Objective To ecaluatc the diagnostic value of digital subtraction angiography (DSA) and carotid artery ultrasound for transient ischemia attack (TIA). Methods Among the 74 patients with TIA, 45 had internal carotid artery (ICA)-TIA and 29 had vertebrobasilar artery (VBA)-TIA. DSA examination was performed in order to detect intracranial and extracranial arterial stenosis in the above two systems. Cervical artery ultrasound examination was used to understand the distribution of arterial plaques. Results DSA shoved that the detection rate of vascular stenosis in patients with ICA-TIA was 84. 4% (n = 38),and the patients with serious, moderate and slight stenoses were 31.1% (n = 14), 26. 7% (n = 12) and 11.1% (n =5), respectively. Of those, intracranial arterial stenosis was 44.4% (n =20), and it was significantly higher than 22.2%(n = 10) in extracranial arterial stenosis (P ＜0. 001 ); the detection rate of vascular stenosis in patients with VBA-TIA was 65.5% (n = 19), and the patients with serious, moderate and slight stcnoscs were 17. 2% (n = 5), 27. 5% (n = 8), and 20. 7% (n = 6), respcctivegly. Of those, cxtracranial arterial stenosis was 44.8% (n = 13), and it was significantly higher than 13.8% (n = 4) in intracranial stenosis (P ＜ 0. 001 ). Carotid artery ultrasound shoved that the detection rate of ICA plaque was 44.4% (n = 20), and it was higher than 24, 1% (n =7) in patients with VBA-TIA; the detection rate of the plaques in the initial segment of subclavian artery in patients with VBA-TIA was 44. 8% (n = 13), and it was significantly higher than 13.3% (n = 6) in patients with ICA-TIA (P ＜ 0.001 ). Conclusions There were differences between the intracranial and extracranial vascular lesions and the distribution of atherosclerotic plaques in patients with ICA-TIA and VBA-TIA. 1he former was more common in intracranial lesions, and the latter was more common in extracranial lesions.

Objective: To study the effects of Ruanmailing Oral Liquid, a compound traditional Chinese herbal medicine, on spatial learning and memory ability and expression of apurinic/apyrimidinic endonuclease/redox factor-1 (APE/Ref-1) in hippocampal CA1 region in rats with experimental vascular dementia (VaD). Methods: VaD was induced in rats by permanent occlusion of bilateral common carotid arteries. Forty-five VaD rats were randomly divided into untreated group, nimodipine group, low-dose Ruanmailing group and high-dose Ruanmailing group. Another 15 rats underwent a sham operation consisting of similar skin incision and manipulation but without occlusion of carotid arteries. From the next day after occlusion, the rats were intragastrically administered with normal saline, nimodipine suspension or Ruanmailing Oral Liquid respectively for 30 days. Morris water maze experiment was adopted to test learning and memory of rats in each group. Expression of APE/Ref-1 protein in the hippocampal CA1 region was measured by immunohistochemical method. Results: Escape latency was significantly shortened and number of entries in the target area of rats was significantly increased in the high-dose Ruanmailing group as compared with those in the untreated group (P<0.01). Compared with the untreated group, count of APE/Ref-1 positive cells was significantly increased in the hippocampal CA1 region in the high- and low-dose Ruanmailing groups (P<0.01). Compared with the low-dose group and the nimodipine group, the count of APE/Ref-1 positive cells was remarkably increased in the hippocampal CA1 region in rats of the high-dose Ruanmailing group (P<0.01). There was no statistical difference between the low-dose Ruanmailing group and the nimodipine group. Conclusion: Ruanmailing Oral Liquid can improve the learning and memory ability and enhance the lowered expression level of APE/Ref-1 in the hippocampal CA1 region of rats with VaD.

Objective:To describe the epidemiological characteristics of mental disorders in Ximeng Wa Au-tonomous County and explore psychosocial risk factors of mental disorders. Methods:Two thousand three hundred and eighty one residents aged 1 8 years and over were sampled using multistage sampling in Ximeng Wa Autono-mous County in 2013. All respondents were investigated by face-to-face interview. Mental disorders were screened out by using the General Health Questionnaire (GHQ)and diagnosed according to the International Classification of Diseases Checklist (ICD-10-Checklist)criteria. Results:Life time prevalence of any mental disorder was 19. 86%(419/2110). The lifetime prevalence rates of substance use disorder,anxiety disorder,insomnia,mood disorder, schizophrenia were 12. 99%(274/2110),6. 30%(133/2110),2. 94%(62/2110),2. 32%(49/2110)and 1. 00%(21/2110)respectively. Male (OR=0. 43),older age (35 -49 years,OR=1. 78;50 -64 years,OR=2. 59;≥65 years,OR=3. 5 1 ),unmarried and other marital status (OR=0. 3 1 ),non-Wa and non-Lahu ethnic groups (OR=0. 29)were associated with neurotic,stress-related and somatoform disorders. Male (OR=2. 41),older age (35 -49 years,OR=2. 29;50-64 years,OR=3. 20;≥65 years,OR=4. 58),non-farmer and non-self-employed occupation (OR=0. 41),and non-Wa and non-Lahu ethnic groups (OR=0. 32)were associated with psychoactive substance use disorder. Male (OR =0. 35 ) and order age (≥65 years,OR =3. 05 ) were associated with mood disorders. Conclusion:Lifetime prevalence of any mental disorder,substance use disorders and anxiety disorders are high in Ximeng Wa Autonomous County. Measures should be strengthened against prevalence of mental disorders in ethnic minority areas.

OBJECTIVETo study the chemical constituents in the rhizoma of Iris dichotoma.

METHODThe chemical constituents were isolated by various column chromatographic methods. The structures of the compounds were elucidated on the basis of physiochemical properties and spectral analysis.

RESULTEleven compounds, hispidulin (1), rhamnocitrin (2), iristectorigenin A (3), 4', 5, 7, 8-tetrahydroxy-6-methoxy isoflavone (4), 6-hydroxybiochanin A (5), iristectorin B (6), iristectorigenin A (7), kaempferol-7-methyl ether (8), tamarixetin-7-glucoside (9), iristectorin A (10), 3', 3, 5-trihydroxy-4', 7-dimethoxy-flavone-3-O-beta-D-galactopyranoside (11) were isolated and identified.

CONCLUSIONCompounds 1-11 were obtained from this plant for the first time.

Objective To investigate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke (CES) due to atrial fibrillation.Methods Patients with CES admitted to Nanjing First Hospital from January 2015 to September 2017 were enrolled retrospectively.They were divided into the thrombectomy group and the intravenous thrombolysis alone group.The baseline data,the National Institutes of Health Stroke Scale (NIHSS) score at 24 h after treatment,rates of good outcome (defined as the modified Rankin Scale score 0-2) at 90 d after onset,hemorrhagic transformation and death between the two groups were compared.Multivariate logistic regression analysis was used to determine the independent factors for the outcomes in patients with CES.Results A total of 117 patients with CES were enrolket,inchding 65 (55.6％) in the thrombectomy group and 52 (44.4％) in the intravenous thrombolysis alone group.Sixty-two patients (53.0％) had good outcome and 55 (47.0％) had poor outcome.The proportion of patients whose NIHSS score decreased ＞ 4 within 24 h after treatment (58.4％ vs.26.9％;x2 =6.254,P =0.007),rates of good recanalization (78.5％ vs.57.7％;x2 =5.850,P =0.016),and good outcome at 90 d (63.1％vs.40.4％;x2 =5.972,P=0.015) in the thrombectomy group were significantly higher than those in the intravenous thrombolysis alone group,while there were no significant differences in the incidences of hemorrhagic transformation,symptomatic intracerebral hemorrhage and gastrointestinal bleeding,as well as mortality at 90 d.Multivariate logistic regression analysis showed that good recanalization (odds ratio [OR] 0.371,95％ confidence interval [CI]0.157-0.876;P =0.024) and thrombectomy (OR 0.398,95％ CI 0.179-0.883;P =0.024) were the independent factors for good outcome,while diabetes (OR 6.572,95％ CI 1.684-25.641;P =0.007) was the independent factor for poor outcome.Conclusion The efficacy of mechanical thrombectomy for patients with CES due to atrial fibrillation is superior to intravenous thrombolysis alone,and it dose not increase the mortality and complications.Good recanalization and mechanical thrombectomy are the independent factors for good outcome,while diabetes is an independent factor for poor outcome in patients with CES due to atrial fibrillation.

Objective:To investigate the safety of the use of the intermediate catheter in the endovascular treatment (EVT) of patients with acute anterior circulation large vessel occlusive stroke and its impact on the outcomes.Methods:From May 2015 to September 2018, patients with anterior circulation large vessel occlusive stroke received EVT in Nanjing First Hospital, Nanjing Medical University were enrolled retrospectively. According to whether intermediate catheter was used during the procedure, they were divided into intermediate catheter group and non-intermediate catheter group. The demographics, clinical data and procedure related information were collected. The outcome evaluation indicators included secondary embolization, symptomatic intracranial hemorrhage, clinical outcome and death at 90 d after onset. A good outcome was defined as the modified Rankin Scale score of 0-2. Multivariate logistic regression analysis was used to determine the independent predictor of clinical outcome. Results:A total of 195 patients with anterior circulation large artery occlusive stroke received EVT were enrolled, including 161 in the intermediate catheter group and 34 in the non-intermediate catheter group. There were no significant differences in demographics and clinical characteristics between the intermediate catheter group and the non-intermediate catheter group. In terms of procedure related information, the number of mechanical thrombectomy passes in the intermediate catheter group was significantly decreased (2 [1-3] times vs. 2.5 [1.75-4] times; Z=2.218, P=0.017), the recanalization rate of one-pass thrombectomy was significantly higher (38.5% vs. 20.6%; χ2=3.943, P=0.047), and the rate of thrombus escape and secondary embolism was significantly lower (19.3% vs. 35.3%; χ2=4.202, P=0.041). In terms of clinical outcome, there were no significant differences in the incidence of symptomatic intracranial hemorrhage, mortality and good outcome at 90 d between the intermediate catheter group and the non-intermediate catheter group. Multivariate logistic regression analysis showed that the use of intermediate catheter was an independent predictor of good outcome at 90 d (odds ratio 0.430, 95% confidence interval 0.196-0.947; P=0.036). Conclusion:In EVT of patients with acute anterior circulation large vessel occlusive stroke, the use of intermediate catheter can reduce the number of mechanical thrombectomy passes, improve recanalization rate of one-pass thrombectomy, reduce the rate of thrombus escape and second embolization, and then improve the outcome of patients.

Objective:To investigate the predictive value of serum hypersensitive C-reactive protein (hs-CRP) for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) who received intravenous thrombolysis.Methods:From May 2015 to April 2017, the clinical data of the patients with AIS treated with intravenous thrombolysis in Nanjing First Hospital were collected retrospectively. Multivariate logistic regression analysis was used to determine the independent risk factors for SAP in patients with AIS after intravenous thrombolysis. Receiver operating characteristic (ROC) curve and nomogram-based methods were used to analyze the predictive value of hs-CRP for SAP. Results:A total of 243 patients with AIS who received intravenous thrombolysis were included, and 63 (34.6%) of them had SAP. There were significant differences in age ( P=0.006), leukocyte count ( P=0.044), fasting blood glucose level ( P=0.003), serum hs-CRP level ( P=0.001), hs-CRP classification ( P=0.001) and dysphagia rate ( P=0.035) between the SAP group and non-SAP group. Multivariate logistic regression analysis showed that after adjusting for the confounding factors, taking the first quartile of serum hs-CRP level as a reference, the third quantile (odds ratio [ OR] 18.790, 95% confidence interval [ CI] 4.771-74.007; P=0.001) and the fourth quantile ( OR 54.054, 95% CI 12.248-324.088; P=0.001) of hs-CRP were the independent predictors of SAP. The area under the ROC curve of the baseline serum hs-CRP level for predicting SAP was 0.805 (95% CI 0.742-0.868; P<0.001). When the optimal cut-off value of hs-CRP was 5.54 mg/L, the sensitivity and specificity of predicting SAP were 76.11% and 76.19%, respectively. The analysis of nomogram also showed that hs-CRP was an independent predictor of SAP (consistency index 0.862, 95% CI 0.738-0.986; P<0.001). Conclusions:The increased serum hs-CRP was an independent predictor of SAP in patients with AIS receiving intravenous thrombolysis, and had a higher predictive value.

Objective:To compare the effects of intensive and standard blood pressure control on the outcomes of patients with acute ischemic stroke in the anterior circulation who have successfully recanalized after endovascular therapy (EVT).Methods:A multicenter, open-label, blinded-endpoint, randomized controlled design was used. Patients with anterior circulation stroke received EVT and successfully recanalized in Nanjing First Hospital, Nanjing Medical University and several branch hospitals from July 2020 to October 2022 were prospectively included. They were randomly divided into the intensive blood pressure control group (target systolic blood pressure [SBP] 100-120 mmHg) or the standard blood pressure control group (target SBP 121-140 mmHg). The blood pressure of both groups needs to achieve the target within 1 h and maintain for 72 h. The primary outcome endpoint was outcome at 90 d, and the good outcome was defined as a score of 0-2 on the modified Rankin Scale. Secondary outcome endpoints included early neurological improvement, symptomatic intracranial hemorrhage (sICH) within 24 h, and death and serious adverse events within 90 d.Results:A total of 120 patients were included, including 63 in the intensive blood pressure control group and 57 in the standard blood pressure control group. There was no statistically significant difference in baseline characteristics between the two groups. The SBP at 72 h after procedure was 122.7±8.1 mmHg in the intensive blood pressure control group and 130.2±7.4 mmHg in the standard blood pressure control group, respectively. There were no significantly differences in the good outcome rate (54.0% vs. 54.4%; χ2=0.002, P=0.963), the early neurological improvement rate (45.2% vs. 34.5%; χ2=1.367, P=0.242), the incidence of sICH (6.3% vs. 3.5%; P=0.682), mortality (7.9% vs. 14.0%; χ2=1.152, P=0.283) and the incidence of serious adverse events (12.7% vs. 15.8%; χ2=0.235, P=0.628) at 90 d between the intensive blood pressure control group and the standard blood pressure control group. Conclusion:In patients with anterior circulation stroke and successful revascularization of EVT, early intensive blood pressure control don’t improve clinical outcomes and reduce the incidence of sICH.