Objective To observe the effects of ginkgolide B (GB) on mRNA expression of foxgl and proliferation of cells in brain tissue of newborn rats with hypoxic-ischemic brain damage (HIBD).Methods A total of 128 clean 7-day-old healthy SD rats were randomly divided into sham operation group,the model group,the low-GB dose and the high-GB dose treatment groups.Classic Rice method were used to establish HIBD models in the latter 3 groups.Four hours after operation,and GB in dose of 5 mg/kg and 10 mg/kg was given to rats in the low and the high dose treatment groups by intraperitoneal injection postoperatively,once a day for 5 days,while sham operation and model groups were treated with equal physiological saline.All groups were respectively sacrificed on 3 d,7 d,14 d,28 d respectively.Quantitative real-time fluorescent polymerase chain reaction was employed to detect expression of Foxg1 gene.Then the number of 5-bromodeoxyuridine positive cell in subgranular zone was investigated by immunolluorescent stairning.Results The Foxg1 mRNA expression was observed 3 days after HIBD,peaked on 7th day,and then declined gradually; the levels of Foxg1 mRNA in the 2 treatment groups were higher than that of the HIBD group (all P ＜ 0.01) ; The expression of Foxgl at 7 d,14 d,28 d,in high-dose group were higher than those in the low-dose group (all P ＜ 0.01).The number of 5-bromodeoxyuridine positive cell was increased after HIBD,and the levels in the low-and the high-dose treatment groups were all higher than that of the model group (all P ＜ 0.05) ; the number of positive cell in high-dose treatment groups were higher than that in the low-dose treatment groups (P ＜ 0.05).Conclusions GB can promote the expression of Foxg1 gene and improve the proliferation of cells in Brain tissue after HIBD,which shows more significant efficacy in high-dose group than in low-dose group.

Objective To observe the effect on Foxg1 gene expression in the subgranular zone (SGZ) of cerebral tissue from neonatal rats with hypoxic-ischemic brain damage (HIBD) after transplantation of neural stem cells (NSCs) derived from umbilical cord blood.Methods Mononuclear cells separated from umbilical cord blood by density gradient centrifugation were cultured with orientated induction to differentiate the NSCs.The neuronal phenotype was identified using immunocytochemical methods.A total of 150 Sprague-Dawley rats were randomly divided into a sham-operation group,an HIBD group and an HIBD-NSCs group.Rats in the HIBD group and the HIBD-NSCs group were subject to ligation of the left carotid artery and then kept in a box under 8％ oxygen and 92％ nitrogen for 2.5 hours to establish the HIBD animal model.The artery was separated but not ligated in the sham operation group,which was not subjected to hypoxia.Twenty-four hours after the operation,the cultivated NSCs were transplanted by caudal vein injection into the rats in the HIBD-NSCs group.Rats were then sacrificed on the 3rd,7th,14th,21st and 28th days after the operation.Foxg1 gene expression in the SGZ was examined using in-situ hybridization methods.Results The number of Nestin-positive cells peaked on the 6th day of cultivation and then decreased by the 9th day.The Foxg1 gene was expressed in the SGZs of each group.The expression increased by the 3rd day after surgery in the HIBD and HIBD-NSCs groups,and peaked on 7th day after the operation,then declined gradually.The average expression level of Foxg1 in the HIBD group was significantly lower than that in the HIBD-NSCs group on the 7th day and thereafter.Conclusions Human umbilical cord blood mesenchymal stem cells can be induced and differentiated into neural stem cells.Foxg1 genes can still be present in the SGZ after birth.HIBD can induce the expression of Foxg1 genes.Transplanting NSCs can promote the expression of Foxg1 genes and improve morphological and functional recovery after HIBD,at least in neonatal rats.

Objective To investigate the effect of Solitaire stent combined with coils on endovascular embolization of intracranial wide-necked aneurysms.Methods Twenty-six cases with intracranial wide-necked aneurysms from June 2009 to December 2011 in the NO.264 Hospital of the Chinese People's Liberation Army were treated with Solitaire stent-assisted coils,and anticoagulation and antiplatelet therapy were done among peri operation period.The effect of endovascular embolization was evaluated after 3 months cerebral angiography.Results A total of 27 solitaire stent were used in the 26 patients,one of which used 2 stents.The stents were successfully put in place,and the placement effect were satisfaction.The immediate angiography showed that 24 cases were dense embolism,2 cases of subtotal embolization.Stent were placed at right position.Twenty-three patients were followed with DSA for 3 months,and no aneurysm evidence of recurrence was found.Conclusion Solitaire stent-assisted coil embolization of intracranial wide-necked aneurysms is simple to perform and embolism rate is high and the recurrence rate is low.

Objective To investigate the morbidity of anomalous coronary origin from the opposite coronary sinus, which may cause sudden death of young athletes in Chinese population.And to identify the imaging characteristics of this anomaly and its clinical significance combined with literature review.Methods The computed tomographic coronary angiography (CTCA) database at TEDA International Cardiovascular Hospital was reviewed.All of the patients diagnosed with isolated anomalous origin of a coronary artery from the opposite sinus of valsalva (anomalous origin of coronary artery, AOCA) and subsequent coursing between the pulmonary artery and the aorta were collected from 14 343 Chinese individuals.The location of anomalous coronary origin, the shape and course of the proximal ectopic arterial segments were identified.The nonatherosclerostic stenotic caliber of the segments and the angle between the ectopic coronary artery and the adjacent aortic wall were assessed.Results Seventy-four patients of AOCA (including the left or right single coronary artery) were diagnosed using CTCA.Among the 74 cases, the potentially serious course of the ectopic coronary artery between the pulmonary artery and the aorta were identified in 59 individuals.Fifty-six cases of ectopic right coronary with interarterial course (anomalous origin of right coronary artery, AORCA) and three patients with anomalous origin of the left coronary artery (AOLCA) were found, including two cases judged as potentially serious origin of either single left coronary artery (n=1) or single right coronary artery (n=1).The morbidity of the potentially serious anomalous origin of coronary artery in Chinese population was established as 4.1‰ (59/14 343).In the subgroup of AORCA, the lumen of initial ectopic segment was frequently compressed and stenotic.In 29 cases (52.7%) the stenosis of the lumen were more than 50%, and in 3 cases (5.4%) the stenosis of the ectopic coronary artery were more than 70%.The incidence of AORCA was 17.7 times higher (56/3) than that of AOLCA in Chinese population.Conclusions Nowadays CTCA is considered the most useful imaging technique in identifying the origin, shape and course of ectopic initial segment of the coronary artery.The significance of these anatomic characteristics, that may induce sudden death in Chinese young athletes, need to be investigated further.

OBJECTIVE: To investigate the treatment of benign positional paroxysmal vertigo of posterior semi-circular canal by Epley maneuver combined with Semont maneuver. METHOD: One hundred and fifty patients with benign positional paroxysmal vertigo of posterior semicircular canal were randomly divided into three groups: group A, B and C. Patients in group A were treated by Epley maneuver and patients in group B were treated by Semont maneuver. Patients in group C were received the treatment of Epley maneuver combined with Semont ma- neuver. We recorded the times of treatments in different groups respectively. Statistics of treatment effects and follow-up studies with 3 months after the recovery were assessed. RESULT: The cure rate of the canalith repositioning on the primary, secondary and tertiary treatment in group A was respective 72% (38/53) and 81% (43/53) and 85% (45/53), in group B was 68% (30/44) and 80% (35/44) and 84% (37/44), in group C was 89% (47/53) and 94% (50/53) and 98% (52/53). The cure rate in group C is significantly higher than group A and group B (χ2 = 6.777, P < 0.05; χ2 = 6.647, P < 0.05). 3 months after recovery 6 patients in group A, 5 patients in group B and 1 patient in group C were relapsed. CONCLUSION By the use of Epley maneuver combined with Semont maneuver in the treatment of benign positional paroxysmal vertigo of posterior semicircular canal, the primary cure rate was increased and the numbers of treatments were reduced and the relapse was decreased. It is suitable to use Epley maneuver combined with Semont maneuver in the clinic.
Benign Paroxysmal Positional Vertigo ; therapy ; Follow-Up Studies ; Humans ; Patient Positioning ; Physical Therapy Modalities ; Posture ; Recurrence ; Semicircular Canals ; Vertigo

ObjectiveTo explore the state of misdiagnosis, missed diagnosis and excesseive diagnosis related to cerebral palsy(CP).Methods389 cases were retrospectively analyzed who were misdiagnosed, missed or escessively diagnosed related to CP as the first diagnosis in the inpatient and outpatient department from July 1999 to March 2010.ResultsAmong 389 cases, 156 cases were missed or misdiagnosed as nutritional disease, and 118 cases of other diseases were misdiagnosed as CP, while 115 cases who were normal children was excessively diagnosed as CP. The false diagnosis had relativity with children's age: doctors are more prone to make misdiagonsis when the children's age are smaller, while 293 cases were misdiagnosed before 12 months old (75.3%); 102 cases (65.4%) were misdiagnosed or missed as other diseases before September, 2004, while 87 cases (75.7%) were excessively diagnosed as CP after September, 2004. Frequency of misdiagnosis as CP reduced from 2004, and the proportion dropped from 55.9% to 44.1%.ConclusionIt is very important to master the diagnostic standard of CP. Both sides of the question are important, one side is to make early diagnosis and early treatment in order to achieve the best effect of rehabilitation, and the other side is to prevent misdiagnosis and excessive diagnosis which woud delay illness, or waste medical resources, increase the financial and psychological burden.

Objective:To investigate the preoperative evaluation, safety and clinical efficacy of intravascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion .Methods:Twenty-six patients with symptomatic non-acute middle cerebral artery occlusion admitted between January 2018 to June 2021 were retrospectively analyzed. The clinical symptoms, cerebral perfusion, occlusive site, occlusive length, collateral circulation and distal capillary were evaluated. There were 17 cases accorded with intravascular recanalization. The cerebral blood flow , cerebral blood volume, MTT, peak time and scores of 17 patients before and after revascularization were compared by paired t test.Results:Endovascular recanalization was performed in 17 patients and extracranial-intracranial artery bypass grafting was performed in 9 patients. Among the 17 cases, there were 7 cases of hemiplegia of contralateral limbs, 6 cases of recurrent cerebral infarction, 4 cases of paroxysmal contralateral limb numbness or weakness, 3 cases of cognitive dysfunction and 3 cases of headache. The cerebral perfusion of the occluded side of the middle cerebral artery in 17 cases was significantly lower than that of the healthy side. One patient failed to pass through the occlusion with micro guide wire, and gave up the operation after repeated attempts. The occluded vessels were successfully recanalized in 16 cases (thrombolytic grade of cerebral infarction=2b-3), and recanalized in 16 cases, including 9 cases of simple balloon dilatation and 7 cases of stent implantation. Three months after the operation, the National Institute of Health Stroke Scale (NIHSS) score of 17 patients decreased from (9.57±2.32) to (3.75±1.42). The cerebral blood flow, cerebral blood volume, mean transit time and peak time were also significantly improved compared with those before the operation（ t value was 9.08，5.54，4.26，8.56，6.00，respectively，all P<0.001）. The Montreal Cognitive Assessment (MoCA) score of cognitive function was (22.70±1.70) before the operation, and there months after operation (26.30±2.30) points ( t=6.66, P<0.001) were statistically significant. After operation, CT cerebral angiography or whole cerebral angiography showed that 1 case was occluded, 15 cases had good recanalization, no intracranial hemorrhage occurred during the perioperative period, and no new stroke occurred during the 6-month follow-up period. Conclusion:For patients with symptomatic non acute middle cerebral artery occlusion, the patients who may benefit from multi-dimensional evaluation are selected for intravascular recanalization treatment. There are few complications and high recanalization rate. The short-term follow-up clinical effect is good, but the long-term effect needs to be further observed.

Objective To retrospectively analyze the diagnostic value of thrombin-antithrombin complex(TAT),thrombomodulin(TM),and tissue plasminogen activator-inhibitor complex(t-PAIC)in severe cases of corona virus disease 2019(COVID-19).Methods A cohort of 79 patients clinically diagnosed with COVID-19 was retrospectively assembled and categorized into two groups based on disease severity:non-severe(n=51)and severe(n=28).In this study the differences of coagulation function and inflamma-tory marker levels between the two groups were compared.The correlations of TAT,TM and t-PAIC with other biomarkers were investi-gated.The diagnostic values of all the markers for severe COVID-19 were assessed.Results The patients of severe COVID-19 exhibi-ted significantly higher levels of TAT,TM,and t-PAIC compared to those of non-severe group(P＜0.001).The levels of TAT,TM and t-PAIC showed notable positive correlation with other biomarkers.TAT demonstrated the strongest positive correlation with the level of D-dimer(r=0.786,P＜0.001).Binary logistic regression analysis identified TAT(OR=1.346,P＜0.05)and t-PAIC(OR=1.128,P＜0.05)were independent risk factors in term of severe COVID-19.The combined ROC curve for TAT,TM and t-PAIC revealed high diagnostic efficacy in severe cases with the area under the curve(AUCROC)were 0.918,and the sensitivity and specificity were of 75％and 94.1％,respectively.Conclusion The results of combined measurement of TAT,TM and t-PAIC effectively demonstrates its diagnostic value in identifying severity and stratification of COVID-19 cases and may have important clinical significance for assessment of the severity and prediction of the prognosis.

Objective:To investigate the clinicopathological and molecular genetic features of POLE mutant endometrioid carcinoma.Methods:Genetic test data of 230 cases of endometrial carcinoma that underwent surgical resection and molecular typing by next generation sequencing in the First Medical Center of Chinese PLA General Hospital from January 2021 to June 2023 were retrospectively analyzed. Seventeen cases of endometrioid carcinoma with POLE mutation were selected. Clinical and prognostic information was collected. The paraffin-embedded tissue and immunohistochemical sections were reviewed, and the gene detection data were analyzed.Results:In the 17 cases of endometrioid carcinoma with POLE mutations, 16 cases (16/230, 6.9%) had mutations at known pathogenic sites, and 1 case had a mutation site (S459Y) that had not been reported, which was inferred to be pathogenic based on clinical prognosis. The 17 patients aged from 48 to 79 years (median 56 years, mean 58 years). All cases had typical histological features of endometrioid carcinoma, including 7 cases (7/17) of poorly-differentiated, 4 cases (4/17) of moderately-differentiated and 6 cases (6/17) of well-differentiated. Squamous differentiation was noted, mucous differentiation was less commonly found and often accompanied by superficial muscle infiltration. The number of stromal lymphocyte infiltration was variable. Lymph-vascular embolus was found in 6 cases, and lymph node metastasis was only detected in 1 case. According to the FIGO staging system for endometrial cancer in 2023, all the cases were in FIGO stage ⅠA m-POLEmut except for one case in FIGO stage ⅢC1. There were 8 cases with genetic co-mutation, 5 cases with TP53 mutation (immunohistochemically subclonal expression pattern), 1 case with MSI-H, and 2 cases with both TP53 mutation and MSI-H. Five of 7 patients with POLE mutation (poorly-differentiated) received postoperative chemotherapy and/or radiotherapy, 4 patients received endocrine therapy, and 8 patients had no treatment after surgery. One of the stage ⅠA m-POLEmut tumor patients was found to have pelvic recurrence one year after surgery, and the other 16 patients were followed up for 10-38 months without recurrence or metastasis. Conclusions:POLE mutant endometrioid carcinoma may have different differentiation, and most patients have good prognosis. Correct interpretation of molecular results, accurate identification and classification are important for predicting prognosis and avoiding overtreatment. However, a small number of cases may have recurrence and metastasis, and therefore it is necessary to make a reasonable treatment plan based on the comprehensive judgment of other high risk factors.

Objective:To construct the "Internet +" peripherally inserted central catheter (PICC) home nursing service quality evaluation index system, so as to provide objective basis for standardizing the "Internet +" PICC home nursing service quality evaluation.Methods:Based on the three-dimensional quality structure model of "structure-process-outcome", combined with literature research, semi-structured interviews, group discussions and Delphi method, 20 experts who were engaged in intravenous therapy nursing and had management or practical experience in "Internet + nursing services" were selected for two rounds of consultation to determine the "Internet?+" PICC home nursing service quality evaluation index system. The positive coefficient of experts was expressed by the effective response rate of the questionnaire and the rate of expert opinion submission. The degree of expert authority was expressed by the expert authority coefficient. The coordination degree of expert opinions was represented by the Kendall harmony coefficient. The concentration degree of expert opinions was usually expressed in terms of the importance assigned to the indicator, the coefficient of variation, and the full score rate (%) .Results:The effective response rates of the two rounds of consultation questionnaires were all 100%, with expert authority coefficients of 0.793 and 0.848 respectively. The Kendall coordination coefficients of expert opinions were 0.202-0.216 and 0.222-0.270 respectively ( P<0.05). After the second round of expert consultation, the mean importance assigned to all indicators was greater than 4.0, the coefficient of variation was less than 0.2, and the full score rate was greater than 20%. The final "Internet +"PICC home nursing service quality evaluation index system included 3 first-level indicators, 12 second-level indicators and 64 third-level indicators. Conclusions:The "Internet + " PICC home nursing service quality evaluation index system constructed is scientific, reliable and practical, and reflects the specialty characteristics. It can effectively evaluate the "Internet + " PICC home nursing service quality and provide guidance for continuous improvement.