Objective: To investigate the trend in incidence of stroke in Yongkang City, Zhejiang Province from 2015 to 2022, so as to provide the evidence for improving stroke prevention and treatment strategies. Methods: The incidence of stroke in Yongkang City from 2015 to 2022 was collected through the Zhejiang Chronic Disease Monitoring Information System, and standardized by the data of the Chinese National Population Census in 2010. The incidence of stroke in gender-, age- and subtype-specific was analyzed, and the incidence trend of stroke was analyzed by average annual percentage change (AAPC). Results: A total of 22 408 stroke cases were reported in Yongkang City from 2015 to 2022, with crude incidence of 457.97/105 and standardized incidence of 379.55/105. The crude incidence of stroke appeared a tendency towards a rise (AAPC=6.447%, P<0.05). The crude incidence of stroke was higher among males than females (495.97/105 vs. 417.58/105, P<0.05), and the standardized incidence of stroke was higher among males than females (425.29/105 vs. 332.49/105, P<0.05). The average age of stroke cases was (70.74±12.64) years. The crude incidence of stroke appeared a tendency towards a rise with age (P<0.05), and which in residents aged 30 to 44 years showed an increasing trend (AAPC=6.142%,P<0.05). There were 18 040 cases of ischemic stroke (80.51%), 4 121 cases of hemorrhagic stroke (18.39%) and 247 cases of unclassified stroke (1.10%) reported from 2015 to 2022. The crude incidence of ischemic stroke was higher than which of hemorrhagic stroke (368.70/105 vs. 84.22/105, P<0.05). The crude incidence of ischemic stroke appeared a tendency towards a rise (AAPC=7.851%, P<0.05). Conclusions The crude incidence of stroke appeared a tendency towards a rise in Yongkang City from 2015 to 2022, with ischemic stroke as the predominant subtype. Male and the elderly should be given a high priority for stroke control.

Objective To compare the effects of aspirin and clopidogrel on platelet aggregation function by TEG,and to study the antiplatelet agents tailored therapy of Thrombelastography(TEG)in treatment of cerebral infarc-tion patients.Methods 100 patients with acute cerebral infarction were included in two groups:aspirin group and clopidogrel group.The inhibitory rates of AA and ADP receptor pathway in platelets were detected by TEG.The effect of inhibitory rates in group aspirin and clopidogrel was compared with nerve function and the recurrence rate of stroke. Results The inhibitory rates of group aspirin (85.23 ±21.98)% was higher than group clopidogrel (47.31 ± 22.37)% (t =7.340,P =0.005).The patients with which the inhibitory rates showed goodby TEG in group aspirin and clopidogrel got better neurological recovery,and the patients showed goodby TEG in group aspirin got lower stroke recurrence rate within 1 year(χ2 =4.460,P =0.035;χ2 =7.232,P =0.007).Conclusion TEG had guided the antiplatelet individual therapy for cerebral infarction patients,and can be used to predict and confirm the efficacy of antiplatelet drug.

To explore the pathogenicity of VEG strain Toxoplasma gondii oocysts on China Kunming mice,T.gondii oocysts of ＜ 1 and 102-108 were chosen to feed the mice orally.And the modified agglutination test (MAT),H&E and IHC were used to check the infection of mice.The infection rate,the survival rate of mice,and number of cysts in brain were analyzed.Results showed that 100％ of the mice fed with ≥102 oocysts were infected,the minimum lethal dose was 102 oocysts and the 100％ lethal dose was 108 oocysts.The time of death in acute infection was 7 DPI to 14 DPI.T.gondii cysts formation rate was 32.14％ (9/28),and the number of cysts was 9 to 857 per mouse.The survival rate of infected mice was 67.44％ (29/43),and the longest survival time was more than 390 DPI.Accordingly,the virulence of T.gondii VEG strain is medium,and has a higher cysts formation rate.

Objective Primitive neuroectodermal tumor ( PNET) is a small round cell tumor occurring mostly in children or young adults and categorized into the Ewing sarcoma family of tumors, the purpose of the study was to investigate the clinical features, treatment and prognosis of Children PNET. Methods A retrospective study was performed on clinical data of 13 children with PNET hospitalized in our hospital from March 2010 to Octorber 2014.In order to analyze the clinical effects and prognostic results, statistical analysis was made on their clinical manifestations, CT and ultrasonic results, therapeutic schemes, postoperative pathology and immu-nohistochemical staining results, along with telephone and outpaitient follow-up of average 19 months. Results Of the 13 patients, 4 cases were central nervous system PNET(CNS-PNET) and 9 cases were peripheral PNET(pPNET).The clinical manifestations of the former were headache, vomiting, convolsion, movement disorder or decreased muscle strength, while the latter mainly showed mas-ses and abdominal distention.3 cases with metastasis to lung, lymph nodes and bones respectively showed masses on surface or in cavi-ty in imaging.Homer-Wright pseudorosette textures were found in 12 patients.Immunohistochemical results showed 11 cases with CD99(+), 9 cases with VIM(+) and 8 cases Syn( +).Among 11 patients underwent chemotherapy, 2 cases were lost to follow-up, 7 cases were in stable condition without occurrence and the other 2 cases recurred 4-6 months after chemotherapy.3 of 4 cases with CNS-PNET survived with the sequelae of decreased muscle strength, convolsion and movement disorder.1 case with CNS-PNET and 1 case with pPNET died 7 months and 16 months after diagnosis respectively. Conclusion PNET in children is a very highly malignant tumor with low long-term survival rate.Immunohistochemi-cal examination including CD99 and VIM is of important diagnostic value and CNS-PNET is prone to sequelae.

Objective To evaluate the feasibility of MRI-guided vacuum-assisted breast biopsy in domestic clinical prac tice.Methods A total of 45 patients with 45 suspicious breast lesions were examined with MRI-guided vacuum assisted bi opsy.The complications were observed.And the followed-up was performed.Results In 45 suspected breast lesions,43 lesions (43/45,95.56％) were successfully sampled under MRI-guided vacuum-assisted biopsy and the pathologic diagnosis was obtained.For another 2 lesions (2/45,4.44％),the pathology diagnosis were not obtained.The time to perform MRI-guided biopsy was (45.87±8.41)min for one lesion.The 5 malignant lesions (5/45,11.11％) confirmed by biopsy pathology were consistent with postoperative pathological results.For the 38 benign lesions (38/45,84.44％) confirmed by biopsy pathology,there was no malignant performance found in MRI follow-up for 6 months.Because of successful MR imaging-guided core biopsy findings,the clinic treatments were changed in 14 patients (14/45,31.11％).Five cases (5/45,11.11％) with malignant tumors were diagnosed early.The surgical biopsy was avoided in 9 benign cases (9/45,20.00 ％) who suspected as malignant.In all 45 patients,no complications occurred,such as hematoma and infection.Con clusion MRI-Guided vacuum-assisted breast biopsy is sufficient and safe for obtaining histologic proof of lesions,and plays an important role in guiding clinic treatment of some lesions visible only by MRI.

Objective To investigate physiological changes in peri extracorporeal circulation period of patients who underwent cardiac valve replacement surgeries with crystalloid solution mixed with colloidal solutions and pure crystal solution as extracorporeal circulation priming solution, and explore the clinical value and practicability of crystalloid solution as the sole extracorporeal circulation priming solution.Methods A retrospective analysis was performed in 130 patients who underwent cardiac valve replacement surgeries.Pure lactated Ringer's solution liquid and Lactated Ringer's solution mixed with Voluven as the extracorporeal circulation priming solution were used.We respectively compared hematocrit at different time points, postoperative blood routine, liver and kidney function, blood coagulation index, duration of intensive care and trachea cannula in two groups.Results There were no significant differences in ages, preoperative blood routine, kidney function, blood coagulation function, duration of operation, clamping time, bypass time, intensive care, postoperative blood routine, kidney function, blood coagulation function and hematocrit at different time points in two groups (P ＞0.05).However, the hospital day of group which used crystalloid solution as extracorporeal circulation priming solution was significant shorter compared to group which used lactated Ringer's solution mixed with Voluven (P ＜ 0.05).Alanine aminotransferase of group which used crystalloid solution as extracorporeal circulation priming solution was significant higher compared to group which used lactated Ringer's solution mixed with Voluven (P ＜0.01).Conclusions Crystalloid solution as extracorporeal circulation priming solution is safe and economy in cardiopulmonary bypass.Pure crystalloid solution as the sole extracorporeal circulation priming solution can be safely used on patients (New York Heart Association class Ⅱ-Ⅲ) who have normal liver and kidney function before the operation of adult heart valve replacement with cardiopulmonary bypass.

objective To investigate the value of NT-proBNP in assessing the volume status in maintenance hemodialysis patients with non-dominant edema.Methods One hundred and forty-five patients were recruited.Bioimpedance measurements were performed for overhydration (OH).NT-proBNP was detected by colloidal gold method.Patients were divided into three groups by levels of OH variability (△ OH,equal to OH minus weight increase) as group H (hypervolemia,n=90); group N (normovolemia,n=36) and group L (hypovolemia,n=19).Hemoglobin,albumin,blood urea nitrogen and serum creatinine were assayed,blood pressure and body mass increase were recorded.Dry weight of patients in Group H were adjusted in 3 months,the relationship between NT-proBNP and volume change were assessed.Results (1) At baseline,overall plasma NT-proBNP levels were higher than normal range.The median NT-proBNP levels in group H and group N were [1318.50(IQR 717.00,3154.25) pg/ml] and [703.50 (IQR 873.00,450.50) pg/ml],respectively.NT-proBNP was positively correlated with △OH value (r=0.801,P ＜ 0.001).(2) After 3 months,NT-proBNP levels in group H was significantly lower than baseline.Forty-one patients reached normal volume range (group H1),49 patients were resistant hypervolemia (group H2).The median NT-proBNP levels in group H1 and group H2 were [685.00 (IQR 422.50,988.50) pg/ml] and [1569.00 (IQR 982.50,2500.50) pg/ml],△ OH in group H1 and group H2 were [(0.63±0.23)L] and [(1.75±0.71)L],respectively.NT-proBNP and △ OH value in two groups had significant difference (P ＜ 0.05).NT-proBNP was positively correlated with △ OH value (r=0.684,P ＜ 0.001).(3) The area under ROC curve for NT-proBNP was 0.818,95％CI (0.733～ 0.904),P ＜ 0.001,since the absolute value of normovolemia was defined as ≤ 1.The cut off value of plasma NT-proBNP was set at 962.50 pg/ml in MHD patients with non-dominant edema,the diagnostic specificity and sensitivity were 79.6％ and 73.2％.Conclusion NT-proBNP could be used to assess volume status in MHD patients with non dominant edema.

To investigate the pathogenic characteristic of ToxoDB # 17 Toxoplasma gondii in Kunming mice,the mice were fed with ＜1,1,101,102,103,104,105,106 oocysts,and the clinical symptoms of mice were observed.MAT,HE and IHC were used to research the infection rate of T.gondii,survival rate of mice and the number of cysts in brain.The results showed that the mice fed with ≥104 oocysts appeared transient depression,mice were arched,messy hair after infection.The mice fed with ≥102 oocysts were all infected,T.gondii cysts formation rate was 2.38％ (1/42),the survival rate of infected mice was 85.71％ (36/42),the survival time was greater than 360 days.In conclusion,the pathogenicity of ToxoDB# 17 T.gondii is weak,and cysts formation rate is also low.

Objective To investigate the clinical efficacy and mechanism of Huoxue-Qingjie decoction for acute pancreatitis (AP). Methods According to the random table method, 89 patients with AP from April 2015 to March 2017 were divided into control group (n=44) and observation group (n=45). Two groups of patients were treated with conventional treatment, while the observation group was treated with Huoxue-Qingjie decoction on the basis of routine treatment for 7 days. The clinical total effective rate and improvement of clinical symptoms of two groups of patients were counted, at the same time the serum inflammation and oxidative stress indicators of patients were detected respectively before and after treatment. In addition, the incidence of adverse reactions of two groups of patients was analyzed.. Results The total clinical efficiency of the patients in the observation group was 86.7% (39/45), while the control group was 68.2% (30/44). The difference of two groups was statistically significant (χ2=4.363, P=0.037). The imaging returning to normal time (6.3 ± 1.2 d vs. 9.1 ± 1.1 d, t=-12.161), anal exhausted time (35.7 ± 6.8 h vs. 45.6 ± 7.2 h, t=-6.659), abdominal distension relief time (3.0 ± 0.8 d vs. 3.7 ± 0.9 d, t=-4.154) and bowel sounds recovery time (32.5 ± 5.5 h vs. 39.9 ± 6.1 h, t=-5.998) of the observation group were significantly lower than those of the control group (P<0.01). After treatment, the levels of TNF-α (101.21 ± 17.65 ng/L vs. 132.07 ± 20.32 ng/L, t=-7.654), IL-1β (20.33 ± 6.21 pg/ml vs. 29.03 ± 7.03 pg/ml, t=-6.191), IL-6 (30.07 ± 7.32 ng/L vs. 51.71 ± 7.05 ng/L, t=-14.200), IL-8 (80.23 ± 15.22 ng/L vs. 100.56 ± 16.37 ng/L, t=-6.069), HMGB1 (1.35 ± 0.43 μg/L vs. 2.63 ± 0.57 μg/L, t=-11.977) and MDA (3.02 ± 0.64 nmol/L vs. 4.02 ± 0.83 nmol/L, t=-6.374) of the treatment group were significantly lower than those of the control group (P<0.01), while the levels of SOD (119.63 ± 15.69 U/ml vs. 98.54 ± 10.73 U/ml, t=7.836) and CAT (238.87 ± 42.67 U/ml vs. 196.36 ± 39.65 U/ml, t=4.866) were significantly higher than those of control group (P<0.01). No serious adverse reactions occurred during the treatment of the two groups. Conclusions The clinical effect of Huoxue-Qingjie decoction on AP is significant, and the clinical symptoms can be improved by anti-inflammatory and anti-oxidative effect. The safety is high, and it is worth promoting the application in clinic.

Purpose To analyze the CT and MRI findings as well as follow-up changes of infantile hepatic hemangio-endothelioma (IHE),so as to provide basis for guiding the clinical establishment of therapeutic protocols.Materials and Methods The clinical data of 21 infants with IHE were analyzed retrospectively,including the imageological manifestations in initial diagnosis and during follow-up.Among the infants,3 received non-enhanced and enhanced scan of both CT and MRI,13 received non-enhanced and enhanced scan of CT only,while 5 received non-enhanced and enhanced scan of MRI only.All infants received ultrasonic examination.Results In non-enhanced CT scan,the tumor was marked by multiple or single intrahepatic low-density nidus with clear boundary,while non-enhanced MRI showed low T1WI signal and high T2WI signal.Enhanced scan of single IHE in arterial phase indicated notable nodular,streak-like and annular enhancement of the edge,while that in delayed period suggested a characteristic of progressive enhancement of tumor from periphery to center.There was not enhancement in necrotic zone in the center of large nidi all the time,while streak-like calcification nidi were found in partial nidi.Obvious whole-tumor enhancement was found in most nodes in the multiple nodular IHE,while moderate enhancement in partial nodes.The enhancement in each enhanced period decreased gradually,and most nidi in delayed period showed slightly high-density or isopycnic shadow.3 infants were misdiagnosed with hepatoblastoma and received surgical resection,but none had recurrence during postoperative ultrasonic follow-up.The rest infants were treated with oral administration of Propranolol and then followed up,and the follow-up results showed that most nidi shrunk to different extent while partial nidi disappeared completely.Conclusion IHE is marked by multiple nidi or single nidus,and the characteristic manifestations of CT and MRI are beneficial to promoting the accuracy rate of diagnosis of IHE.Tumor may shrink spontaneously or disappear if Propranolol is orally administered in treatment of IHE.