Objective To investigate the correlation between plasma fibronectin (Fn) level and the hemorrhagic transformation (HT) in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke,symptom onset within 72 hours,no bleeding at baseline MRI (including gradient echo sequences) and without thrombolytic therapy were recruited prospectively.At 7 - 10 days after symptom onset reexamined MRI.The patients were divided into HT and non-HT groups according to whether they had a hemorrhage or not.The plasma Fn levels in both groups were compared.Logistic regression analysis was used to investigate the predictors of HT.Results A total of 78 patients were included,and among them 11 patients (14.10％ ) showed HT.The proportions of atrial fibrillation (36.4％ vs.9.0％,P =0.012) and cardioembolism (36.4％ vs.6.0％,P =0.021) in the HT group were significantly higher than those in the non-HT group.The baseline mean systolic blood pressure (182.09 ±20.73 mm Hg [ 1 mm Hg=0.133 kPa]vs.161.25 ±26.40)mm Hg,P =0.015),mean diastolic blood pressure (98.00 ± 11.26 mm Hg vs.86.60 ± 15.21 rnm Hg,P =0.020),and plasma Fn level (4 835.04 ± 756.30 μg/L vs.3 849.44 ± 1 289.18 μg/L,P =0.016) were all significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that plasma Fn level (odds ratio [ OR],1.001,95％ confidence interval [ CI] 1.000 - 1.001,P =0.017) and atrial fibrillation (OR,13.408,95％ CI 1.963 -91.592,P =0.008) were the independent predictors of HT in patients with acute ischemic stroke.Conclusions The plasma Fn level in patients with HT increased significantly.The plasma Fn level can be used as an independent predictor of non-thrombolytic HT after the onset of acute ischemic stroke.

ObjectiveTo investigate the risk factors for recurrent ischemic stroke in patients with atrial fibrillation.MethodsThe ischemic stroke patients with atrial fibrillation were enrolled retrospectively.Their demographic and clinical data were collected.The relative risk factors for strokes were compared in the first-ever stroke group and the recurrent stroke group.Multivariate logistic regression analysis was used to determine the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.ResultsA total of 504 ischemic stroke patients with atrial fibrillation were enrolled, including 245 males (48.6%).and 259 females (51.4%).The average age was 76.67±8.26 years.There were 314 patients (62.3%) in the first-ever stroke group and 190 (37.7%) in the recurrent stroke group.The proportions of hypertension (78.9% vs.69.4%;χ2=5.446, P=0.020), diabetes mellitus (38.9% vs.26.8%;χ2=8.181, P=0.004), and age >75 years (68.9% vs.60.2%;χ2=3.915, P=0.048), as well as the baseline systolic blood pressure (153.30±26.02 mmHg vs.148.13±26.40 mmHg, 1 mmHg=0.133 kPa;t=-2.141, P=0.033) in the recurrent stroke were significantly higher than those in the first-ever stroke group.Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 1.734, 95% confidence interval [CI] 1.121-2.682;P=0.013), diabetes (OR 1.757, 95% CI 1.188-2.597;P=0.005), and age >75 years (OR 1.680, 95% CI 1.132-2.494;P=0.010) were the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.ConclusionHypertension, diabetes, and age >75 years were the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.

ObjectiveTo investigate the associations of the Oxfordshire Community Stroke Project (OCSP) subtypes with severity and outcomes of acute ischemic stroke.MethodsThe inpatients with acute ischemic stroke were enrolled prospectively and divided into total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), and lacunar infarction (LACI) according to the OCSP classification.Demographic and baseline clinical data of the patients were recorded.The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity, ≤8 was mild stroke and >8 was moderate to severe stroke.The clinical outcome was assessed at 90 d after onset with the modified Rankin Scale (mRS), and the favorable outcome was defined as mRS score 0-2, and the unfavorable one was defined as mRS score 3-5, death or cardiovascular event.Multivariate logistic regression analysis was used to determine the independent associations of the OCSP subtypes and stroke severity and outcomes.ResultsA total of 765 patients with acute ischemic stroke were enrolled, including 46 (6.0%) with TACI, 281 with PACI (36.7%), 229 (29.9%) with POCI, and 209 (27.3%) with LACI.There were 580 patients (75.8%) with mild stroke, and 185 (24.2%) with moderate to severe stroke;17 were lost to follow-up, 513 (68.6%) had favorable outcomes, and 235 (31.4%) had unfavorable outcomes.There were significant differences between the baseline NIHSS scores and outcomes in each OCSP subtypes (all P<0.05), in which the baseline NIHSS score in TACI was the highest, the outcome was worst, and the proportion of patients with unfavorable outcome was 89.1%;there was significant difference in the baseline NIHSS scores between the PACI and the POCI (P<0.05), however, the proportion of patients with unfavorable outcome was not the case.Multivariate logistic regression analysis showed that TACI was an independent risk factor for moderate to severe stroke (odds ratio 84.881, 95% confidence interval 20.307-354.792;P<0.001) and unfavorable outcome (odds ratio 21.472, 95% confidence interval 8.362-55.136;P<0.001).Conclusion The OCSP subtypes were independently associated with the severity and outcomes of acute ischemic stroke.

Objective To study the mRNA expression levels and clinical significance of omsomucoid 1-like protein 3 (ORMDL3) gene in the peripheral blood of recurrent wheeze children under 3 years old.Methods Peripheral blood specimens of 25 recurrent wheeze children including 14 non-atopy patients (group A) and 11 atopy patients (group B) that were registered in the First Affiliated Hospital of Nanjing Medical University,from Sep.2010 to Sep.2012 were enrolled based on the inclusion criteria and 24 non-allergic controls(the children with food allergy,drug allergy or ectema was excepted).The mRNA expression levels of ORMDL3 gene were detected by reverse transcription (RT)-PCR and clinical features were analyzed.Results The expression levels of ORMDL3 were up-regulated in the peripheral blood specimens of group B compared with group A (t =14.12,P ＜ 0.01).Compared with peripheral blood specimens from normal subjects,mRNA expression of ORMDL3 were significantly increased in recurrent wheeze children(t =10.29,5.73,P ＜0.01).The incidence of wheeze groups exist gender differences,male ＞ female.Wheeze usually with a high incidence in winter and spring.Conclusions The increase of ORMDL3 gene expression levels were correlated with recurrent wheeze under 3 years old especially in atopy group and may be involved in the pathogenesis of recurrent wheeze.

Objective:To explore clinical application value of color Doppler ultrasound (CDU) assigned to diagnose triple-negative breast cancer (TNBC) and axillary lymph node metastasis (ALNM).Methods:A retrospectively analyzed of proved of clinical data on the 863 patients breast cancer in women by CDU inspection,operation and pathology.According results will be divided into TNBC group and non negative breast cancer (NTNBC) group via clinical pathological and immunohistochemical detection.Using multi-factor unconditioned Logistic regression analysis the CDU supposed the diagnosis and the correlation of TNBC.Results:The coincidence rate of CDU and pathological diagnosis was 90.96％ (785/863),78 cases (9.04％) remove breast masses,105 patients TNBC group and NTNBC group 680 patients.The mass circular or elliptic (48.57％ vsl0.70 ％),the tumor maximum diameter 5.0 cm (21.90％ vs 15.30 ％),micro calcifications (87.62％ vs 74.12 ％),state clearly (56.19％ vs 41.47 ％),no burr edge character (74.29％ vs 41.62 ％),peripheral hyperechoic halo ring (74.29％ vs46.76 ％),rear echo attenuation (72.38％ vs 46.76 ％),no ALNM (61.90％ vs 37.35％) comparing the two groups exists significant difference (P＜ 0.05),while the mass number,and vertical and horizontal diameter ratio,degree of echo,echo distribution and blood flow classification comparing the two groups were no significant difference (P＞ 0.05).The CDU fu points ＞ 10 divided into NTNBC and pathological coincidence rate 93.93％ (680/724),8 ～ 10 points TNBC suspected diagnosis coincidence rate 11.51％ (16/139),＜ 8 points TNBC tendency diagnosis coincidence rate 64.03％ (89/139),TNBC total diagnostic coincidence rate was 75.54％ (105/139).In CDU diagnosed 785 cases of breast cancer,the ALN enlargement in 319 cases (40.64％),with TNBC group was 61.90％ (65/105),NTNBC group was 37.35％ (254/680).Logistic regression analysis results:tumor assumes the circular or elliptic,edge without burr,peripheral hyperechoic halo ring,rear echo attenuation and ALNM with TNBC has certain correlation (P＜0.05).Conclusion:The seemingly benign breast diseases and axillary lymph node enlargement,the CDU,supposed less than 8 points,age 50 or less or not at the same time,menopause or having a history of breast cancer susceptibility to family,important reference index,clinical value has high of CDU diagnostic of TNBC and ALNM.

Objective To investigate the correlation between ultrasound findings and clinical pathological types of adrenal cortical tumors(ACT).Methods The clinical data and ultrasonographic finding of 138 ACT patients undergoing surgical treatment in Affiliated Hospital of Qingdao University from January 2006 to December 2015 were retrospectively reviewed.The correlation between ultrasonic signs and pathological types of ACT was analyzed with Spearman method.Results There were 65 males and 73 females aged 18-71 years old.Among 138 cases,90 patients were characterized by hypertension,Cushing signs,Coon signs and abnormal sexual character, with the clinical diagnosis of adrenal cortical hyperplasia or adenoma;while 48 asymptomatic patients were first detected by ultrasonography.The coincidence rate of ultrasound and clinical pathological diagnosis was 92.0%(127/138),and 11 cases were misdiagnosed.The coincidence rate of ultrasound and surgical diagnosis was 94.2%(130/138), and 8 cases were misdiagnosed.The coincidence rate for no functional adenoma was 95.8%(46/48), for cortisol cortical adenoma was 94.1%(32/34),for aldosterone cortical adenoma was 93.6%(29/31),for cortical cysts was 9/10,for no functional adenocarcinoma was 5/6,for sexual abnormal cortical adenocarcinoma was 3/4,for cortisol cortical adenocarcinoma was 2/3,for mucous cortical adenoma was 1/2.The diameter of ACT was 0.6-11.5 cm.The low echo nodules of the adrenal region with a diameter <2.0 cm were associated with aldosterone cortical adenomas(r=0.485, P=0.01); the low echo or isoechoic nodules with a diameter 2.0-5.0 cm were associated with cortical adenomas or non-functional adenomas(r=0.567,0.452,P=0.01),and the circular non-echo nodules were associated with cortical cysts(r=0.483, P=0.01); the irregular nodules with a diameter >5.0 cm were associated with cortical adenocarcinoma(r=0.595, P=0.01).Conclusion The ultrasound image of ACT is related to different clinical pathological types,which can provide important information for clinical diagnosis and selection of surgical modalities.

Objective:To establish the reference values of stimulation single fiber electromyography (SFEMG) in orbicularis oculi, and to explore its sensitivity in repetitive nerve stimulation (RNS) negative ocular myasthenia gravis (OMG) patients, and the relationship between jitter and various clinical parameters.Methods:Thirty-two healthy volunteers were included to establish the reference value of normal controls from January 2019 to December 2019. From December 2019 to January 2023, 36 OMG patients with negative RNS were collected. Quantitative MG score (QMGS) was performed, neostigmine test and antibody titers as well as thymus CT results were recorded. One side of the orbicularis oculi muscle was tested with a disposable concentric needle electrode in stimulation SFEMG, and the mean consecutive difference (MCD) value was calculated, which was compared with the average MCD value and upper limit of individual values in normal controls to evaluate whether the jitter was abnormal. Spearman correlation analysis of abnormal mean MCD values with QMGS and antibody titer was conducted.Results:Among the 32 healthy volunteers, there were 13 males and 19 females, the age was (46.8 ±18.7) years, and the MCD was (19.0 ±4.4) μs. The upper limit of the reference value was 27.7 μs for average MCD, and 37.4 μs for 10% individual values. Among 36 OMG patients negative at RNS tests, 20 were male and 16 were female, with a age of (37.2 ±17.0) years. The MCD was (29.9 ±14.7) μs, and Jitter was abnormal in 29 patients (81%). Among them, 20 (20/25) patients were antibody positive, 6 (6/26) patients had thymic hyperplasia, and 7 (7/26) patients had thymoma. The QMGS was 3(2, 4). There were 7 patients (19%) with normal jitter, whose QMGS was 3(2, 4). Among the patients with normal Jitter, 5 (5/5) patients were antibody positive, 2 (2/6) patients had thymic hyperplasia. There was no statistically significant difference in clinical indicators between the two groups of patients with abnormal or normal jitter. There was no significant correlation in antibody titer or QMGS with abnormal mean MCD value. Conclusions:The upper limit of the mean MCD value in the normal controls is 27.7 μs. The upper limit of a single value is 37.4 μs. Its sensitivity for OMG patients with RNS negative is 81%, and the abnormal mean MCD value does not show a significant correlation with various clinical indicators. Abnormal jitter indicates dysfunction of neuromuscular junction transmission, which is an important neuroelectrophysiological indicator for MG patients and is suitable for RNS negative patients. Orbicularis oculi muscle stimulation SFEMG provides a reliable and sensitive electrophysiological means for functional evaluation of neuromuscular junction.

OBJECTIVE：To compare the protective effects model mice between the aboveground and underground parts of Astragalus membranaceus on immunosuppression ，and to provide reference for further utilization and development of A. membranaceus. METHODS ：A total of 240 ICR mice were divided into 4 batches，60 mice in each batch ，with half male and half female. Each batch of mice were randomly divided into blank group ，model group ，A. membranaceus aboveground part and undergroud part low-dose and high-dose groups （3，6 g/kg，by crude drug ）according to body weight and sex ，with 10 mice in each group. Blank group and model group were given normal saline intragastrically. A. Membranaceus groups were given corresponding concentration of drug intragastrically ，10 mL/kg，once a day ，for consecutive 30 days. Except for blank group ， other groups were intraperitoneally injected with cyclophosphamide 40 mg/（kg·d）for consecutive 3 days，since 24th day of treatment，to establish immunosuppression model. The levels of serum immunoglobulin （IgG，IgM，IgA），inflammation factors [nitric oxide ，interleukin-2（IL-2），IL-6，tumor necrosis factor-α] and half hemolysis value were detected in each group. Body weight ，thymus index ，spleen index ，phagocytic index ，activity of natural killer （NK）cell，splenic lymphocyte proliferation ability，dinitrofluorobenzene-induced delayed metamorphosis reaction in mice （by weight difference between left and right ears ） and the number of hemolytic plaque were determined. RESULTS ： Compared with blank group ， the serum levels of immunoglobulin，body weight ，thymus index ，spleen index ，phagocytic index ，NK cell activity ，the proliferation ability of splenic lymphocyte，the number of hemdytic plaque and half hemolysis value were decreased significantly in model group （P＜0.05）， while inflammation factor level as well as weight difference between left and right ears were increased significantly （P＜0.05）. Compared with model group ，above indexes of mice in A. membranaceus groups were improved significantly ，in dose-dependent manner（P＜0.05）. Compared with A. membranaceus undergroud part group ，above indexes of A. membranaceus aboveground part group were improved significantly （P＜0.05）. CONCLUSIONS ：Aboveground and underground part of A. membranaceus both have pretective effect on immunosuppression model mice ，and the effect of aboveground part of A. membranaceus is stronger than underground part of A. membranaceus .

OBJECTIVES: To explore the metabolite characteristics in medial prefrontal cortex (mPFC) by METHODS: A total of 46 patients with the first-episode schizophrenia (FES), 49 people with clinical high risk (CHR), 61 people with genetic high risk (GHR), and 58 healthy controls (HC) were enrolled. The levels of N-acetylaspartylglutamate+N-acetylaspartate (tNAA), choline-containing compounds (Cho) and myo-inositol (MI), glutamate+glutamine (Glx) in medial prefrontal cortex were measured by single-voxel RESULTS: There were significant differences in Glx, tNAA, and MI concentrations among 4 groups (all CONCLUSIONS The decreased levels of MI and Glx in the FES patients suggest that there may be glial functional damage and glutamatergic transmitter dysfunction in the early stage of the disease. The compensatory increase of metabolites may be a protective factor for schizophrenia in the genetic individuals.
Aspartic Acid ; Glutamic Acid ; Glutamine ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Proton Magnetic Resonance Spectroscopy ; Schizophrenia