Diastolic and systolic dysfunction of cerebral artery is an important pathophysioiogical basis of the occurrence and development of cerebrovascular diseases, and is also the presence of decreased cerebrovascular reserve capacity. Cerebrovascular myogenic and metabolic regulation abilities can be evaluated by different methods so as to reflect cerebrovascular reserve capacity, of those, transcranial Doppler ultrasonography is the most widely used one. Various diseases, such as hypertension, diabetes mellitus, and carotid atherosclerosis also have great effect on cerebrovascular reserve capacity.

Objective To discuss the clinical application of individualized strategy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of bile duct stenosis after liver transplantation (LT).Methods Fifty-two patients,including 40 men and 12 women,aged 54.3 ± 9.1 years old,who suffered from bile duct stenosis and accepted 88 times of ERCP from June 2014 to May 2016 in our department were investigated.The procedures,clinical features and biochemical criteria were analyzed retrospectively.Results According to the treating occasions and clinical symptoms,single plastic stent,dilatation combined with single plastic stent,and dilatation combined with multiple plastic stents were chosen to use.ERCP in 8 patients out of 52 patients failed technically,and the therapeutic efficacy was 82.7％.The treatment duration was 8.2 ± 2.9 months.The recurrence rate was 4.7％ (2 cases) during the follow-up period.The most common complications were postERCP pancreatitis (2.3％) and cholangitis (3.4％),which would be cured by conservative treatment in most cases.Conclusion ERCP,as an effective and safe method,could be used as the first choice or bridge treatment for bile duct stricture after LT.We recommend individualization strategy,including step by step mode and different combinations of PTC or endoscopic procedures,in order to improve clinical efficacy of all kinds of stricture.

Objective To investigate the efficacy ,safety and compliance of mesalazine sustained‐release (SR) granules taking once daily or multi‐times daily in the treatment of patients with mild to moderate active ulcerative colitis .Methods Sixty patients with mild to moderate active ulcerative colitis were divided into group A ,B and C with 20 patients in each group .Group A received mesalazine SR granules 4 g once daily ,Group B with 2 g each time and twice daily ,Group C with 1 g each time and four times daily . The total course was eight weeks . The vital signs ,Mayo score ,compliance and adverse effects of patients were monitored at 0 ,4th ,8th weeks .At 0 and 8th weeks ,colonoscopy were performed . The parameters of efficacy assessment were clinical complete remission rate , clinical remission rate , efficacy rate ,mucosal healing rate ,remission time and safety .The F test ,t test or Chi‐square test was performed for comparison among groups .Results The clinical complete remission rate of group A ,B and C was 20% (4/20) ,10% (2/20) and 10% (2/20) ,respectively .The clinical complete remission rate was 70% (14/20) ,65% (13/20) and 70% (14/20) ,respectively .The efficacy rate was 95% (19/20) ,85%(17/20) and 90% (18/20) ,respectively .The mucosal healing rate was 70% (14/20) ,60% (12/20) and 50% (10/20) ,respectively .The side effects rate was 20% (4/20) ,15% (3/20) and 20% (4/20) .There was no significant difference between groups (all P > 0 .05) .The remission time of group A and B was (15 .4 ± 3 .7) days and (15 .6 ± 2 .9) days ,which were both shorter than that of group C (18 .4 ± 3 .6) days ,and the differences were statistically significant (t= 2 .661 and 2 .710 ,both P< 0 .05) .There was no significant difference among three groups in gender ,disease course , severity , location and clinical remission rate of sub‐groups .Conclusions The efficacy and safety of mesalazine SR granules taking once daily or multi‐times daily are similar in the treatment of patients with mild to moderate active ulcerative colitis .Once daily have better compliance than other regimens .

Objective: To compare the effect of scalp acupuncture and scalp acupuncture plus acupuncture exercise therapy (AET) on walking ability in children with spastic cerebral palsy (CP). Methods: A total of 60 spastic CP children with gross motor function classification system (GMFCS) grades Ⅰ-Ⅲ were divided into a control group and an observation group by the random number table method, with 30 cases in each group. Both groups were treated with the same conventional rehabilitation and scalp acupuncture therapy for CP. The control group received conventional rehabilitation first and then scalp acupuncture. The observation group received AET, which was to receive the conventional rehabilitation and scalp acupuncture simultaneously. Before and after treatment, the clinical efficacy was evaluated by the modified Ashworth scale (MAS) score, scores of dimensions D and E of the gross motor function measure (GMFM) scale, walking speed, and walking distance. Results: During treatment, there were 2 dropouts in the observation group. After 3 courses of treatment, the MAS scores in both the control group and observation group decreased compared with the same group before treatment (P<0.05), and the scores of dimensions D and E of the GMFM, walking speed, and walking distance were increased (P<0.05); the between-group comparison showed that the MAS score in the observation group was lower than that in the control group (P<0.05), and the scores of dimensions D and E of the GMFM, walking speed, and walking distance in the observation group were higher or longer than those in the control group (P<0.05). Conclusion: W ith the same treatments, scalp acupuncture combined with AET is superior to the conventional scalp acupuncture method in reducing lower-limb muscle tone, improving standing balance ability, and walking stability in children with spastic CP.

Objective:To investigate the value of dual-layer detector spectral CT in preoperative evaluation of immunohistochemical expression levels in breast cancer patients.Methods:The clinical, pathological and imaging data of breast cancer patients who received preoperative spectral CT chest scan in Affiliated Hospital of Southwest Medical University from October 2020 to January 2021 were retrospectively analyzed. A total of 70 patients were divided into positive or negative estrogen receptor (ER) group, positive or negative progesterone receptor (PR) group, positive or negative human epithelial growth factor receptor 2 (HER2) group, and positive or negative Ki-67 group according to the immunohistochemistry. Philips workstation and Special Diagnostic Suite software were used for processing and analysis. The CT value and iodine concentration value (IC) of the lesion and the effective atomic number (Z eff) of the lesion in the arterial and venous phases were measured, and the standardized CT value (NCT), standardized iodine concentration value (NIC), slope (K) of the keV-CT value curve in the arterial and venous phases as well as the CT difference and the IC difference in the arteriovenous phase were calculated. Independent sample t test was used to compare the differences in spectral parameters between patients with positive and negative immunohistochemical parameters, and ROC curve was used to analyze the efficacy of spectral parameters in the differential diagnosis of positive and negative different immunohistochemical parameters. Results:Z eff, NIC, K value, CT value, IC value of arterial and venous phase and NCT value of venous phase in negative ER group were higher than those in positive ER group, the difference was statistically significant ( P<0.05). Z eff, NIC, K value, IC, CT difference in arteriovenous phase and IC difference in arteriovenous phase in positive HER2 group were higher than those in negative HER2 patients, the difference was statistically significant (P<0.05). The arterial K value in positive Ki-67 group was higher than that in negative Ki-67 group, the difference was statistically significant ( P<0.05). Taking arterial phase K value of 1.22 as the diagnostic threshold, it had the highest diagnostic efficiency in differential diagnosis of ER positivity versus negativity (area under curve of 0.791, sensitivity of 84.00%, specificity of 65.00%). Taking the arteriovenous phase IC difference of 0.47 mg/ml as the diagnostic threshold, it had the highest performance in differential diagnosis of HER2 positivity versus negativity (area under curve of 0.736, sensitivity of 76.32%, specificity of 65.62%). Conclusion:Dual-layer detector spectral CT has certain diagnostic value for the immunohistochemical expression of breast cancer patients, which can provide reference for clinical diagnosis and treatment.

Objective:To explore the role played by clinical pharmacists in the formulation and pharmaceutical care of individual-ized administration of warfarin. Methods:Clinical pharmacists adopted maximum a posteriori Bayesian method to formulate the dosage regimen of patients treated with warfarin and monitored the implementation process. The increase of INR was timely identified on ac-count of drug interactions to avoid bleeding events,as well as the decrease of INR caused by patients' medication mistakes to avoid re-currence of thrombosis. Results:The maximum a posterior Bayesian estimation method could be used to estimate and guide clinical medication,which showed great reference value for individualized drug regimen. Conclusion:Clinical pharmacists should formulate in-dividualized administration plan according to genetic testing results and choose optimal treatment for patients. Moreover,the implemen-tation of dosage regimen should be monitored during the whole progress,so as to timely find INR abnormal fluctuations due to disease interactions,drug interactions,poor treatment compliance and so on,and consequently improve anticoagulant effect and reduce adverse reactions such as bleeding and thrombosis etc.

Objective:To investigate the correlation between different degrees of white matter hyperintensities (WMHs) and outcome after intravenous thrombolysis (IVT) in patients with acute ischemic stroke.Methods:Patients with AIS received intravenous thrombolytic therapy with standard dose of alteplase in the First Hospital of Putian City from January 2019 to June 2022 were retrospectively included. The Fazekas scale was used to score the WMHs shown on MRI, and the patients were divided into without or mild WMH group and moderate-to-severe WMH group. The clinical baseline data and the clinical outcome after 3 months of the two groups were compared. The poor outcome was defined as the modified Rankin scale score >2. Multivariate logistic regression analysis was used to determine the influence of the severity of WMHs on the outcome after intravenous thrombolysis. Results:A total of 103 patients with AIS were included. Their age was 64.85±10.89 years old, and 66 (64.1%) were men. There were 60 patients (58.3%) in the without or mild WMH group, and 43 (41.7%) in the moderate-to-severe WMH group. There were significant differences in age, body mass index, systolic blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) scores, as well as the proportion of patients with hypertension, smoking, hemorrhagic transformation and poor functional outcome at 3 months after onset in different degrees of WMH groups (all P<0.05). There were 73 patients (70.9%) in the good outcome group and 30 (29.1%) in the poor outcome group. There were significant differences in age, body mass index, baseline NIHSS score, WMH score, as well as the proportion of patients with hypertension, large atherosclerotic stroke and symptomatic intracranial hemorrhage between the two groups ( P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors, moderate-to-severe WMHs were the independent risk factors for the poor outcome at 3 months after intravenous thrombolysis (odds ratio 3.810, 95% confidence interval 1.298-1.124; P=0.015). Conclusion:Moderate-to-severe WMHs are associated with the poor outcome in patients with AIS at 3 months after intravenous thrombolysis.