Objective To investigate the clinical and imaging characteristics of isolated pontine infarction as well as the influencing factors for early progressive motor deficits (PMD) and short-term prognosis.Methods A total of 86 patients with isolated pontine infarction who admitted in hospital within 24 hours of symptom onset were analyzed retrospectively.The patients were divided into paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI) according to the maximal diameter of the lesions and the locations of infarction.They were divided into either a PMD group or a non-PMD group according to the early status of PMD.They were also divided into a poor outcome group (mRS score ＞ 2) and a good outcome group (mRS score ≤ 2) according to the modified Rankin Scale (mRS) scores at discharge.The clinical and imaging features of the different patient groups were compared.Results The patients' constituent ratios of hyperlipidemia (57.14％ vs.33.33％;x2 =4.80,P=0.028),hemiplegia (97.14％ vs.72.55％;x2 =8.718,P=0.003),basilar artery stenosis (45.71％ vs.17.65％;x2=7.930,P=0.005) and poor outcome at discharge (54.29％ vs.31.37％ ; x2 =4.515,P =0.034),and the baseline National Institutes of Health Stroke Scale (NIHSS) scores (6.00 ± 2.39 vs.4.61 ± 3.41; t =2.087,P =0.040) in the PPI group (n =35) were significantly higher than those in the LPI group (n =51).The constituent ratios of the baseline diastolic blood pressure levels (97.82 ± 15.61 mm Hg vs.89.55 ± 12.23 mm Hg,1 mm Hg=0.133 kPa; t =2.258,P =0.031),PPI (63.64％ vs.32.81％ ;x2 =6.445,P =0.011) and basilar artery stenosis (59.10％ vs.18.75％ ;x2 =12.922,P =0.000) in the PMD group (n =22) were significantly higher than those in the non-PMD group (n =64).The baseline NIHSS scores (6.80 ± 2.63 vs.3.73 ± 2.55; t =5.426,P =0.000),fasting blood glucose levels (9.40 ±5.15 mmol/L vs.6.56 ±2.69 mmol/L; t =2.985,P=0.004) and the constituent ratios of PPI patients (54.29％ vs.31.37％ ;x2 =4.515,P =0.034) in the poor outcome group (n =35) were significantly higher than those in the good outcome group (n =51).Multivariate logistic regression analysis showed that basilar artery stenosis was an independent risk factor for the onset of PPI (odds ratio [OR] 3.801,95％ confidence interval [CI] 1.357-10.646; P =0.011) and the early PMD of isolated pontine infarction (OR 4.571,95％ CI 1.214-17.214; P=0.025).The baseline NIHSS score ≥ 5 was its independent predictor for poor outcome (OR 4.277,95％ OR 1.505-12.151; P =0.006).Conelusions PPI is mainly associated with the lesions in the branches of basilar artery.The baseline NIHSS score ≥ 5 may be an independent predictor for short-term poor outcome of isolated pontine infarction.Its early PMD and short-term poor outcome may be associated with the basilar artery lesions.

Objective:To explore the association of miRNA-146a (miR-146a), miRNA-196a2 (miR-196a2), and miRNA-499 (miR-499) single nucleotide polymorphisms with genetic susceptibility in hepatocellular carcinoma.Methods:A case-control study was designed. A total of 175 patients (hepatocellular carcinoma group) in Affiliated Hospital of Yangzhou University from April 2015 to March 2019 and 302 healthy people undergoing physical examination during the same period (the control group) were selected. The genotype distribution of miR-146a, miR-196a2 and miR-499 in the peripheral blood of the two groups were detected by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Logistic regression model was used to analyze the association of 3 genotypes of miRNA, genotypes of hepatitis virus infectors with genetic susceptibility in hepatocellular carcinoma. The relationship between miR-146a gene polymorphism and demography factor as well as the clinical characteristics was also analyzed by using Spearman correlation analysis.Results:In hepatocellular carcinoma group, miR-146a single nucleotide polymorphism of CC, CG, GG site genotypes had 52 (29.7%) cases, 86 (49.1%) cases, 37 (21.1%) cases, respectively; in the control group, the corresponding genotypes had 137 (45.4%) cases, 135 (44.7%) cases and 30 (9.9%) cases, respectively, and the difference in genotype distribution of both groups was statistically significant ( χ2 = 17.23, P < 0.05). There were no statistical differences in genotype distribution of miR-196a2 and miR-499 ( χ2 = 0.51, P = 0.776; χ2 = 0.05, P = 0.976). Single factor logistic regression analysis showed that in the co-dominant model of miR-146a genotype, genotypes of CG ( OR = 1.96, 95% CI 1.13-3.41, P = 0.017) and GG ( OR = 3.30, 95% CI 1.85-5.89, P<0.01) had elevated risk of hepatocellular carcinoma compared with CC genotype. In the dominant model, the risk of hepatocellular carcinoma in CG+GG genotypes was increased compared with that in CC genotype ( OR=1.97, 95% CI 1.33-2.93, P = 0.001); in the recessive model, the risk of hepatocellular carcinoma in GG genotype was increased compared with that in CG+ GG genotype ( OR=2.43, 95% CI 1.44-4.11, P = 0.001). Single factor logistic regression analysis showed that there was no significant difference in the risk of hepatocellular carcinoma in the co-dominant, dominant and recessive models between miR-196a2 and miR-499 genotypes (all P > 0.05). For hepatocellular carcinoma patients with positive hepatitis B virus (HBV), CG genotype had a 2.02-fold (95% CI 1.06-5.07) risk of hepatocellular carcinoma compared with CC genotype, and GG genotype had a 3.12-fold (95% CI 1.66-10.07) risk of hepatocellular carcinoma compared with CC genotype; CG+GG genotype had a 1.91-fold (95% CI 1.85-3.38) compared with CC genotype, GG genotype had a 1.54-fold (95% CI 1.15-6.08) compared with CG+GG genotype. The increasing risk of hepatocellular carcinoma by miR-146a gene polymorphisms was not found in hepatocellular carcinoma patients with hepatitis C virus (HCV) infection or without HBV and HCV infection. Spearman correlation analysis showed that miR-146a gene polymorphisms was not related with age, gender, smoking, drinking, family history of cancer, alanine transaminase and aspartate aminotransferase (all P>0.05). Conclusions:GG and CG genotypes of miR-146a increase the risk of genetic susceptibility in hepatocellular carcinoma, especially for patients with HBV infection. miR-196a2 and miR-499 single nucleotide polymorphisms don't increase the risk of hepatocellular carcinoma.

Objective To observe therapeutic effects of intravesical instillation of mitomycin C (MMC) immediately after TUR added with low dose BCG maintenance therapy to prevent recurrence of superficial bladder cancer. Methods 83 patients with superficial bladder cancer were randomly divided into two groups, 50 cases were managed with intravesical instillation of mitomycin C immediately after TUR added with low dose BCG maintenance therapy (group A), 33 cases were treated with traditional method of MMC therapy (group B) to prevent recurrence of superficial bladder cancer. Results After 12-66 months (mean 32 months) following up, 3 patients had tumor recurrence in the group A and 7 patients in the group B, the rate of tumor recurrence of the group A was 6.0% (3/50) and that of the group B was 21.2%(7/33), and there was a significantly difference between two groups (P<0.05). Side effects of the group B were obviously more than that of the group A. Conclusion Intravesical instillation of MMC immediately after TUR added with low dose BCG maintenance therapy is effective to prevent patients with superficial bladder cancer from recurrence.

Objective To measure and analyze the staffing standards of family doctor interdisciplinary team by means of the WHO workload indicator of staffing need (WISN)method,for reference of the government in building family doctor interdisciplinary teams.Methods 150 community health centers in 16 provinces were selected.The related data from 150 centers were collected to analyze the population served by each family doctor,and the staffing standards of family doctor interdisciplinary team by means of the WHO workload indicator of staffing need(WISN)method.Results There were 10 721 community health professionals in the sample centers which provide 132.14 million standard equivalents of service to the public.1 9 6 1 6 community health professionals were needed to ensure the quality of service and no extra workload after work for professionals.Averagely,each family doctor can serve 1 558 residents,who needs 1.3~1.5 nurses or public health workers.Conclusions A huge gap was found for community health professionals.The population served by each family doctor should be lowered compared to the governmental requirement and more nurses should be introduced to the family doctor interdisciplinary team.

The most important harms of atrial fibrilation are stroke and the embolic events of the systemic circulation. The latest data have show n that the etiology of up to 1/3 of stroke patients w as atrial fibrilation. The stroke morbidity and mortality caused by atrial fibrilation are higher than other types of stroke. So the prevention of stroke is very important for patients with atrial fibrilation. The anticoagulant therapy is the core strategy for stroke prevention in patients with atrial fibrilation. This article reviews the advances in research on the safety and compliance of anticoagulation therapy in patients w ith atrial fibrilation.

Objective To investigate the correlation between hemorrhagic transformation (HT) and each parameter of blood pressure variability (BPV) in patients with massive cerebral infarction caused by cardioembolic middle cerebral artery occlusion. Methods The patients with massive cerebral infarction caused by unilateral cardioembolic middle cerebral artery occlusion admitted to hospital within 24 h after onset were selected. For patients without revealing HT with head MRI on admission were analyzed retrospectively. According to the results of MRI rescan within 7 days after onset, they were divided into either a HT group or a non-HT group. Al specific parameters of blood pressure were compared and analyzed between the 2 groups, specificaly including initial value (initial), mean value ( mean), maximum value (max), minimum value (min), maximum-minimum difference (max-min), standard deviation (sd), successive variation (sv), and maximum value of sv (svmax) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results A total of 146 patients were enroled in the analysis, and 77 (52. 7% ) had HT within 7 d after onset. Al the blood pressure parameters were grouped by quartiles. Multivariate logistic regression analysis showed that after adjusting for age, admission time, baseline National Institutes of Health Stroke Scale score, congestive heart failure, antiplatelet therapy, initial blood glucose, prothrombin time, and international normalized ratio of the patients, SBPmin , SBPmax-min , SBPsv , SBPsvmax , DBPinitial, DBPsd , DBPmax , DBPmax-min , DBPsv , and DBPsvmax had significant independent association with and HT (likelihood ratio test of trend, al P < 0. 05). Conclusions Higher BP level and variability may increase the risk of HT in patients with massive cerebral infarction after cardioembolic middle cerebral artery occlusion. A smooth and slow antihypertensive treatment may need for these patients.

Objective To evaluate the impact of lower renal calyceal anatomic structure on flexible fibreoptic ureteroscopy with holmium laserin treatment of calyceal calculi.Methods From January 2007 to December 2011,a total of 60 patients with a lower calyceal renal stone were enrolled in this study.The mean age was 51 years (range 23 to 78 years).The mean height was 169.8 cm,and mean body mass was 71.2 kg.Intravenous urogram (IVU) was performed on all patients and the lower pole anatomy (including infundibulopelvic angle,length of the inferior caliceal infundibulum and infundibular width) were measured in these patients.The correlation between lower pole anatomy and the success of flexible fibreoptic ureteroscopy with holmium laser for calyceal calculi was analyzed.Results Of the 60 patients,42 patients were successful in stone clearance.The patients in the stone-free group age of (50.1 ± 14.6) years,height (169.8 ±5.1) cm,body mass (71.4 ±5.1) kg,the maximum stone size in diameter (10.9 ±2.1) mm,stone burden (85.4 ± 9.5) mm2,lower infundibular length (36.3 ± 3.7) mm and lower infundibular width (4.9 ±1.4) mm; the other 18 patients age (50.7 ± 11.7) years,height (169.9 ±6.4) cm,body mass (71.6±4.7) kg,the maximum stone size in diameter (11.3 ±2.4) mm,stone burden (82.5 ±8.6)mm2,lower infundibular length (37.2 ± 2.3) mm and lower infundibular width (4.8 ± 1.9) mm.There was no difference between the stone-free group and the residual group in all above parameters (P ＞ 0.05).However,the infundibulopelvic angle in the stone-free group was significantly greater than that in the residual group (63.4 ± 23.2 vs 45.32 ± 17.6,P ＜ 0.05).x2 test showed the stone clearance rate in patients with angle ≥45 was better than that in those with angle ＜45 (84.6％ vs 42.7％,P ＜0.05).If grouped by infundibulopelvic angle,patients with infundibulopelvic angle greater than 90°had stone clearance rate 92.3％ (12/13),those with angle ranged from 30° to 90° had 73.2％ (30/41),and those with infundibulopelvic angle smaller than 30° had 0％ (0/6).Logistic regression analysis showed that the angle was a significant independent predictor of stone clearance (OR =1.12,P ＜ 0.05).Conclusions The infundibulopelvic angle has adverse influences on the performances of flexible ureteroscopy.The samller the angle is,the poorer the performances of flexible ureteroscopy is.

Objective: To build up rabbit models of hepatic cirrhosis in through common bile duct partial ligation (CBDPL). Methods: Male New Zealand rabbits were subjected to CBDPL to induce hepatic cirrhosis. The liver biopsies were performed during the surgery and after sacrifice to evaluate hepatic fibrosis. The serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), total protein (TP) and albumin (ALB) were determined at week 0, 1, 2, 4 and 11 following the occlusion. Results: There were two kinds of morphological and histological manifestations after CBDPL, the one was inconspicuous hepatic fibrosis coexisted with sacculation-like bile ductal dilation and muddy stone; the other is remarkable hepatic fibrosis and cirrhosis along with uneven bile ductal dilation. The serum levels of ALT, AST, TBIL and DBIL were significantly higher after one week of operation. The levels of ALT, AST, TP and ALB decreased after two-week of operation, and the levels of TBIL and DBIL were returned to the normal level after two-week of operation. Conclusion: The animal models of hepatic cirrhosis can be built up through CBDPL in rabbits.

Objective To study a histopathological classification system for hippocampal cell loss in patients suffering from mesial temporal lobe epilepsy.Methods Fifty-one surgically resected specimens were microscopically examined with respect to neuronal cell loss in hippocampal subfields CA1—CA4.Clinical data including age at first seizure,with or without initial precipitating injuries (IPIs),latecy,epilepsy duration,Engel score of half and one year after surgery were collected to analyse the clinical characteristics between different pathological types.Eight additional hippocampal specimens obtained from neurologically healthy autopsies served as controls.Results (1)Five distinct patterns were recognized within a consecutive cohort of anatomically well-preserved surgical specimens.Type 1 a (21/51,41.18 ％):severe cell loss in CA1 and moderate neuronal loss in all other subfields excluding CA2; Type 1b(18/51,35.2％):severe cell loss in all sectors; Type 2(9/51,17.65％):severe neuronal loss restricted to sector CA1 ;Type 3 (1/51,1.96％):severe neuronal loss restricted to the hilar region; no mesial temporal sclerosis (2/51,3.92％):a group comprised hippocampi with neuronal cell densities not significantly different from age matched autopsy controls.(2)The patients of type 1 a and 1 b had younger age of first onset,longer latency and duration,more frequency of IPIs,the proportion of ourrence of febrile seizures in type 1a was 10/19,type 1b was 7/16,type 2 was 4/7,type 3 was 0 (x2 =11.790,P =0.019).(3) The patients of type 1a and 1 b had better postsurgical outcome.Conclusion Type 1 is the most common type of mesial temporal sclerosis,which have better postsurgical outcome than the other 3 types.

Objective To investigate the impact of early enteral nutrition on the nutritional status and complications of patients with advanced esophageal carcinomas.Methods Sixty-five patients with advanced esophageal carcinomas were randomly divided into the enteral nutrition group group (n =33) and the control group (n =32).The two groups were given enteral nutrition support and normal nasogastric feeding diet respectively in 24-72 h after hospitalization.The two groups were tested with nutrition indicators:body Mass Index (BMI)/brachial triceps skinfold thickness/upper arm circumference measurement,fasting blood glucose/serum total protein/albumin/cholesterol/triglyceride and the liver function (alanine aminotransferase (ALT)/aspartate aminotransferase(AST)/total bilirubin (TBiL)),and were observed the incidences of complications with liver/intestinal and infection diseases.Results After one month's treatment,compared with the control group,there was significant statistical difference between the two group in patients' nutritional status (BMI index:(22.1 ±4.5) kg/m2 vs.(19.2±4.3) kg/m2; skinfold thickness:(6.2 ±0.4) mm vs.(5.1 ±0.4)mm ; upper arm circumference:(22.8 ± 3.0) cm vs.(20.4 ± 3.2) cm ; serum total protein:(49.2 ± 10.1) g/L vs.(45.1 ± 9.9) g/L; Albumin:(35.5 ± 5.8) g/L vs.(30.6 ± 6.1) g/L; Cholesterol:(5.0 ± 0.6) mmol/L)vs.(4.3 ± 0.7) mmol/L)),the liver function(ALT:(36.0 ± 4.7) U/L vs.(61.5 ± 9.9) U/L; AST:(29.6 ±6.7) U/Lvs.(88.9±10.6) U/L;TBiL:(17.7±3.8) μmol/Lvs.(31.6 ±9.4) μmol/L) (t=2.624,2.036,2.220,2.256,4.155,2.207,2.349,2.476,2.280 respectively,P ＜ 0.05 for all),and the incidence of diarrhea (12％ (4/33) vs.34％ (11/32)) and infection (15％ (5/33) vs.41％ (13/32)) (x2 =2.501,2.193 respectively;P ＜0.05).No statistical difference was observed between the two groups on the levels of serum glucose and triglycerides,and the incidences of complications like bloating/constipation/reflux (P ＞ 0.05).Conclusion The early enteral nutrition could improve the nutritional status of patients with advanced esophageal carcinomas effectively,and reduce the incidence of liver injury,diarrhea and infection.