Objective To investigate the effect of intravenous thrombolysis with different doses of alteplase on neurological function in patients with acute ischemic stroke.Methods 120 patients with acute ischemic stroke were selected as the research subjects.According to the admission time,the patients were divided into the observation group and the control group,60 patients in each group.The observation group was treated with low dose alteplase(0.6mg/kg),the control group was given standard dose(0.9mg/kg).The clinical curative effect,incidence rate of adverse event,NIHSS score and mRS score before and after treatment were observed and recorded in the two groups.Results Before treatment,there was no significant difference between the two groups in NIHSS score(t=0.288 0,P=0.773 9).After treatment for 3 days,the NIHSS score of the control group decreased compared with before treatment,and was lower than that of the observation group at the same period,there was significant difference between the two groups(t=0.778 5,P=0.000 0).Before treatment,the mRS score between the two groups had no siginificant difference(t=0.801 0,P=0.424 7).After treatment for 90 days,the mRS score of the two groups decreased,the difference was statistically significant(t=6.811 5,P=0.000 0).After treatment,1 patient with cerebral hemorrhage was observed in the observation group,while 3 cases in the control group,the difference between the two groups was not statistically significant(χ2=1.034 5,P=0.309 1).The mortality of the observation group was 11.47％,which of the control group was 1.67％,there was significant difference between the two groups(χ2=4.821 4,P=0.028 1).The good prognosis rate of the observation group was 45％,which of the control group was 68.33％,the difference was significant between the two groups (χ2=6.651 6,P=0.009 9).Conclusion Standard dose of alteplase in the treatment of acute ischemic stroke has better efficacy than low-dose alteplase,it has improved conditions of neurological deficits in patients,better recovery of neurological function,the prognosis is good,it can be widely recommended.

AIM: To explore the regulatory effects of cytokines such as EGF, bFGF on expression of neural-specific molecules in mononuclear cells (MNCs) cultured in H-DMEM medium. METHODS: The umbilical cord blood samples were collected from health puerperal natural delivery. The mononuclear cells were isolated by centrifugation over Lymphoprep and planted in T-75 flasks containing H-DMEM medium with or without addition of EGF, bFGF or EGF plus bFGF at a final concentration of 20 ?g/L, respectively. Phenotypic changes were monitored by inverse phase-contrast microscopy. Tau and MAP2 mRNA were determined by reverse-transcript polymerase chain reaction (RT-PCR). Tau and MAP2-positive cell were determined by immunocytochemistry. RESULTS: The expression of tau protein mRNA was negative in uncultured cells, but MAP2 mRNA was positive. In cultured cells, tau protein mRNA expressed positively, MAP2 mRNA expression was upregulated by EGF+bFGF, EGF or bFGF compared with control group (no cytokines). The upregulatory capability of EGF+bFGF to MAP2 mRNA expression was stronger than that of EGF or bFGF alone. The same upregulatory tendency was noted in tau mRNA expression. In the group of control, bFGF, EGF, EGF+bFGF, the rate of MAP2-positive cells was 14.4%, 19.6%, 25.6%, 33.5%, respectively. Tau protein-positive cells were 13.5%, 15.3%, 21.4%, 29.8%, respectively. Under inverse microscopy, the freshly isolated MNCs were small and round, after culturing, the cells became larger with some big, long cytodenrites in the EGF+bFGF group, with 1 or 2 threadlike cytodenrites in the EGF group, or with some short multi-dendron like-astrocyte in the bFGF group and control group, but the number of astrocyte-like cells in the control group was less than that in bFGF group. CONCLUSION: MNCs derived from human umbilical cord blood cells express some neural specific molecules and are upregulated by cytokines, especially EGF and bFGF, which have the synergetic action. [

Objective:To investigate the sex differences in severe traumatic death patients of different ages.Methods:A total of 408 patients with severe trauma who received treatment in The Second Affiliated Hospital of Zhejiang University School of Medicine and Taizhou First People's Hospital from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into the children group (≤ 14 years old, n = 47), the adult group (14-50 years old, n = 171), and the older adult group (> 50 years old, n = 90). Multivariate logistic regression was used to evaluate the difference in sex-based mortality among the groups. Nonlinear regression was used to evaluate the mutual interaction of increasing age and sex on the predicted survival rate. Results:Traffic accidents were the most common cause of death among men in the adult group (58.93%, χ2 = 7.95, P = 0.027). Falls were the most common cause of death among men in the older adult group (57.36%, χ2 = 8.63, P = 0.001). The Injury Severity Score of women in the adult and older adult groups was significantly higher in women than that of men in the same group [adult group: men: (24.39 ± 4.17) points, women: (26.32 ± 4.31) points, t = 2.84, P = 0.005). The incidence of post-traumatic complications in the older adult group was very higher in men than in women (respiratory failure: 28.68% in men, 14.75% in women, χ2 = 4.37, P = 0.036; circulatory failure: men: 27.13%, women: 13.11%, χ2 = 4.64, P=0.031; neuropsychiatric disorders: men: 20.93%, women: 8.20%, χ2 = 4.79, P = 0.029; respiratory infection: men: 31.78%, women: 18.03%, χ2 = 5.55, P = 0.047; other infectious diseases: men: 28.68%, women: 13.11%, χ2 = 0.69, P = 0.018). After adjusting for covariates, the mortality rate of men in the older adult group was significantly higher than that of women in the same group ( OR: 1.261, 95% CI: 1.185-1.343, P < 0.001). With the increase of age, the predicted survival rate after the trauma in patients of different sexes also decreased, in particular in men aged > 50 years (interaction P = 0.051). Among patients with blunt and severe head trauma, age-related mortality decline in patients aged > 50 years had a strong interaction with sex (interaction P = 0.002). In patients with penetrating trauma, there was a weak interaction between the predicted survival rate of different sexes (interaction P = 0.192). Conclusion:There is no significant difference in age-related change in post-traumatic mortality between different sexes. In the population aged > 50 years, men have a relatively higher risk of death than women.

AIM:To evaluate the effectiveness of heparin-binding protein(HBP)in combination with organ function indicators for early diagnosis and prognosis prediction in patients with severe trauma complicated with sepsis.METHODS:A retrospective analysis was conducted on 184 patients with multiple injuries who were admitted to the Emergency Medicine Department of the Second Affiliated Hospital of Zhejiang University Medical College between January 2019 and September 2020 and underwent HBP testing.Patients were classified according to the SEPSIS 3.0 diagnostic cri-teria into a sepsis group(n=89)and a non-sepsis group(n=95).Clinical outcomes were tracked,dividing patients into a deceased group(n=43)and a survival group(n=141).HBP levels were continuously measured,and the peak values of the two groups were compared to assess the efficacy of diagnosing sepsis.Further analysis on the correlation of HBP peak value median with clinical prognosis was conducted.The effectiveness of HBP alone and in combination with total biliru-bin(TBil)and white blood cell(WBC)count in prognosis assessment was evaluated.RESULTS:(1)No significant dif-ference was found in the peak level of HBP between the sepsis group(n=89)and the non-sepsis group(n=95)(71.7±68.6 vs 52.5±56.1,P=0.051).(2)Among the 184 patients,the peak level of HBP was positively correlated with WBC count(r=0.244,P<0.01)and TBil levels(r=0.241,P<0.01).(3)The area under curve(AUC)for independent diag-nosis of sepsis using TBil levels,WBC count,and PCT levels were 0.618,0.631,and 0.718,respectively,and the com-bined AUC was 0.684,with a diagnostic sensitivity of 60.7%and specificity of 71.6%(P<0.05).(4)Prognostic analy-sis of mortality showed that patients in the high HBP level group had a significantly higher mortality rate than those in the low-level group(30.4%vs 16.3%,P<0.05).The WBC count was also significantly higher in the deceased group than in the survival group(17.5±6.9 vs 12.8±4.7,P<0.01),especially in those with sepsis(P<0.01).The AUCs for predict-ing sepsis mortality prognosis using HBP peak level,TBil levels,WBC count,SOFA score,and APACHE-II score were 0.618,0.603,0.719,0.823,and 0.811,respectively.The combined AUC of HBP with TBil and WBC for assessing sepsis prognosis was 0.750,with a sensitivity of 74.4%and specificity of 74.5%,showing statistically significant differ-ences(P<0.05).(5)The combined assessment of these three indicators showed no statistically significant difference from artificial scoring systems in predicting sepsis prognosis(P>0.05).CONCLUSION:The combination of HBP,TBil,and WBC is highly effective in predicting the risk of sepsis in patients with multiple injuries and has significant clinical value in predicting the mortality risk of trauma patients with sepsis.