0.52 vs. 7.70±0.94, P<0.001) were significantly lower than those in the cerebral ischemia group. Moreover, the expression of GRP78 in leptin-preconditioning group was significantly higher than that in ischemia group (48.69 ±5.06 vs. 35.78± 4.35, P<0.01), and the expression of CHOP was significantly lower than that of ischemia group (60.24 ±4.11 vs. 38.81±5.34, P<0.01). Conclusion Leptin can reduce the neurological deficit and may be associated with the up-reg-ulation of GRP78 protein, and down regulation of CHOP protein to weaken the endoplasmic reticulum stress caused by cerebral ischemia

Objective Recent studies have indicated that early brain injury is the leading cause of death in patients with subarachnoid hemorrhage ( SAH) .Our study investigated the role of aminoguanidine ( AG) in early brain injury after SAH . Methods Sixty-eight male SD rats were equally randomized into four groups of equal number :control, sham, SAH, and AG.The animals in the sham group were injected with isotonic saline solution , while those of the latter two groups with femoral artery blood ( FAB) and FAB+AG, respectively, into the pre-chiasmatic cistern to induce SAH. At 24 hours after modeling , all the rats were killed for HE staining , obtainment of behavioral neurological assessment ( BNA ) scores by Garcia, measurement of the apoptosis of neurons by TUNEL , and de-termination of the expressions of the iNOS and NSE proteins by West-ern blot. Results The results of HE staining showed the presence of more red blood cells in the subarachnoid cavity of the rats in the SAH group, with a significantly decreased BNA score ( 14.47 ± 0.62) as compared with those in the control (17.94 ±0.24), sham (17.59 ±0.51), and AG group (15.71 ±0.47) (P<0.05). The rate of positive cells was remarkably higher in the SAH group ([42.38 ±2.38]%) than in the control ([6.35 ±0.94]%), sham ([6.85 ±0.69]%), and AG group ([30.48 ±2.89]%) ( P<0.01), with significant differences among the latter three groups (P<0.05).The expressions of iNOS and NSE were markedly higher in the SAH group ([3.86 ±0.07] and [1.59 ±0.06]) than in the control (0 and[0.35 ±0.09]), sham ([2.96 ±0.34] and [0.38 ±0.08]), and AG group ([3.41 ±0.04] and [0.70 ±0.12]) ( P<0.05).Both the expression levels of iNOS and NSE were positively correlated with the rate of positive cells (r=0 .879 and 0.935, P<0.01). Conclusion AG can alleviate early brain injury after SAH in SD rats by improving the neuro-ethologic function , suppressing the apoptosis of neurons , and reducing the expressions of iNOS and NSE .

Objective To investigate the expression of Nestin and its relationship with tamoxifen cura-tive effect and prognosis of patients with breast cancer. Methods A total of 82 patients with breast cancer who received tamoxifen therapy after radical mastectomy in Department of Breast Surgery of Enshi Tujia Miao Auton-omous Prefecture Central Hospital of Hubei Province from March 2009 to March 2013 were collected. And the paired cancer tissues and adjacent normal tissues preserved in liquid nitrogen were also collected. Fluorescent quantitative real-time PCR( RT-PCR)and immunohistochemistry were used to detect the content of Nestin mRNA and the expression of Nestin in breast cancer tissues. The expression of Nestin in breast cancer tissues and its relationship with clinicopathologic features were analyzed. Breast cancer cell line MCF-7 was selected, small interfering RNA(siRNA)was used to silence Nestin in MCF-7 cells,and the influence on tamoxifen sen-sitivity was observed. The relationship of Nestin and epithelial-mesenchymal transition( EMT)was detected using Western blotting. Results The results of RT-PCR indicated that the mRNA level of Nestin in breast cancer tissues was 3. 87 times as high as that in paracancerous tissues(6. 34 ± 1. 56 vs. 1. 64 ± 0. 52,t =26. 140,P < 0. 001). Immunohistochemical staining suggested that the positive rate of Nestin in breast cancer tissues was 75. 61％(62 / 82),which was significantly higher than that in paracancerous tissues[24. 39％(20 / 82)],with a significant difference(χ2 = 43. 024,P < 0. 001). The expression of Nestin was related to lymphatic vessel infiltration(χ2 = 7. 499,P = 0. 006)and lymph node metastasis(χ2 = 6. 770,P = 0. 034), and it was not related to the age of patients(χ2 = 3. 242,P = 0. 072),tumor size(χ2 = 2. 358,P = 0. 308), histological grade(χ2 = 0. 294,P = 0. 863),ductal infiltrating status(χ2 = 0. 180,P = 0. 671)and triple neg-ative breast cancer(χ2 = 0. 142,P = 0. 706). The analysis of Cox risk ratio model showed that Nestin expres-sion(HR = 1. 982,P < 0. 001;HR = 1. 537,P < 0. 001),lymphatic vessel invasion( HR = 2. 502,P <0. 001;HR = 1. 715,P < 0. 001)and lymph node metastasis(HR = 1. 818,P < 0. 001;HR = 1. 446,P <0. 001)were independent prognostic risk factors for progress-free survival and overall survival in breast cancer patients. After Nestin knockout in breast cancer cell line MCF-7,the IC50 value of MCF-7 to tamoxifen de-creased from(48. 05 ± 2. 22)μmol/ L to(35. 59 ± 2. 92)μmol/ L,with a significant difference(t = 6. 489, P = 0. 003). Silencing Nestin significantly up-regulated E-cadherin(7. 21 ± 1. 15 vs. 1. 02 ± 0. 01,t = 6. 654, P = 0. 024)and down-regulated the mesenchyme index Vimentin(0. 17 ± 0. 08 vs. 1. 01 ± 0. 02,t = 25. 015, P < 0. 001)in MCF-7 cells. Conclusion Nestin is over-expressed in breast cancer,which is associated with reduced efficacy of tamoxifen. Nestin may be a new potential prognostic biomarker for breast cancer.

Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.

OBJECTIVE: To establish a new emergency dynamic score (EDS) method based on modified early warning score (MEWS) combined with clinical symptoms, rapidly available examination results and bedside examination data in the emergency department, and to observe its applicability and feasibility in the clinical application of emergency department. METHODS: A total of 500 patients admitted to the department of emergency of Xing'an County People's Hospital from July 2021 to April 2022 were selected as research objects. After admission, EDS and MEWS scores were performed first, and then acute physiology and chronic health evaluation II (APACHE II) was performed retrospectively, and the prognosis of patients was followed up. The difference of short-term mortality in patients with different score segments of EDS, MEWS and APACHE II were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the prognostic value of various scoring methods in critically ill patients. RESULTS: The mortality of patients in different score groups of each scoring method increased with the increase of the score value [The mortality of 0-1, 2-3, 4-5, 6-7 and ≥ 8 of MEWS were 1.9% (3/159), 2.9% (6/208), 12.4% (11/89), 29.0% (9/31) and 61.5% (8/13), respectively. The mortality of EDS stage 1 weighted MEWS score 0-3, 4-6, 7-9, 10-12 and ≥ 13 were 0 (0/49), 3.2% (8/247), 6.6% (10/152), 31.9% (15/47) and 80.0% (4/5), respectively. The mortality of EDS stage 2 clinical symptom score 0-4, 5-9, 10-14, 15-19, ≥ 20 were 0 (0/13), 0.4% (1/235), 3.6% (6/165), 26.2% (17/65), 59.1% (13/22), respectively. The mortality of EDS stage 3 rapid test data score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 0 (0/16), 0.6% (1/159), 4.6% (6/131), 13.7% (7/51) and 65.0% (13/20), respectively. The mortality of patients with APACHE II score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 1.9% (1/53), 0.4% (1/277), 4.6% (5/108), 34.2% (13/38) and 70.8% (17/24), respectively, all P < 0.01]. When the MEWS score was more than 4, the specificity was 87.0%, the sensitivity was 67.6%, and the maximum Youden index was 0.546, which was the best cut-off point. When the weighted MEWS score of EDS in the first stage was greater than 7, the specificity of predicting the prognosis of patients was 76.2%, the sensitivity was 70.3%, and the maximum Youden index was 0.465, which was the best cut-off point. When clinical symptom score of EDS in the second stage was more than 14, the specificity and sensitivity of predicting the prognosis of patients were 87.7% and 81.1%, respectively, and the maximum Youden index was 0.688, which was the best cut-off point. When the third stage rapid test of EDS reached 15 points, the specificity of predicting the prognosis of patients was 70.9%, and the sensitivity was 96.3%, and the maximum Youden index was 0.672, which was the best cut-off point. When APACHE II score was higher than 16, the specificity was 87.9%, the sensitivity was 86.5%, and the maximum Youden index was 0.743, which was the best cut-off point. ROC curve analysis showed that: EDS score in the stage 1, 2 and 3, MEWS score and APACHE II score can predict the short-term mortality risk of critically ill patients. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) were 0.815 (0.726-0.905), 0.913 (0.867-0.959), 0.911 (0.860-0.962), 0.844 (0.755-0.933) and 0.910 (0.833-0.987), all P < 0.01. In terms of the differential ability to predict the risk of death in the short-term, the AUC in the second and third stages of EDS were highly close to APACHE II score (0.913, 0.911 vs. 0.910), and significantly higher than MEWS score (0.913, 0.911 vs. 0.844, both P < 0.05). CONCLUSIONS EDS method can dynamically evaluate emergency patients in stages, and has the characteristics of fast, simple, easy to obtain test and inspection data, which can facilitate emergency doctors to evaluate emergency patients objectively and quickly. It has strong ability to predict the prognosis of emergency patients, and is worth popularizing in emergency departments of primary hospitals.
Humans ; Research Design ; Critical Illness ; Retrospective Studies ; Hospitals ; Emergency Service, Hospital

Objective:To investigate the risk factors of thrombocytopenia in elderly patients with sepsis-associated acute kidney injury(SA-AKI), and to further evaluate whether the degree of thrombocytopenia is related to the increased risk of death on day 28.Methods:Elderly patients with SA-AKI admitted to ICU of our hospital from June 2017 to June 2020 were selected.The patients were divided into normal platelet group(56 cases)and thrombocytopenia group(72 cases)according to the platelet(PLT)count, and according to the degree of thrombocytopenia, they were further divided into three groups: PLT<20×10 9/L(group A, 22 cases), 20×10 9/L≤ PLT<50×10 9/L(group B, 27 cases), 50×10 9/L≤ PLT<100×10 9/L(group C, 23 cases).The general data, clinical baseline indicators and prognostic indicators of each group were compared to evaluate the risk factors of thrombocytopenia.At the same time, the impact of platelet count on the prognosis of elderly patients with SA-AKI was evaluated according to the length of stay in ICU, total length of stay and whether the patient died, and the correlation between the degree of thrombocytopenia and survival was analyzed. Results:A total of 128 elderly patients with SA-AKI were enrolled, including 73 males and 55 females.59.4 % of the patients were hospitalized in the department of internal medicine.The APACHEⅡ score was(15.5 ± 3.3)points, invasive mechanical ventilation accounted for 78.9%, positive inotropic therapy accounted for 12.8%, and 56 patients had normal platelet count.Thrombocytopenia occurred in 72 patients, including 22 patients with PLT<20×10 9/L, 27 patients with platelet count in 20-50×10 9/L, and 23 patients with platelet count in 50-100×10 9/L.There were significant differences in bloodstream infection, Gram-negative bacteria, APACHEⅡ score and procalcitonin(PCT)among the four groups( P<0.05).Further multivariate logistic regression showed that PCT was an independent risk factor for thrombocytopenia in elderly patients with SA-AKI( OR=1.05, 95% CI: 1.00-1.10, P=0.042).Compared with the normal platelet group, the 28-day mortality rate of the thrombocytopenia group was significantly higher than that of the normal platelet group, while the length of stay in ICU and the total length of stay were prolonged( P<0.05).Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of thrombocytopenia group was lower than that of normal platelet group, and the risk of death increased with the degree of thrombocytopenia( χ2=31.479, P<0.001).Univariate Cox regression analysis showed that thrombocytopenia, bloodstream infection, APACHEⅡ score and PCT were risk factors for 28-day death in elderly patients with SA-AKI.Multivariate Cox analysis showed that bloodstream infection and APACHEⅡ score were independent risk factors for 28-day death.After adjusting these confounding factors, thrombocytopenia was an independent risk factor for death, and the degree of thrombocytopenia was related to the increased risk of death. Conclusions:Thrombocytopenia is common in elderly patients with SA-AKI, and elevated PCT levels increase the risk of thrombocytopenia.The degree of thrombocytopenia is an independent risk factor for 28-day mortality in such patients.