Objective To investigate the efficacy and safety of intraarterial or intravenous recombinant tissue plasminogen activator(rtPA) for patients with acute cerebral infarction.Methods 60 patients consistent with the inclusion criteria were divided into intra-arterial thrombolysis group, intravenous thrombolysis group and control group. rtPA of 10～20 mg was infused over the course of 30 minutes in intra-arterial thrombolysis group. rtPA was administered in a dose of 0.7～0.8 mg/kg(maximum dose 50 mg),with 100% as a constant infusion over a period of 90 minutes in intravenous thrombolysis group.24 hours late, both groups were followed by subcutaneous injection of low molecular weight heparin(0.4 ml,twice daily) for 7 days. The control group received only routine treatment. European Stroke Scale(ESS) and Barthel Index(BI) were used to evaluate the recovery of neurological functions.Results The efficacy in both thrombolysis groups was significantly higher than that in the control group(all P 0.05).But in intraarterial group, the stenosis of intracranial arteries or extracranial arteries could be found, and new thrombosis could be prevented by transluminal stent-assistant angioplasty. One case of intracerebral hemorrhage and one case of asymptomatic hemorrhage occurred in intraarterial thrombolysis group. One case of asymptomatic hemorrhage was found in intravenous thrombolysis group and control group respectively. No dead case was found in the three groups.Conclusion Thrombolytic therapy of intra-arterial and intravenous rtPA can be performed safely and efficaciously in patients with acute cerebral infarction within 6 hours from the onset.

Objective To obtain protein of the major surface antigen P30 of Toxoplasma gondii by molecularcloning. Methods The gene of P30 (containing the whole P30 gene sequence, without the gene encoding signalpeptide) was obtained by polymerase chain reaction (PCR) using the primer designed according to the DNA sequence ofP30. The recombinant plasmid was constructed using EcoR Ⅰ, Xho Ⅰ and was then transformed into E. coli Top10. Thepositive clones were identified by restriction enzymes and DNA sequence analysis. The fusion protein was induced by IPTGand purified by affinity chromatography using ProBond~(TM) Resin (a kind of nickel-charged sepharose resin) and was identi-fied by SDS-PAGE and Western blotting. Results The products of PCR, cleavage and link reaction were same as ex-pected and the sequence of inserted fragment in the recombinant plasmid was same as reported except one synonymy muta-tion. A 58 kDa fusion protein was induced by IPTG and was purified by chromatography. Conclusion Fusion proteincontaining Toxoplasma gondii P30 was achieved and was provided as experiment material for further research.

Objective To analyze distribution of intracranial and extracranial arteriostenosis in patients with ischemic stroke. Methods 306 patients with ischemic stroke were collected during January 2002 to March 2005. All patients underwent color ultrasonography of carotid, TCD, MRA and DSA. According to NASCET, arteriostenosis was grouped into five grades: normal artery, mild stenosis(29%), moderate stenosis (30%—69%), severe stenosis(70%—90%) and occlusion(100%). Results (1) As for incidence of intracranial and extracranial arteriostenosis, 149 were of intracranial stenosis, 25 extracranial stenosis and 33 both. (2) As for incidence of single or dual stenosis, among 207 with arteriostenosis, single stenosis amounted to 129 and dual to 78. (3) Stenosis occurred in middle cerebral artery, distal vertebral artery, basilar artery, extracranial part of internal carotid artery, anterior cerebral artery, posterior cerebral artery, siphon part of internal carotid artery and onset part of vertebral artery in an order of decreased frequency. (4) DSA analysis revealed that, among 316 narrow blood vessels of 207 patients, 87 vessels were shown as severe stenosis or obstruction, accounting for 27.5%. (5) Among 164 cases, infarction occured in the corresponding stenostic vessel in 157 patients, accounting for 95.7%. ConclusionsIntracranial arteriostenosis is the most frequently encountered in those with ischemic stroke. Thereto, frequency of stenosis in middle cerebral artery is the highest, distal vertebral artery and basilar artery are next.

Objective: To explore the effect of behavioral activation (BA) therapy on depressive mood and behavioral characteristics among subliminal depressed nursing students, and to provide a reference for effective mental health education to nursing students. Methods: A cluster sampling method was used to select 614 sophomore nursing students from a medical college in Jiangxi Province. Sixty subjects who met the inclusion criteria were enrolled in the study, and divided into a control group and an intervention group using a random number table method, with 30 participants in each group. The control group received general mental health education, and the intervention group participated in a BA intervention on the basis of general mental health education. The Center for Epidemiologic Studies Depression (CES-D), Beck Depression Inventory II(BDI-II) and the Behavioral Activation For Depression Scale Short Form (BADS-SF) were used to evaluate students depression status before, immediately after, and 1 month after the intervention, respectively. Results: The time effect, group effect, and time group interaction of the CES-D, BDI-II and BADS-SF scores of the two groups of students were all statistically significant ( F =82.78, 9.65, 69.92; 42.19, 10.52, 13.50; 15.59 , 19.61, 8.49, P <0.01). Immediately after the intervention and 1 month after the intervention, the CES-D and BDI-II scores of the intervention group were significantly lower than those of the control group, and the BADS-SF score of the intervention group (14.63±4.63, 14.80±4.85; 11.23±4.98, 11.13±5.53) was significantly lower than that of the control group (22.67±6.70, 22.13±5.66; 17.57±9.59, 18.37±7.91); the differences were all statistically significant ( P <0.05). Conclusion BA shows lasting effects on alleviating depressive symptoms among nursing students with subthreshold depression, improve their behavioral activation level, and have a lasting effect. Nursing educators can improve the depression of nursing students and improve their mental health through individual BA.

Objective To analysis the mental health status of the victims in Wenchuan earthquake. Methods Post-traumatic stress disorder checklist-civilian version (PCL-C), symptom checklist-90 (SCL-90) , Zung' s self-rating anxious scale/depressive scale (SAS/SDS) and simple coping style ques-tionnaires were use to investigate the mental health status of the victims that were transferred to Xinaiao Hospital, Third Military Medical University, one month after earthquake. Results (1) Compared with national ensemble, SCL-90 scores ranked the highest in aspects of somatization and anxiety (t = 3.733, P <0.01; t = 2.368, P < 0.05) but the score of paranoid ideation decreased significantly (t =-3.584, P<0.01), with score over 3 accounting for 20.7%. (2) The proportion of moderate anxiety and depres-sion was 21.7% and 26.0%, respectively. (3) The PCL-C total score was positively correlated with SCL-90 scores and SAS scores (r = 0.642, P < 0.01 ; r = 0.506, P < 0.05), but negatively with negative items in SCL-90(r =-0.681, P <0. 01). (4) Multiple linear regression analysis showed that 36. 6% of variation of PCL-C total score could be forecast by comhining SAS scores with positive copy scores. Conclusions One month after earthquake, more. than 20% of the victims transferred to Xinqiao Hospital have moderate mental health problem and need early mental intervention for improvement in physical and mental health.

Objective To explore the clinical effect of lamotrigine combined with small dose of valproic acid in the treatment of newly diagnosed epilepsy .Methods 90 patients with newly diagnosed epilepsy were selected ,and they were randomly divided into control group and observation group according to the digital table ,45 cases in each group.The control group was only given small dose valproic acid treatment ,the observation group was given lamotrigine based on the control group .The curative effect ,clinical indicators ,and the change of cognitive function were compared between two groups .Results The total effective rate of the control group was 82.22％,which was significantly lower than 91.11％of the observation group (χ2 =5.36,P<0.05).After treatment,the attack frequency,duration,the attack of epilepsy discharge,involving lead number of the control group were (1.29 ±0.55)times per year,(3.36 ± 0.63)min,(11.69 ±1.26)180s/time,(5.69 ±1.52)180s/time,which of the observation group were (0.51 ± 0.22)times per year,(2.09 ±1.02)min,(7.56 ±1.34)180s/time,(3.54 ±1.48)180s/time,the differences between the two groups were statistically significant (t=4.18,4.28,5.14,4.28,all P<0.05).Compared with before treatment,the MMSE,digit span along the back test B scores after treatment in the two groups were increased ,and the indicators of the observation group after treatment improved more significantly than those in the control group ( t=4.18,4.28,5.14,all P<0.05).Conclusion The therapeutic effect of lamotrigine combined with small dose of valproic acid in the treatment of newly diagnosed epilepsy is significant , which can reduce clinical indicators and improve cognitive function .

Objective:To explore the correlation between post-traumatic stress disorder(PTSD),resilience and quality of life of front-line medical staff in public health emergencies.Methods:From Nov to Dec 2020,the medical staff of 4 COVID-19 designated hospitals in Wuhan were investigated with the general demographic questionnaire,10-item Connor-Davidson Resilience Scale,PTSD Checklist for DSM-5 and Simplify Qualify of Life Scale.Spearman correlation analysis and hierarchical regression analysis were used to investigate the correlation between PTSD,resilience and quality of life.Results:A total of 545 questionnaires were collected in this survey and the valid effective rate was 97.8% (533/545).The score of psychological resilience,PTSD and quality of life of medical staff were 26(20,30),17(8,25),and 20(18,23),respectively.And 13.1% (70/533)of medical staff had obvious PTSD symptoms.There were significant differences in the score of quality of life among medical staff with different genders,occupations and PTSD levels.Spearman correlation analysis results showed that the score of PTSD was negatively correlated with quality of life and psychological resilience(r=-0.488 and-0.464,P＜0.01).The score of psychological resilience was positively correlated with the score of quality of life(r =0.578,P＜0.01).Psychological resilience and PTSD were important predictors of quality of life,with an explanatory capacity of 37.0% .Conclusions:PTSD is a risk factor for quality of life,and psychological resilience is a protective factor for quality of life.In public health emergencies,improving psychological resilience,preventing and treating PTSD can improve the quality of life of medical staff.

The prevalence of metabolic syndrome among the 2057 urban adults in Wuhan was 10.74%, being 13.47% in males and 4.99% in females.The prevalence increased with aging,blood uric acid level and insulin resistance index.

Objective:To explore the death risk factors of extremely severe burn patients, establish a death risk nomogram predicting model, and investigate the predictive value for death risk of extremely severe burn patients.Methods:The medical records of 231 extremely severe burn patients (190 males and 41 females, aged 18-60 years) who were admitted to the Institute of Burn Research of the First Affiliated Hospital of Army Medical University from January 2010 to October 2018 and met the inclusion criteria were analyzed retrospectively. According to the final outcome, the patients were divided into survival group of 173 patients and death group of 58 patients. The sex, age, severity of inhalation injury, total burn area, full-thickness burn area, burn index, rehydration coefficient and urine volume coefficient of the first and second 24 h after injury, the first base excess, shock index, and hematocrit (HCT) after admission, whether to have pre-hospital fluid infusion, use of ventilator, and use of continuous renal replacement therapy (CRRT), and abbreviated burn severity index (ABSI ) and Baux score on admission of patients in the two groups were recorded or calculated. According to the use of ventilator, the patients were divided into with ventilator group of 131 patients and without ventilator group of 100 patients, and the death, total burn surface area, burn index, incidence and severity of inhalation injury were recorded. According to the use of CRRT, the patients were divided into with CRRT group of 59 patients and without CRRT group of 172 patients, and the death, total burn surface area, and burn index were recorded. Data were statistically analyzed with t test, chi-square test, and Mann-Whitney U test to screen the death related factors of patients. The indexes with statistically significant differences between survival group and death group were included in the multivariate logistic regression analysis to screen the independent death risk factors of patients, and the death risk nomogram predicting model was constructed based on the results.The Bootstrap method was used to validate the death risk nomogram predicting model internally. The predictive value of the nomogram model for predicting death risk of patients was detected by drawing calibration graph and calculating concordance index, and the death risk scores of 231 patients were acquired according to the death risk nomogram model. The receiver′s operating characteristic (ROC) curve was drawn, and the optimal threshold and the sensitivity and specificity of optimal threshold in the ROC curve and the area under the curve were calculated. Results:(1) There were statistically significant differences in burn index, ABSI on admission, severity of inhalation injury, total burn area, full-thickness burn area, rehydration coefficient at the first 24 h after injury, use of ventilator, use of CRRT, and Baux score on admission of patients between the two groups ( Z=-7.696, -7.031, χ2=18.304, 63.065, 23.300, 13.073, 34.240, 59.586, t=-7.536, P<0.01). (2) There were statistically significant differences in death, incidence and severity of inhalation injury, total burn area, and burn index of patients between with ventilator group and without ventilator group ( χ2=34.240, 17.394, 25.479, Z=-6.557, -7.049, P<0.01). (3) There were statistically significant differences in death, total burn area, and burn index of patients between with CRRT group and without CRRT group ( χ2=62.982, Z= -47.421, -6.678, P<0.01). (4) The use of ventilator, use of CRRT, and burn index were independent risk factors for the death of extremely severe burn patients (odds ratio=3.277, 5.587, 1.067, 95% confidence interval=1.073-10.008, 2.384-13.093, 1.038-1.096, P<0.05 or P<0.01). (5) The initial concordance index of nomogram predicting model was 0.90 and the corrected concordance index was 0.89. The concordance indexes before and after correction were higher and similar, which showed that the nomogram had good concordance and predictive effect. The optimum threshold of ROC curve was 0.23, the sensitivity and specificity of optimum threshold were 86.0% and 80.0%, respectively, and the area under ROC curve was 0.90 (95% confidence interval=0.86-0.94, P<0.01). Conclusions:Severe burns and damage and/or failure of organ are the main death causes of extremely severe burn patients. The death risk nomogram predicting model established on the basis of use of ventilator, use of CRRT, and burn index have good predictive ability for death of extremely severe burn patients.

OBJECTIVES: To determine the association between glycosylated hemoglobin (HbA1c) and ambulatory blood pressure or heart rate in hypertensive patients. METHODS: A total of 585 patients, who performed ambulatory blood pressure monitoring (ABPM) from September 2018 to April 2019 in Xiangya Hospital, Central South University, were enrolled and assigned into 2 groups (470 in a hypertensive group and 115 in a normal group). HbA1c levels were compared. According to the HbA1c level, the hypertensive group was divided into 2 subgroups: A high HbA1c group (HbA1c≥6.1%, RESULTS: The hypertensive group had higher HbA1c level than the normal group [(6.1±1.3)% vs (5.1±1.7)%, CONCLUSIONS In hypertensive patients, HbA1c is positively correlated with ambulate blood pressure, blood pressure load, and heart rate, and it has no correlation with blood pressure variability, heart rate variability, or morning blood pressure.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Glycated Hemoglobin A/analysis* ; Heart Rate ; Humans ; Hypertension