Objective To investigate the incidence of white matter lesions(WML) in acute ischemic stroke ,and to analyze its the risk factors .Methods Totally 248 cases of acute ischemic stroke patients were selected ,patients′general information were in‐vestigated ,the WML severity with Fazekas rating scale were evaluated and patients were divided into severe group and no severe group according to the results ,the differences of general information between two groups were compared ,the severe WML was set as dependent variable ,the risk factors were ananlzed by multiariable Logistic regression analysis .Results There were 106 cases se‐vere WML patients among 248 cases acute ischemic stroke ,the incidence was 42 .74% ;single factor analysis found that the age in severe group was significantly higher than non severe group ,the incidence of hypertension ,diabetes in severe group was significantly higher than non severe group ,the difference was statistical significance (P<0 .05);multiariable Logistic regression analysis showed that age (OR=4 .116 ,95% CI:1 .816-6 .454 ,P=0 .000) ,hypertension (OR=1 .462 ,95% CI:0 .842-1 .946 ,P=0 .026) and dia‐betes (OR=1 .157 ,95% CI:0 .698-1 .673 ,P=0 .038)were the independent risk factors of severe WML in acute ischemic stroke . Conclusion The incidence of severe WML in acute ischemic stroke patients is high ,we need to targeted prevention measures on ol‐der age ,hypertension ,diabetes mellitus patients to reduce severe WM L occurred .

Objective To investigate the efficacy of dexmedetomidine on anesthesia analgesia and postopera-tive cognitive dysfunction (POCD)in elderly patients with lumbar surgery.Methods Ninety elderly patients with lumbar surgery were randomly divided into dexmedetomidine group (A group with 46 cases)and control group (B group with 44 cases)by the random number table method.A group received load dosage (1μg/kg)dexmedetomidine before anesthesia induction,and this process must last for more than 10 minutes,then the dexmedetomidine was main-tained at a speed of 0.5μg/(kg·h)during the operation.B group were given the same dosage normal saline in the same way instead.The amount of intraoperative sedation drugs was observed and analyzed in the two groups.MMSE was measured at one day before surgery and seven days after surgery.And,the incidence rate of POCD was compared between the two groups.Results The dosage of intraoperative sedation drugs of fentanyl[(0.57 ±0.11 )mg vs (0.78 ±0.13)mg;t =8.286,P =0.000],propofol[(522.5 ±137.2)mg vs (734.2 ±175.8)mg;t =6.384,P =0.000]and remifentanil[(0.92 ±0.26)mg vs (1.38 ±0.73)mg;t =3.947,P =0.000]in A group were significantly lower than those of group B.After treatment for 7 days,the MMSE score in A group[(27.57 ±1.58)points]was higher than that of B group[(25.02 ±2.14)points](t =6.451,P =0.000).The incidence rate of POCD in A group (6.52%)was significantly lower than that of B group (22.73%),and the difference was statistically significant (χ2 =4.779,P =0.028).Conclusion In elderly patients with lumbar surgery,the dexmedetomidine can cut down the dosage of intraoperative sedation drugs,and it also could reduce the incidence of POCD.

Objective To establish a novel method for detecting circulating tumor cells (CTCs) in phripheral blood of lung cancer patients with high sensitivity and specificity.Methods Experimental study.42 cases of initial treatment patient who underwent resection and diagnosed to be non-small cell lung cancer by biopsy were studied,including 7 patients at stage Ⅰ,9 patients at stage Ⅱ,16 patients at stage Ⅲ and 10 patients at stage Ⅳ.As a control group,20 cases of healthy volunteers were selected.A series of experiments was conducted to determine the efficiency of tumor cells isolation,in which varied concentration (50,100,200,500,1000 cells) of A549 cells spiked into 2 ml peripheral blood drawn from healthy donors.The blood was removed of unwanted erythrocytes by lysis buffer,and made the rest of nucleated cells incubate with anti-EpCAM magnetic beads,then separated and enriched by a specific detector.All epithelia cells were retained on a slide because of a magnetic force and identified by H&E staining protocol.On the basis of cell recovery rate we calculated the sensitivity of tumor cells isolation.20 blood samples taken from healthy individuals were also detected to validate the specificity of this method.Samples of 42 patients with lung cancer were assayed for CTCs detection by above method.The correction of CTCs quantity with the patients' clinical features,for example,ages,gender,clinical stage,tumor size was analyzed in lung cancer patients by chi-square statistics.The correction of recovery cells with the spiked cells were assayed by linear correlation.Results The recovery rate was ranging from 68％ to 82％ by spiking varying numbers of A549 lung cancer cells into 2ml blood samples of healthy volunteers.Regression analysis of number of recovered vs.spiked A549 cells yielded a regression equation of Y =0.6419X + 8.8875.The number of CTCs detected has signification correlate with the cells spiked (R2 =0.9916,P ＜ 0.05),Eighteen of the 42 patients (43％) were found have CTCs in peripheral blood.The detection rate of lung cancer cells was 0 at stage Ⅰ,the detection rate of lung cancer cells was 11.1％ at stage Ⅱ,the detection rate of lung cancer cells was 62.5％ at stage Ⅲ and the detection rate of lung cancer cells was 70％ at stage Ⅳ.The positive rate of CTCs has no signification correlate with ages and gender of patients and tumor size (P ＞ 0.05),has signification with the clinical stage (P ＜ 0.05).None of the peripheral blood samples of the 20 healthy subjects analyzed was found to have CTCs.Conclusions This novel immunomagnetic separation technology is a sensitive and specific method,which provides a new tool allowing for feasible and specific detection of CTCs in lung cancer patients.The level of CTCs increases with the clinical stage and tumor size increased,which has important value to discover the early stage micrometastasis and redefine the clinical stage.But further multicenter and large sample clinical research are needed to confirm its clinical value.

Objective: To try to find out the morbidity of elderly chronic pulmonary disease's malnutrition by means of MNA and analyze the consistency between traditionalindex and MNA score. Methods: According to the score of MNA,we divided the 143 elderly pulmonary disease patients into three groups: A group(malnutrition); B group(malnutrition risk);C group(well nourished).The records included anthropometry,biochemical markers,dietary intake as well as the occurrence rate of pneumonia and respiratory failure. Results: There were marked differences on anthropometry,biochemical markers,dietary intake and the occurrence rate of pneumonia and respiratory failure among three groups. And the dietary intake of all three groups did not reach the standard of normal people. Conclusion: MNA is a good method that can be used to evaluate the nutritional state in elderly pulmonary disease patients.

The corn germ protein tested was a by-product from, corn starch plant and it contained more lysine (average 5.7%) and a relatively ideal proportion of eight essential amino acids similar to the 1973 FAO/WHO provisional amino acid pattern. A 5-week rat growth experiment was conducted to evaluate the nutritive value of corn germ protein by using body weight gain, nitrogen balance and apparent net protein utilization as assessment criteria.The feed of the experimental group was made of wheat protein supplemented with 17.3% germ protein and that of the control with 2.4% wheat glu- ten to made the final protein level of both feeds equivalent to 10%.These results showed that the body weight gain of rat in the experimental group was higher than that of the control group regardless of female or male, the body weight gain per 100g feed consumed in two groups of female was 19.0g and 12.2g and that of male was 17.6g and 10.4g respectively (p

Objective To explore the clinical effect of ultrasound-guided ilioinguinal/iliohypo-gastric nerve blocks marked by arteriae circumflexa ilium profunda in elderly hernia surgery. Methods Forty ASA Ⅰ-Ⅲ grade patients (33 males and 7 females)of 65-90 years old scheduled for elective hernia surgery were randomly divided into two groups (n =20).In group T,patients received ilioinguinal/iliohypogastric nerve blocks bytraditional anatomical positioning;in group V,patients re-ceived ultrasound-guided ilioinguinal/iliohypogastric nerve blocks marked by arteriae circumflexa ilium profunda.The comparison was made between the two groups in term of onset time of anesthe-sia,VAS score of intraoperative and postoperative 6 h.Anesthesia satisfaction,incidence of uros-chesis,misplacement local anesthetics into blood-vessels were recorded.Results The onset time of anesthesia in group V was significantly shorter than that in group T [(6.1 ± 1.8)min vs (12.1 ± 2.0)min,P <0.05].The VAS score of intraoperative in group T was significantly higher than that of group V [(4.5 ± 1.1 )scores vs (2.1 ± 0.9 )scores,P < 0.05 ].The anesthesia satisfaction of group V was higher than that of group T (P <0.05).There was one misplacement local anesthetics into blood-vessels in group T.Conclusion Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks marked by arteriae circumflexa ilium profunda can provide safe,effective and reliable anesthesia in elderly hernia surgery.

Clinical data of 65 patients with acute cerebral infarction (frontal or temporal or both lobes) treated in our hospital during 2015-2016 were retrospectively reviewed.The patients were followed up for 6 months,34 cases were diagnosed as vascular dementia (VD) according to ICD-10 (VD group) and 31 cases were diagnosed as simple cerebral infarction (control group).The abnormal rate of electroencephalograph (EEG) at baseline in VD group was significantly higher than that in control group (x2 =5.44,P =0.02).Compared to control group,the powers of slow wave (θ wave and δ wave) at baseline,third month and sixth month in VD group were significantly increased (Fbet groups =17.39,Finner groups =163.50,Finteraction =38.71;all P =0.00) and (Fbetween groups =5.10,Finner groups =119.04,Finteraction =6.54;P ＜ 0.05).Compared to baseline,the α wave and β wave were significantly decreased at third month and sixth month in VD (Finner groups =116.40,P =0.00) and (Finner groups =55.90,P ＜ 0.05).Compared to control group,the powers of θ wave (except in the frontal lobe at baseline and third month) and δ wave were significantly increased at all time points (P ＜ 0.05).Except the θ wave in occipital lobe,there were significant differences in slow wave at all time points between VD group and control group (P ＜ 0.05).The featured EEG with increased slow wave in many regions of cerebral infarction can be used for early diagnosis of VD in patients with cerebral infarction.

Objective: To analyze the epidemiological characteristics of varicella epidemic situation at schools and kindergartens in Fengxian district of Shanghai during 2012-2018, and to provide evidence for developing control and prevention strategies. Methods: Data of varicella epidemic situation at schools and kindergartens and varicella cases were analyzed by descriptive methods. The rates were compared with chi-square test. Results: A total of 6 727 varicella cases were reported in Fengxian during 2012-2018, for an incidence of 85.34 per 100 000 population. Totally 66 varicella epidemic outbreaks and public health emergencies caused by varicella were reported, which involved 741 varicella cases. Among them, 426 were breakthrough cases (57.49%). The average interval time of breakthrough cases were (6.78±2.79)years, and the incidence was more concentrated in the 3-9 years after vaccination with varicella vaccine. Most breakthrough cases appeared 5 years past vaccination. The peak time of varicella was from April to June and from October to December. Most of cases were in the 5-11 year-old group and 15-17 year-old group. The cases in males was higher than in females. Kindergarten childcare and primary school children were at high risk of varicella. Timeliness of reporting was positively correlated with the duration of the varicella epidemic situation( r =0.52， P <0.05). Conclusion Most varicella epidemic situation in Fengxian district of Shanghai occued in primary schools during autumn and winter, and most of the varicella cases were breakthrough cases. Emergency vaccination of varicella vaccine can effectively control the spread of the epidemic. It is suggested to increase the publicity of the immunization program of 2 doses of varicella vaccine and raise the awareness of varicella vaccination of children’s parents.

Molecular targeted drugs are one of the treatments for hepatocellular carcinoma (HCC), the primary factor influencing their therapeutic efficacy is drug resistance. Diminished drug intake, greater efflux, improved DNA damage repair capacity, aberrant signal pathways, hypoxia, epithelial-mesenchymal cell transition, and the cellular autophagy system are summarized herein as aspects of the drug resistance mechanism. Simultaneously, effective strategies for addressing drug resistance are elaborated, providing ideas for better clinical treatment of HCC.

Systemic treatment, including molecular targeted therapy, immunotherapy, and chemotherapy, is an important means of achieving long-term survival in patients with intermediate-and advanced-stage liver cancer. However, some patients are insensitive to treatment and even develop drug resistance. Mitochondria are the center of cellular energy metabolism and, at the same time, are the priority targets for systemic therapy. Mitochondrial homeostasis plays an important role in the treatment of liver cancer. The relationship between the two advances is elucidated so as to provide better ideas for the clinical treatment of liver cancer.