OBJECTIVE: To discuss the strategy of commodity circulation of our pharmaceutical wholesale enterprises in new period. METHODS: To describe the present conditions of pharmaceutical wholesale enterprises:high cost and low beneficial result.To discuss the need of commodity distributing of pharmaceutical manufacturers and retails.To analyses the status of wholesale enterprises in supply chain.RESULTS & CONCLUSION: Our pharmaceutical wholesale enterprises must develop their commodity distributing strategy on the basis of the status of wholesale enterprises in supply chain.

Objective:To investigate frailty status of the elderly patients with leukoaraiosis (LA) and to analyze the correlation between white matter hyperintensities and their frailty status.Methods:From June 2019 to September 2020, a total of 162 patients with leukoaraiosis over 65 years old were screened by cranial MRI.The Fried frailty phenotype was used to evaluate their frailty status.The Fazekas scale scoring method was used to independently assess the periventricular white matter hyperintense (PVH) and deep white matter hyperintense (DWMH) by the cranial MRI images.SPSS 22.0 software was used for statistical analysis.ANOVA test was used to compare normal distribution data between groups, and Kruskal-Wallis H test was used to compare non-normal distribution data between groups.Spearman rank correlation analysis was used to analyze the correlation between PVH and DWMH scores and Fried frailty phenotype score. Results:Among 162 elderly patients with leukoaraiosis, 46 patients (28.40%) were non-frailty, 76 patients (46.91%)were pre-frailty and 40 patients (24.69%) were frailty.There were statistically significant differences in age( F=9.382, P<0.01), number of chronic diseases( H=10.736, P<0.01), number of medication ( H=15.927, P<0.01) and mini-nutritional assessment short form (MNA-SF) scores( F=5.263, P<0.01) among older LA patients with different frailty phenotype.There was statistical difference in PVH scores in elderly LA patients with different frailty phenotype (χ 2=108.537, P<0.01), but no significant difference in DWMH scores (χ 2=4.239, P>0.05). Spearman correlation analysis showed significant positive correlation between PVH score and frailty phenotype score in elderly LA patients ( r=0.718, P<0.001). Conclusion:Elderly LA patients have a high incidence of frailty, which may be related to aging, multi-disease coexistence, multiple medication, nutritional risk and other factors.The occurrence of weakness in elderly LA patients is related to periventricular white matter lesions, and the more serious the white matter damage, the more obvious the degree of frailty.

Objective To compare the recurrence rate and long-term follow-up angiographic findings between stent-assisted coil embolization and simple coil embolization in treating large and giant intracranial aneurysms.Methods The clinical data and imaging materials of a total of 90 patients with large and giant intracranial aneurysms (＞10 mm,91 aneurysms in total),who were admitted to authors' hospital during the period from January 2004 to January 2016 to receive interventional embolization therapy,were retrospectively analyzed.Of the 90 patients,52 patients (52 lesions in total) received simple coil embolization (SCE group)and 38 patients (39 lesions in total) received stent-assisted coil embolization (SACE group).Postoperative recurrence rates of aneurysm were compared between the two groups,and recurrence risk factors were analyzed.Results The whole postoperative recurrence rate of aneurysm and re-treatment rate were 38.5％(35/91) and 20.9％(19/91) respectively;the recurrence rate and re-treatment rate of SACE group were 35.9％ (14/39) and 17.9％ (7/39) respectively,while those of SCE group were 40.4％ (21/52) and 23.1％ (12/52) respectively;the differences between the two groups were not statistically significant (P＞0.05).Multivariate logistic regression indicated that the recurrence risk factors of large or giant intracranial aneurysms included rupture of aneurysm (OR=0.284,95％CI=0.083-0.978,P=0.046),simple coil embolization (OR=5.03,95％ CI=1.04-24.44,P=0.045),concurrent hypertension (OR =0.13,95％ CI=0.036-0.51,P=0.003)and long time after operation (OR=1.002,95％CI=1.001-1.003,P=0.002).Conclusion Compared with simple coil embolization,stent-assisted coil embolization can reduce the recurrence rate of aneurysm.Rupture of aneurysm,simple coil embolization,long time after operation and concurrent hypertension are independent risk factors for recurrence of aneurysm after transcatheter arterial embolization.

Objective:To analyze the gait and balance disorder and fall risk in patients with leukoaraiosis (LA) in different degrees and locations.Methods:Seventy-eight patients with LA (LA group) and thirty healthy controls (NC group) were selected.According to Fazekas grading scale, the LA group were subgroups of different degrees(LA1, LA2, LA3)and evaluated independent scores for periventricular white matter hypersignal (PVH) and deep white matter hypersignal (DWMH). All subjects were tested by Tinetti scale, and the gait test, balance test and fall risk assessment were carried out, and the correlation between gait test results and balance test results and PVH and DWMH scores were analyzed.Results:There were significant differences in gait test((11.47±0.51), (10.18±1.29)), balance test((15.63±0.49), (13.96±1.58)) and fall risk((27.10±0.76), (24.15±2.73)) between LA group and NC group ( t=5.310, 5.667, 5.799, all P< 0.01). There were no significant differences in gait test, balance test and fall risk between NC group and LA1 group (all P>0.05). There were significant differences in gait test, balance test and fall risk between NC group and LA2 group and LA3 group ( t=1.110, 1.562, 1.336; 2.592, 3.342, 2.985; all P<0.01). There were significant differences in gait test, balance test and fall risk between LA1 group((11.19±0.85), (15.38±0.75), (26.58±1.47)) and LA2 group((10.36±0.82), (14.07±1.09), (24.43±1.64)) and LA3 group((8.88±0.99), (12.23±1.08), (21.21±1.93)) ( t=0.835, 1.313, 1.039; 2.317, 3.093, 2.756; all P<0.01). There were significant differences in gait test, balance test and fall risk between LA2 group and LA3 group ( t=1.482, 1.780, 1.639, all P<0.01). The analysis showed that the gait test was negatively correlated with the PVH and DWMH scores ( r=-0.810, P<0.01; r=-0.452, P<0.01). The balance test was negatively correlated with the PVH and DWMH scores ( r=-0.502, P<0.01; r=-0.836, P<0.01). Conclusions:There are gait disorder and balance disorder in patients with moderate and severe LA.With the increase of the degree of LA , the damage of gait and balance function is significantly increased, and the risk of fall is also significantly increased.The gait disorder and the balance disorder of LA patients has different correlation with the high-signal score of the white matter in different parts.The correlation between gait disorder and PVH score is more obvious, and the correlation between balance disorder and DWMH score is more obvious.

Objective To evaluate the effect of cerebral microbleeds (CMBs) on intracranial aneurysm rupture and hemorrhage. Methods A total of 2023 patients with intracranial single aneurysms (944 un-ruptured aneurysms and 1029 ruptured aneurysms) were enrolled in our study. The 3D-DSA was applied to all patients to evaluate the aneurysm sizes, locations, and morphous features, and to confirm the presence of A1 dominance and variations of Circle of Willis; moreover, aspect ratio (AR), size ratio (SR) and aneurismal inclination angle were measured. The presence of CMBs identified by T2-weighted gradient-recalled-echo sequence on magnetic resonance imaging (MRI) was evaluated; the clinical data of combined with/without CMBs patients were compared. Ninety-two untreated intracranial aneurysms patients combined with CMBs were followed up to evaluate the incubation periods of CMBs-related intracranial aneurysm rupture and hemorrhage; the clinical data of patients with un-ruptured aneurysms and ruptured aneurysms were compared; the risk factors of intracranial aneurysm rupture and hemorrhage were analyzed by univariate and multivariate Logistic regression analyses. Results CMBs confirmed by MR imaging were presented in 158 patients, with 7.81％ incidence rate (158/2023). Age, proportion of smokers, aneurysm inclination Angle, SR, narrow neck, irregular aneurysm shape, proportion of rupture and hemorrhage, aneurysm sites, and hypertension showed significant differences between patients without CMBs and patients with CMBs (P<0.05). In the untreated intracranial aneurysms patients combined with CMBs, 27 had intracranial aneurysm rupture and 65 did not appear intracranial aneurysm rupture; the rupture time was 3-46 months, with an average of (15.07± 10.76) months. As compared with the un-ruptured group, the ruptured group had a statistically higher proportion of patients with irregular aneurysm morphology (P<0.05). Univariate analysis showed that CMBs, female, age, aneurysm size, aneurysm morphology, ICA and ACA aneurysms, AR, variations of Circle of Willis, hypertension grading II and III, diabetes mellitus with fasting blood glucose≤6.0 mmol/L, hyperlipidemia, coronary heart disease, and drinking alcohol were important factors affecting intracranial aneurysm rupture, and the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that CMB was an independent risk factor for intracranial aneurysm rupture and hemorrhage; as compared with patients without CMBs, patients with CMBs had a 1.75 fold increased risk of aneurysm rupture. Conclusions Patients with intracranial aneurysms with older age, smaller aneurysm inclination Angle and larger SR are more likely to be associated with CMBs. Intracranial aneurysms with CMBs patients with irregular morphology are prone to have rupture and hemorrhage. CMBs is an independent risk factor for intracranial aneurysm rupture and hemorrhage.

Objective:To analyze the clinical characteristics of pertussis cases diagnosed by two pathological detection methods: bacterial culture and real-time polymerase chain reaction (RT-PCR), and to explore the applicable value of two pathological detection methods in the diagnosis of pertussis.Methods:Bilateral nasopharyngeal swabs and clinical information of 165 children suspected of pertussis were collected by Hebei Children′s Hospital from April 2019 to January 2020. The bacterial culture and RT-PCR for nasopharyngeal swab specimens were performed in all cases. Chi-square test was used to analyze the cases of pertussis diagnosed by the above two methods.Results:Based on clinical diagnosis, the sensitivity of bacterial culture and RT-PCR for the diagnosis of pertussis was 61.70% (58/94) and 86.17% (81/94), and the specificity was 92.96% (66/71) and 71.83% (51/71), respectively. The positive rate of RT-PCR in children of all ages, seasons and cough courses is higher than that of bacterial culture. Children with pertussis diagnosed by bacterial culture and RT-PCR were basically similar in age, season, and cough course distribution, with the most common cases ≤3 months old, a high incidence trend in summer and autumn, and the course of coughing in children was mostly within 15-21days. The positive rate of bacterial culture in the diagnosis of pertussis in children is affected by the age of the children, and there are statistical differences between children in different age groups (χ2= 11.929, P=0.036). The positive rate of bacterial culture was the highest in children with >3 years old (51.85% [14/27]), followed by children with ≤3 months old (48.72% [19/39]), and the lowest in children with >6-12 months old (15.00% [3/20]). Moreover, the positive rate of bacterial culture in the diagnosis of pertussis in children is also affected by the cough course of the children, and there are statistical differences between children in different cough course groups (χ2=9.841, P=0.020). The positive rate of bacterial culture was the highest in children with cough course 15-21 days (49.23% [32/65]), followed by 43.59% (17/39) in children with cough course 8-14 days, and the lowest in children with cough course of less than 7 days (22.86% [8/35]). Conclusions:Compared with RT-PCR, bacterial culture has lower sensitivity and higher specificity in the detection of pertussis. These two detection methods have their own advantages and limitations. Medical institutions at all levels should comprehensively analyze different laboratory detection methods. Only by combining the two methods can the diagnostic value and level be effectively improved.

Objective To investigate the role of hesperitin in regulating inflammatory response in early brain injury after subarachnoid hemorrhage (SAH). Methods A total of 96 adult male SD rats were divided into sham-operated group, SAH group, solvent group and intervention group (n=24) by random number table method. The SAH rat models in the latter three groups were prepared by carotid artery puncture method; the rats in the intervention group were given oral administration of hesperidin solution, which was dissolved in 5％ dimethyl sulfolide (DMSO), with a concentration of 1 mg/100 μL and a dosage of 40 mg/kg within 30 min after operation; rats in the solvent group were given oral administration of an equal volume of 5％ DMSO solution. Modified Garcia behavioral scale was used to evaluate the neurobehavior of rats, and the wet/dry weight method was used to measure the water content in the brain tissues of the left and right hemispheres of the rats 24 h after SAH. Immunofluorescence staining was used to detect the microglia activation, Fluoro-dyed Jade C staining was used to assess the brain neuron degeneration, enzyme-linked immunosorbent assay (ELISA) was employed to detect the inflammatory factors interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α) content in the brain tissues, and Western blotting was used to detect the nuclear factor-κB (NF-κB) and phosphorylated (p) -NF-κB protein expressions. Results As compared with the solvent group, intervention group had significantly increased improved modified Garcia behavioral scale scores (10.08±1.73 vs. 13.83±1.70), and significantly decreased water content of brain tissues in the left and right hemispheres ([81.44 ± 1.05]％ vs. ([79.14±0.82]％; [80.55±1.55]％ vs. [78.79±1.02]％), significantly smaller number of CD68+ and Iba1+ microglias (30.17±1.04 vs. 10.67±0.75; 29.33±1.16 vs. 12.00±0.41), significantly smaller number of degenerate neurons (53.21±0.94 vs. 31.33±0.28), significantly reduced levels of inflammatory cytokines IL-1β, IL-6 and TNF-α ([429.88±106.32] pg/mL vs. [221.50±48.80] pg/mL; [1015.50±221.80] pg/mL vs. [448.11±93.40] pg/mL; [1021.75±149.17] pg/mL vs. [595.71±190.81] pg/mL), and significantly lower p-NF-κB/NF-κB ratio (1.13±0.07 vs. 0.71±0.02, P<0.05). Conclusion Hesperitin may reduce the inflammatory response mediated by microglia after subarachnoid hemorrhage by inhibiting NF-κB pathway, thereby improving the neurological dysfunction of rats.

Objective To present our preliminary experience and short-term safety and efficacy of pipeline embolization device (PED) for endovascular of intracranial aneurysms.Methods Six patients treated with PED in our hospital from February 2016 to June 2016 were chosen.Their clinical data and short-term safety and efficacy were retrospectively analyzed.Results Six patients with 6 intracranial aneurysms were treated during the study period.Mean aneurysm size was 18.3±9.2 mm.PED was technically successful in all aneurysms (100％).A total of 8 PEDs were used,and the mean number of devices per aneurysm was 1.3.Treatment was achieved with one single PED in 5 aneurysms,with 3 overlapping PEDs in one aneurysm.Adjunctive coiling was performed in 3 aneurysms.Retention of contrast agent in the tumor cavity was detected by immediate radiography:Kamran grade Ⅰ was noted in 4 patients and grade Ⅱ in 2 patients.No procedure-related complications occurred.Five patients achieved good clinical outcome (mRS score 0 in 2 patients,one in 3 patients and 3 in one patient).MRA was performed in 5 patients 3 months after surgery,indicating no arterial aneurysm residual and far-endvascular patency;and one of these 5 patients was performed DSA showing no arterial aneurysm relapse.Conclusions In our series,early results of the PED are encouraging.However,larger studies with longer follow-up duration are warranted to assess the safety and efficacy of PED for treating intracranial aneurysms.

Objective To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) transplantation on recovery of neurological functions and Nogo-A expression in cerebral ischemia rats at recovery stage.Methods BMSCs were isolated and cultured by whole bone marrow adherence method.Thirty-six SD rats were randomized into sham-operated group,ischemia group and BMSCs transplantation group (n=12).The middle cerebral artery occlusion (MCAO) models in the ischemia group and BMSCs transplantation group were established with Zea Longa line embolism.After 21 d of MCAO,one mL ofBMSCs (3×106) were transplanted into rats of the BMSCs transplantation group,and same amount of phosphate buffer was given to the rats of the sham-operated group and ischemia group.After 14 and 28 d of treatment,neurological functions of the rats were evaluated by modified neurological severity scale (mNSS);the brain infarct sizes were tested by TTC staining;the pathological alterations were tested by HE staining,and the Nogo-A expression was determined by immunofluorescence.Results After 14 and 28 d of treatment,as compared with the ischemia group,BMSCs group had significantly lower mNSS scores (14 d∶ 7.50±0.55 vs.6.17±0.75;28 d∶ 7.33±0.52 vs.5.67±0.82),statistically smaller brain infarct sizes (14 d∶ 31.38％±1.02％ vs.26.32％±1.19％;28 d∶27.71％±0.55％ vs.21.68％±1.09％),and significantly lower Nogo-A expression (14 d∶ 39.33％±2.08％ vs.33.67％±2.52％;28 d∶ 30.33％±0.58％ vs.25.67％±4.39％,P＜0.05).What's more,rats in the BMSCs group had milder cell damage and decreased scar tissues as compared with those in the ischemia group.Conclusion BMSCs transplantation can improve the neurological function of cerebral ischemia rats at recovery stage,and it may work via regulation of Nogo-A expression.

Objective To explore the effect of Willis circle variation and hemodynamic forces alteration arised from vascular structural abnormity on intracranial aneurysm (IA) rupture using 3D-digital subtraction angiography (DSA) and transcranial color Doppler (TCCD) detection.Methods Two hundred and twenty-three patients with IA,admitted to and conformed by DSA in our hospital from November 2010 to November 2011,were divided into ruptured IA group (n=182) and un-ruptured IA group (n=41).The 3D-DSA was applied in all patients to carefully evaluate the aneurysm sizes,locations,and morphous features,and to confirm the presence of A1 dominance and Willis circle variation.Moreover,aneurysmal neck area,diameter of parent artery,angle between A2 segments of bilateral anterior cerebral artery,angle between aneurysmal longitudinal axis and parent artery,aortic diameter (AD) and aspect ratio (AR) were measured with assistance of 3D-DSA images.Besides,TCCD was applied to all patients,and the hemodynamic parameters were recorded to calculate wall shear stress (WSS) and mechanical stretch.The risk factors of IA rupture were analyzed by receiver operating characteristic (ROC) curve and multivariate Logistic regression with emphasis on Willis circle variation and hemodynamic forces alteration.Results Whether it was in ruptured IA group or in un-ruptured IA group,the incidence rate of variation of anterior Willis circle was higher than that of variation of posterior Willis circle.A1 dominance on the left side was the most common asymmetry.As compared with those in un-ruptured IA group,statistically elder age,smaller AD,larger angle between aneurysmal longitudinal axis and parent artery,decreased WSS and increased mechanical stretch in the ruptured IA group were noted (P＜0.05).ROC curve indicated that angle between aneurysmal longitudinal axis and parent artery,AD,WSS and mechanical stretch could be used to evaluate IA rupture (area under the curve:0.606、0.618、0.396、0.637).Age (OR=8.618,95％CI:2.866-25.917,P=0.000),hypertension (grade Ⅲ OR=16.320,95％CI:1.628-163.556,P=0.018),angle between aneurysmal longitudinal axis and parent artery (OR=3.053,95％CI:1.131-8.242,P=0.028),AD (OR=5.638,95％CI:1.507-20.251,P=0.008) and mechanical stretch (OR=4.230,95％CI:1.554-11.516,P=0.000) were risk factors of IA rupture.A1 dominance (OR=0.242,95％CI:0.074-0.785,P=0.018),small aneurysms (2-5 mm,OR=0.207,95％CI:0.054-0.788,P=0.002) and WSS (OR=0.021,95％CI:0.060-0.672,P=0.009) were identified as protective factors.Conclusions Willis circle variation exists in IA patients.Age,hypertension (grade ⅢD,angle between aneurysmal longitudinal axis and parent artery,AD and mechanical stretch are risk factors of IA rupture,while A1 dominance,small aneurysm (2-5 mm) and WSS are identified as protective factors.Accurate assessment of these factors is of great clinical significance for the prevention and treatment of IA in the future.