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.

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.

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 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 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 study the methylation status of CD40L gene regulatory regions in peripheral blood CD4+ T cells from patients with systemic sclerosis (SSc).[Methods] Peripheral blood mononuclear cells were isolated from the venous blood of 21 SSc patients and 20 healthy controls by density gradient centrifugation.CD4+ T cells were separated by using magnetic beads.Genomic DNA was isolated from the CD4+ T cells and treated with sodium bisulfite.Nested PCR was perfonned to amplify the desired regulatory sequences (including the promotor and enhancer) of CD40L,and the amplicons were transformed into the Escberichia coli DH5α.Subsequently,8 independent clones were selected and sequenced for each of the amplified fragments.[Results] In healthy female controls,half of the cloned fragments of CD40L regulatory sequences were unmethylated,and the other half were methylated.The mean methylation levels of CD40L promoter and enhancer from female SSc patients were significantly lower than those from healthy female controls (both P ＜ 0.01 ).Almost all of the cloned fragments of CD40L promoter and enhancer were unmethylated in healthy male controls and male SSc patients,with no significant difference in the methylation level between male SSc patients and healthy controls (both P ＞ 0.05,respectively).[Conclusion]s There is a low methylation level of CD40L regulatory elements on the inactive X chromosome in female SSc patients,which may contribute to the CD40L overexpression in CD4+ T cells.

Objective To compare the value of diffusion kurtosis imaging (DKI) model with single-index DWI model parameters in the differential diagnosis of benign and malignant breast lesions,and to explore the correlation between the parameters and molecular subtypes and prognostic factors of breast cancer.Methods A retrospective analysis was performed with inclusion of 64 cases of breast diseases from January 2016 to May 2017 in Shanghai First People's Hospital.The patients were pathologically confirmed and typed, 30 cases are malignant tumors and 34 cases are benign lesions. DKI and DWI were performed within 2 weeks before the pathological examination. Invasive ductal carcinoma of grade Ⅰ, Ⅱ and Ⅲ were revealed in 1, 7 and 13 cases respectively. Luminal A breast cancer was found in 10 cases, Luminal B breast cancer was diagnosed in 11 cases, HER-2 positive breast cancer was 4 cases and triple negative breast cancer was 5 cases. The expressions of estrogen receptor (ER), Progesterone receptor (PR), and HER-2 positive were found in 20, 14 and 15 cases respectively. Ki67 was highly expressed in 24 cases and low expression in 6 cases. All patients underwent both plain and enhanced mammography scanning. The kurtosis (MK), mean diffusivity (MD) and ADC value were measured. Prognosis analysis was performed according to the maximum diameter (>2 cm, ≤2 cm), vascular or neurological invasion (positive, negative), lymph node metastasis (positive, negative), ER (positive, negative), PR (positive, negative), HER-2 (positive, negative),Ki67 (positive, negative), pathological grade (grade Ⅰ+Ⅱ,Ⅲ). Two independent samples t test was used to compare DKI and DWI parameters between benign and malignant lesions. ROC analysis was performed for assessing the values of parameters in discriminating benign and malignant breast lesions. Mann-Whitney U and Kruskal-Wallis H tests were used for the comparison of various prognostic factors or molecular subtypes.Spearman rank correlation analysis was used to explore the correlation of different prognostic factors and DKI and DWI parameters. Results The MK value of malignant group was higher than that of benign group,and the MD value and ADC value were lower than that of benign group (P<0.05). The area under the ROC for MK, MD and ADC were 0.897, 0.827 and 0.776, respectively. The area under the ROC was improved to 0.935 when three parameters were combined. The MK of ER positive group was higher than that of negative group (P<0.05). There was no significant difference of parameters among the other prognostic groups (all P>0.05). There was a low positive correlation between ER and MK (r= 0.417, P= 0.022). There was no correlation between the other prognostic factors and parameters (r=－0.086 to 0.313, all P>0.05). There was no significant difference in the MD, MK and ADC values among the four different subtypes of breast cancer (all P>0.05). Conclusions MK, MD and ADC values can be used to discriminate benign and malignant breast tumors, among which MK value has the best diagnostic performance. There is a certain correlation between DKI model parameters and prognostic factors.