Objective To investigate the relationship between carotid artery calcification and ischemic stroke.Methods The demographic data,vascular risk factors and clinical features of patients with acute ischemic stroke and non-acute stroke patients admitted in the same period were collected retrospectively.All the patients received 64-slice spiral CT examination,and the scan data were transmitted to a GE workstation.A smart score software was used to evaluate carotid artery calcification.Multivariate logistic regression analysis was used to identify the independent risk factors for ischemic stroke.Receiver operator characteristic (ROC) curve was used to analyze and determine the predictive value of carotid artery calcification in acute ischemic stroke.Results A total of 86 patients with acute ischemic stroke and 89 with non-acute stroke (control group) were enrolled.In addition to the previous stroke history,there were no significant differences in age,gender,and vascular risk factors between the ischemic stroke group and the control group.The calcium score (338.57 ± 77.35 vs.147.79 ± 64.52; t =4.065,P =0.045),total calcified volume (372.22 ± 78.73 mm3 vs.197.27 ±61.12 mm3; t =4.740,P =0.031),and calcification quality (70.33 ± 13.83 mg vs.32.44 ± 12.27 mg; t =6.673,P =0.011) of the ischemic stroke group were significantly higher than those of the control group.In patients with ischemic stroke,there were no significant differences in the carotid artery calcification score (335.50 ± 85.95 vs.312.73 ± 90.61; t =0.052,P =0.820),total calcified volume (357.91 ± 88.93 mm3 vs.311.71 ± 81.43 mm3; t=0.071,P=0.791),and calcium quality (59.68± 17.36 mg vs.51.29 ± 18.69 mg; t =0.071,P =0.791) between the symptomatic sides and non-symptomatic sides.Multivariate logistic regression analysis showed that the carotid artery calcification score (odds ratio [OR] 4.963,95％ confidence interval [CI] 5.932-18.994; P=0.019),total calcified volume (OR 5.967,95％ CI 3.940-14.993; P =0.015),and calcium quality (OR 6.815,95％ CI 4.703-21.946; P =0.007) were the independent risk factors for ischemic stroke.The ROC curve analysis of carotid artery calcification score showed that when it was 231.25,it had a predictive value for acute ischemic stroke.The sensitivity was 85.4％,specificity was 89.9％,positive predictive value was 87.1％,and negative predictive value was 89.1％.The area under the ROC curve was 0.891 (95％ CI 0.808-0.913; P =0.027).Conclusions Carotid artery calcification is one of the independent risk factors for ischemic stroke.Carotid artery calcification score has some predictive value for acute ischemic stroke.

Point-of-care pulmonary ultrasound is a widely used tool for rapid diagnosis and monitoring treatment in emergency departments and intensive care units.Pulmonary ultrasound has high sensitivity,specificity and diagnostic accuracy in identification of pneumonia,pneumothorax,pulmonary-embolism,pleural effusion,alveolar interstitial syndrome,etc.Besides,it can assess the lung aeration from interstitial syndrome to lung consolidation.Additionally,it provides real-time information of treatment response.Lung ulrasound applications in pulmonary disease were reviewed in this article.

AIM　The purpose is to study the non-isothermal decomposition process and mechanics of vitamin B6. METHOD　The TG technique was used to observe between 30～700℃. RESULTS　The decomposition of vitamin B6 was performed by two stages. Vitamin B6 loses HCl at the first stage together with losing H2O. The kinetic equation obtained was dα/dt=A*e-E/RT*1/2(1-α)3; activation energy obtained was 325.27 kJ/mol; and preexponential factor A obtained was 7.22×1032/s as well. CONCLUSION　Vitamin B6 is rather thermal stable, and it loses HCl together with losing H2O at temperature range of 173℃～271℃.

The therapeutic effects of diltiazem in the dosage of 135~240 mg/d on 26 cas-s with coronary myocardial ischemia were observed.It was found that diltiazem could markedly slow down tho heart rate and decrease the blood pressure of the patient when he was at rest and 2,4 and 6 minutes after he underwent exercise test.It could also increase exercise tolerance,delay an exercise-induced anginal attack,improve the ischemic depression of ST segment,and PEP/LVET.Eventually it could pievent the patient from anginal attacks.The therapeutic effects of diltiazem would be more apparent in those cases of myocardial ischemia accompanied with hypertension.

Objective To explore the effect of vertebral artery dominance on basilar artery morphology and vascular vertigo,and understand the possible mechanisms.Methods Fifty-seven patients with vascular vertigo,admitted to our hospital from June 2011 to May 2013,were selected in our study; according to the head CTA vascular imaging,they were divided into vertebral artery dominance group (n=28) and vertebral artery non-dominance group (n=29).The clinical information and vertigo degrees from all of the patients were collected to analyze the vertebral-basilar artery and its relationship with vascular vertigo.Results In 28 patients with vertebral artery dominance,the left side of the dominance was noted in 21 patients (75％) and the right side of the dominance in 7 (25％),with statistically significant difference (x2=8.361,P=0.001); statistical significance of curve rate on both sides of the basal artery morphology was noted (x2=7.729,P=0.006).Most of its characteristic dominance of vertebral artery was C type,and the minority was S type and non-C type.The rate of basal artery bent in the dominant group was significantly higher than that in the non-dominant group (85.71％ and 31.03％,x2=18.196,P=0.000).The diameter (4.68±0.57 mm) and basal artery tortuosity (3.50+0.93 mm) in the dominant group were significantly larger than those in the non-dominant group (4.11 ±0.37 and 1.72±0.57,t=6.289,P=0.015; t=4.621,P=0.036).The theory length of basal artery showed no statistical significance between the two groups (P＞0.05).The greater the differences of both sides of the vertebral artery diameter,and the more obvious the basal diameter and basal artery tortuosity (P＜0.05).The level of vertigo in the non-dominant group was significantly higher than that in the dominant group (t=4.386,P=0.041).Vertigo severity level was positively associated with basal artery tortuosity and vertebral artery diameter (r=0.328,P=0.013; r=0.458,P=0.002).Conclusions There is higher rate of bending degree level and dizziness in patients of dominance of vertebral artery.Vertebral artery dominance is associated with vascular vertigo.

Objective To investigate the predictive value of Essen stroke risk scale (ESRS) scores in stenosis of patients with anterior circulation acute ischemic stroke.Methods A total of 98 patients with atherosclerotic stroke in anterior circulation,admitted to our hospital from June 2011 to June 2013,were selected and performed head+neck CTA inspection cycle and ESRS.According to the ESRS scores,the patients were divided into low risk group (n=35),high risk group (n=44) and extremely high risk group (n=19).The relationship between the cerebrovascular morphology characteristics and ESRS scores were analyzed,and the predictive value of ESRS scores in stenosis was analyzed.Results (1) The distributions of these stenosis (the intracranial segment,the extracranial segment and combined intracranial and extracranial segments) were not significantly different among the three groups (P＞0.05).(2) Following the increase of ESRS scores,the degrees of luminal stenosis showed an increased trend in both circulation symptom side and non-symptom side (x2=9.784,P=0.002;xx2=9.215,P=0.002).(3) When the ESRS scores were higher than or equal to 3 points,the sensitivity of predicting mild stenosis was 63.6％,specificity 53.4％,with area under receiver operating characteristic curve (AUC) of 0.595 (P=0.182,95％CI:0.445-0.764);the sensitivity of predicting moderate stenosis,severe stenosis and occlusion was 60.3％,specificity 66.7％,with AUC of 0.679 (P=0.005,95％CI:0.553-0.805).Conclusions ESRS scores can predict the severity of the stenosis in patients with atherosclerotic cerebral stroke of anterior circulation.The patients having ESRS ≥ 3 scores should accept cerebrovascular examination to provide a certain basis for early and effective stratified intervention.

Objective To investigate the application value of limited liquid resuscitation combined with continuous renal replacement therapy (CRRT) in treatment of severe acute pancreatitis (SAP) companied with abdominal compartment syndrome (ACS).Methods The retrospective cohort study was adopted.The clinical data of 67 patients with SAP companied with ACS who were admitted to the Fuling Center Hospital of Chongqing from January 2005 to December 2014 were collected.Among 67 patients,33 receiving conventional liquid resuscitation between January 2005 and December 2010 were allocated into the control group and 34 receiving limited liquid resuscitation combined with CRRT between January 2011 and December 2014 were allocated into the observation group.Observation indicators included:(1) required fluid volume and time of negative fluid balance in the 2 groups;(2) changes of pathological and physiological indicators after treatment in the 2 groups;(3)outcomes and prognosis of patients in the 2 groups.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using t test.Count data were analyzed using the chi-square test.Repeated measurement data were analyzed by repeated measures ANOVA.Results (1) Required fluid volume and time of negative fluid balance in the 2 groups:required fluid volumes at 6,24,48 and 72 hours after resuscitation were (2 449±339) mL,(4 820±757) mL,(9 428± 1 272) mL,(13 127± 1 565) mL in the control group and (2 360± 314) mL,(4 582±530) mL,(8 564± 970) mL,(11 470± 1 253) mL in the observation group,respectively,with a statistically significant difference in required fluid volume between the 2 groups (F=13.035,P＜0.05) and in required fluid volume at 48 and 72 hours between the 2 groups (t=3.132,4.794,P＜0.05).Time of negative fluid balance in the observation group and control group was (4.3± 1.7)days and (6.4 ±1.8)days,respectively,showing a statistically significant difference between the 2 groups (t =4.913,P＜0.05).(2) Changes of pathological and physiological indicators in the 2 groups after treatment:time factors:from 0 h to 168 h postoperatively,APACHE Ⅱ score,C-reaction protein (CRP),D-dimer,IAP,Bla and oxygenation index were changed from 20.9±4.1 to 13.9±2.6,from (167±39)mg/L to (55±17) mg/L,from (1 652±1 544) μg/L to (993±500)μg/L,from (23.4±3.4)cmH2O (1 cmH2O=0.098 kPa) to (21.4±2.9)cmH2O,from (4.6±1.6) mmol/L to (1.4±0.5)mmol/L,from (189±27) mmHg (1 mmHg =0.133 kPa) to (152±23)mmHg in the control group,and chaged from 21.5±5.1 to 11.0±2.8,from (168±36)mg/L to (44±19)mg/L,from (1 634±1 525) μg/L to (578±350) μg/L,from (23.2±2.5)cmH2O to (17.4±2.6)cmH2O,from (4.5±1.6)mmol/L to (0.8±0.3)mmol/L,from (188±26)mmHg to (196±25)mmHg in the observation group,respectively,showing gradual decreasing with time and statistically significant differences between the 2 groups (F =186.415,581.118,34.618,212.416,262.272,207.645,P＜0.05).Treatment factors:there were no significant differences in changing trends of APACHE Ⅱ score,D-dimer and Bla between the 2 groups (F=3.499,2.350,3.516,P＞0.05),and there were significant differences in changing trends of CRP,IAP and oxygenation index between the 2 groups (F=4.009,15.276,14.959,P＜0.05).Interaction effect between time factors and treatment factors:there were obviously interaction effects between time factors and treatment factors in APACHE Ⅱ score,CRP,IAP and oxygenation index (F=4.890,4.912,23.874,28.615,P＜0.05) and no interaction effects between time factors and treatment factors in D-dimer and Bla (F=2.803,1.920,P＞0.05).(3) Outcomes and prognosis of patients in the 2 groups:numbers of patients with surgery,local complications and infection and duration of hospital stay were 11,16,14,(46±17)days in the control group and 4,6,6,(36±14) days in the observation group,respectively,with statistically significant differences between the 2 groups (x2=4.484,7.221,4.910,t =2.433,P＜0.05).Mortality and hospital expenses were 24.2％ (8/33),(33± 18) x 104 yuan in the control group and 8.8％ (3/34),(27± 14)× 104 yuan in the observation group,respectively,with no statistically significant difference between the 2 groups (x2 =2.901,t =1.283,P＞ 0.05).Conclusion Limited liquid resuscitation combined with CRRT can effectively control IAP of patients with SAP companied with ACS and improve oxygenation index,meanwhile,it can also reduce number of patients with surgery,infection and local complications and duration of hospital stay.

Objective To establish a novel convenient loop?mediated isothermal amplification(LAMP)method with the unique genes coding Plasmodium helical interspersed sub?telomeric superfamily(PHIST)for the rapid molecular diagnosis of P. falciparum. Methods The unique genes coding PHIST with high expression mRNA profile during the ring form or schizont period of P. falciparum were screened and selected from the PlasmoDB database. The LAMP primers of targeted genes were de?signed by the online software(PrimerExplorer V4). The LAMP assay was executed by the color?displaying method with SYBR Green. The dried blood spots of P. falciparum from clinical isolates were collected and the genomic DNA(gDNA)was extracted. For evaluation of sensitivity,the gDNA was diluted to four gradients(10?1,10?2,10?3,and 10?4). For assessment of specificity, the gDNA(s)of P. vivax,P. yoelii,Taenia saginata,and Schistosoma japonicum were also extracted. Results Totally,61 P. falciparum unique genes coding PHIST were found. The PF3D7_1372300 with high expression value during the ring form and PF3D7_1401600 with high expression value during the schizont period were selected for LAMP assay. The lowest detectable lim?its of PF3D7_1372300 and PF3D7_1401600 were 130.5 parasite/μl and 1 305.3 parasite/μl,respectively. Specific tests showed the amplified products of P. falciparum was positive and all the others including P. vivax,P. yoelii,T. saginata,and S. japoni?cum were negative. Conclusions The established LAMP method with PF3D7_1372300 gene is sensitive,specific,simple and useful. It can be applied to the field investigation and clinical diagnosis for falciparum malaria.

Objective To observe the application of multiple fluorescent PCR (Polymerase Chain Reaction) in the diagnosis and clinical detection of bloodstream infection. Methods 256 blood cultures were collected by the Laboratory Department of Yinzhou People′s Hospital from January 2018 to May 2018, and were detected by multiplex fluorescent PCR. The results of the PCR were compared with the traditional blood culture bacteria identification instrument (traditional blood culture method). The number of positive and negative samples and the number of corresponding samples of the two methods were counted. Then, they analyzed the specificity and sensitivity of multiplex fluorescence PCR in the diagnosis of bloodstream flow infections. Results A total of 18 pathogenic microbes are detected through blood culture and PCR. Multiple fluorescent PCR detects 142 positive samples and 114 negative samples. Among them, 132 samples also show positive through blood culture, and 111 samples show negative. The consistency rate between multiple PCR and traditional blood cultures is 91.8％ (235/256). The negative prediction rate of PCR is 97.4％ (111/114), sensitivity rate 97.8％ (132/135), specificity rate 91.7％ (111/121). 10 samples show positive through multiple fluorescence PCR but negative for blood culture, 3 samples show positive through blood culture but negative for PCR. Besides, there are 3 types of pathogens that exceed the detection range of PCR. Conclusions Multiplex PCR method can detect 17 pathogens in blood culture specimens of patients, which can not only optimize the traditional blood culture process, but also greatly shorten the reporting time and improve the detection rate of blood culture methods. Especially for patients treated with antibiotics, it can reduce missed detection and improve the diagnostic rate of bloodstream infections.

Objective:To investigate the clinical significance of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) in patients with chronic atherosclerotic middle cerebral artery occlusion.Methods:From July 2016 to November 2020, patients admitted to the Department of Neurology, Jiangdu People's Hospital of Yangzhou and first found chronic atherosclerotic middle cerebral artery occlusion were enrolled. The demographic, clinical and MRI imaging data were collected. According to the presence or absence of acute cerebral infarction, they were divided into the non-acute cerebral infarction group and the acute cerebral infarction group. According to the modified Rankin Scale score at 3 months after the onset, patients with acute cerebral infarction were further divided into the good outcome group (≤2) and the poor outcome group (>2). A multivariate logistic regression model was used to analyze the independent correlation between FVHs and the risk of cerebral infarction in patients with chronic atherosclerotic middle cerebral artery occlusion and the outcome in patients with cerebral infarction. Results:A total of 94 patients with chronic atherosclerotic middle cerebral artery occlusion were enrolled, including 38 with non-acute cerebral infarction (40.4%) and 56 with acute cerebral infarction (59.6%). In patients with acute cerebral infarction, 13 (23.2%) had a poor outcome, and 43 (76.8%) had a good outcome. The fibrinogen level, the proportion of patients with FVHs and the FVHs score in the cerebral infarction group were significantly higher than those in the non-cerebral infarction group (all P<0.05). Multivariate logistic regression analysis showed that the FVHs score was significantly, independently, and positively correlated with the risk of acute cerebral infarction (odds ratio 2.524, 95% confidence interval 1.400-4.552; P=0.002). The National Institutes of Health Stroke Scale score at admission, the modified Rankin Scale score at admission, and FVHs score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that there was a significant independent negative correlation between the FVHs score and the outcome of patients with cerebral infarction (odds ratio 0.144, 95% confidence interval 0.045-0.459; P=0.001). Conclusions:FVHs suggest that the blood supply is in a state of decompensation. When FVHs are present, the risk of cerebral infarction in patients with chronic middle cerebral artery occlusion is significantly increased; the wider the range of FVHs, the higher the risk of poor outcome after cerebral infarction.