OBJECTIVETo understand the genotypic characteristics and the neutralizing antibody levels of Japanese encephalitis virus (JEV) and Japanese encephalitis (JE) in both vector mosquitoes and in healthy people of Zhejiang province.

METHODSVirus was isolated from mosquitos sampled from the Monitoring Stations located in Xianju county during 2012 to 2013. Phylogenetic and homological studies were carried out on the E gene. A total of 1 263 blood specimens from 642 healthy people were collected before and after the seasons of JE epidemics. JEV neutralizing antibody was detected by the micro-neutralization test.

RESULTSTwenty-five JEV strains were isolated from a total of 11 650 mosquitoes. The identity of nucleotide appeared as 87.8%-99.7% both from 2012 to 2013 and from 1982 to 2010 while as 87.7%-88.0% with vaccine strain SA14-14-2, in Zhejiang. The phylogeny tree of E gene indicated that the newly isolated virus belonged to genotype I but no mutation of amino acid sequence coding conformational epitope was identified in the envelop protein. Both positive rates and the geometric mean titer (GMT) of neutralizing antibody in healthy people were 31.5%-42.0% and 1 : 2.56-1 : 3.53 in Xianju county, during 2012 and 2013, respectively. Both of the two positive rates (χ(2)≤1.76, P > 0.05) and the two GMTs (u≤0.64, P > 0.5) for antibodies pre or post the epidemic season did not show significant differences.

CONCLUSIONJEV isolated in Xianju during 2012 and 2013 belonged to genotype I. The positive rates of JEV neutralizing antibody from healthy people in Xianju were less than 42.0%, which showed no significant differendes pre or post JE epidemic season.

Amino Acid Sequence ; Animals ; Antibodies, Neutralizing ; blood ; Antibodies, Viral ; blood ; China ; Culicidae ; virology ; Disease Vectors ; Encephalitis Virus, Japanese ; genetics ; immunology ; isolation & purification ; Encephalitis, Japanese ; virology ; Epitopes ; Genotype ; Humans ; Neutralization Tests ; Phylogeny

The incidence of ischemic stroke in the middle cerebral artery (MCA )territory is high.Despite intravenous thrombolytic therapy with recombinant tissue type plasminogen activator (rt-PA )can be used at the early stage ,the patients seldom gain benefits from that ,and the morbidity and mortality stay high. In order to provide evidence for optimizing early identification and clinical treatment of patients at high risk of ischemic stroke ,this article reviewed the current state of science and technology regarding prognosis-influencing factors for ischemic stroke of the middle cerebral artery territory ,such as stroke pathogenesis ,the length and site of vessel occlusion ,the collateral circulation and lesion patterns ,initial symptoms and clinical intervention ,and other related indexes after thrombolysis.

Objective To investigate the effect of the location of middle cerebral artery (MCA) occlusion on outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke.Methods The consecutive patients with stroke of acute MCA occlusion treated with rtPA intravenous thrombolysis within 4.5 h after onset were included.The locations of MCA occlusion were divided into either a proximal MCA segment (proximal M1 segment) or a distal MCA segment (distal M1 segment,M2 segment and more distally).Early neurological improvement was defined as National Institutes of Health Stroke Scale (NIHSS) score improvement ≥4 points from baseline or NIHSS 0 point at 24 h after thrombolysis.They were divided into a good outcome group (0-2) and a poor outcome group (3-6) according to the modified Rankin Scale (mRS) scores.Results A total of 70 patients with MCA occlusion were enrolled in the study,including 22 (31.4％) with proximal MCA occlusion and 48 (68.6％) with distal MCA occlusion;52 (74.3％) with good outcome and 18 (25.7％) with poor outcome.The proportion of atrial fibrilhtion (x2 =4.541,P =0.033),the NIHSS scores on admission (t =5.192,P =0.026) and 24 h after thrombolysis (t =5.365,P =0.024) in the proximal MCA occlusion group were higher than those in the distal MCA occlusion group.The proportion of early neurological improvement in the proximal MCA occlusion group was significantly lower than that in the distal MCA occlusion group (x2 =9.434,P =0.002),and the incidence of symptomatic intracranial hemorrhage (x2 =9.563,P =0.002)and the mortality rate within 7 d (x2 =14.491,P ＜0.001) were significantly higher than those in the distal MCA occlusion group.The time from onset to thrombolysis (t =6.346,P =0.014),NIHSS scores on admission (t =4.498,P =0.038) and at 24 h after thrombolysis (t =4.866,P =0.028),and the proportion of proximal MCA occlusion (x2 =18.710,P ＜0.001) in the poor outcome group were significantly longer or higher than those in the good outcome group.Multivariatelogistic regression analysis showed that the proximal MCA occlusion (odds ratio [OR] 14.385,95％ confidence interval [CI] 2.525-81.925;P =0.003),longer time from onset to thrombolysis (OR 12.927,95％ CI 2.624-61.748;P =0.002),higher NIHSS score at 24 h after thrombolysis (OR 3.492,95％ CI 1.027-11.880;P=0.045) were the independent predictors for poor outcome at 90 d.Conclusions There are differences in the outcomes after intravenous thrombolysis in patients with MCA occlusion at different locations.The locations of MCA occlusion,time from onset to thrombolysis,and NIHSS score at 24 h after thrombolysis,and age are the independent predictors for the outcomes after intravenous thrombolysis in patients with acute MCA ischemic stroke.

Objective To investigate the influence of moderate to severe leukoaraiosis (LA) on hemorrhagic transformation and prognosis of patients after intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke and analyze influencing factors of the clinical prognosis.Methods We consecutively collected patients with acute infarct on anterior circulation (n =78) in Department of Neurology or Emergency of our hospital between January 2014 and March 2017,and all patients received intravenous thrombolysis therapy within the 4.5-hour time window.All patients processed brain MRI after intravenous thrombolysis therapy.According to the degree of LA,all subjects were classified into two groups;LA group (moderate to severe) vs no LA group (absent to mild).Clinical data were obtained and compared among patients with different grades of LA.Logistic regression analysis was used to confirm the relevant factors of prognosis 90 days after stroke.Results Among 78 enrolled patients,24 (30.8％) were classified as LA and 54 (69.2％) as no LA.In the group of LA,33.3％ (8/24) patients conducted hemorrhagic transformation,whereas 11.1％ (6/54) patients also underwent hemorrhagic transformation in the group of no LA.There was a significant difference between the two groups (x2 =5.571,P =0.018).But symptomatic intracranial hemorrhage accounted for 16.7％ (4/24) and 5.6％ (3/54) respectively in the two groups without significant difference (x2 =2.304,P =0.129).Three-month recurrence of stroke in the groups of LA and no LA was 20.8％ (5/24) and 5.6％ (3/54) respectively,also without significant difference between the two groups (x2 =3.850,P =0.050).Age ((73.7 ± 6.7)years vs (61.3 ± 10.6) years,t =6.567,P =0.012),90 d Fugl-Meyer Scale (FMS) score (92.3 ± 3.4 vs 72.9 ± 7.8,t =22.345,P ＜ 0.01) and proportion of 90 d modified Rankin Scale score 0-2 (83.3％(45/54) vs 50.0％ (12/24),x2 =9.383,P =0.002) were significantly different between the two groups.Follow-up 90-day after onset showed that the good outcome was found in 57 cases (73.1％),poor outcome in 21 patients (26.9％) and death in six cases (7.7％).The grade of LA (57.1％ (12/21) vs 21.1％ (12/57),x2 =9.383,P =0.002),silent lacunar infarction (66.7％ (14/21) vs 35.1％ (20/57),x2 =6.224,P =0.013),age ((72.8 ± 7.9) vs (61.5 ± 11.7) years,t =4.423,P =0.039),proportion of thrombolysis within 3.0-4.5 hours (71.4％ (15/21) vs 38.6％ (22/57),x2 =6.634,P =0.010),vascular occlusion size (66.7％ (14/21) vs 38.6％ (22/57),x2 =4.865,P =0.027),infarction size (52.4％ (11/21) vs 12.3％ (7/57),x2 =14.053,P =0.001) and baseline NIHSS score (16.9 ±6.7 vs 9.5 ± 4.5,t =5.426,P =0.022) were significantly different between the two groups.After adjusting for age,thrombolysis time,baseline NIHSS score,infarction size,vascular occlusion size and silent lacunar infarction,multivariate analysis revealed that moderate to severe LA (OR =4.564,95％ CI 1.199-67.724,P =0.033) was risk factor for worse outcome of patients after intravenous thrombolysis.Conclusions Acute ischemic stroke patients with moderate to severe LA have high hemorrhagic transformation after intravenous thrombolysis and may have poor 90-day FMS score.And moderate to severe LA was found to be an independent risk factor for prognosis in cerebral infarction patients with intravenous thrombolysis.

Objective To investigate the effect of repeated application of low-frequency transcranial magne-tic stimulation ( rTMS) when combined with hyperbaric oxygen ( HBO) in the treatment non-fluent aphasia after a stroke. Methods Forty-eight stroke survivors with non-fluent aphasia were randomly assigned to a control group, an HBO group or an observation group, each of 16. All received conventional rehabilitation therapy consisting of drug therapy, speech training and conventional physical exercises, while the HBO and observation groups were additionally given HBO and rTMS combined with HBO respectively. The 1 Hz rTMS was applied over the Broca's homologues of the unaffected hemisphere. Before and after 4 weeks of treatment, the Western Aphasia Battery ( WAB) was used to evaluate the subjects' language function and the Modified Barthel Index ( MBI) was used to assess their ability in the activities of daily living. Results There was no significant difference in the average WAB scores among the three groups before the treatment. After 4 weeks of treatment the average WAB and MBI scores of the HBO group and the observation group had improved significantly, and there was then a significant difference among the three groups. The observation group was performing significantly better than the HBO group and the control group in spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score. Pairwise comparisons showed that the observation group's average WAB score, spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score were the best, followed by those of the HBO group and then those of the control group. All of the differences were statistically significant. Conclusions Low-frequency rTMS combined with HBO can significantly improve the language function and the quality of life of patients with non-fluent aphasia. Such combined therapy is worthy of clinical promotion and application.

Objective To investigate the effect of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis on patients with middle cerebral artery (MCA) infarction of different lesions and to analyze the influencing factors of clinical prognoses.Methods Seventy-five patients with acute infarction in the MCA territory were consecutively collected in our hospital from January 2013 to December 2016,and all patients underwent intravenous rt-PA thrombolysis within 4.5 h time window.The sites of MCA were classified into origin of the MCA (type Ⅰ),MCA trunk distal to the lenticulostriate arteries (type Ⅱ) and branches of the MCA (type Ⅲ).Early symptom improvement was defined as 24 h National Institutes of Health Stroke Scale (NIHSS) scores decreased≥4 or down to 0 after intravenous thrombolysis.Clinical data,NIHSS scores on admission and after intravenous thrombolysis,ratio of patients enjoying early symptom improvement,ratio of hemorrhagic transformation,mortality rate within 7 d of intravenous thrombolysis and modified Rankin scale (mRS) scores 90 d after intravenous thrombolysis were obtained and compared among the three groups.And according to mRS scores 90 d after intravenous thrombolysis,the patients were divided into good prognosis group and poor prognosis group;Logistic regression analysis was used to confirm the different prognoses of patients with MCA infarction of different lesions.Results Among the 75 enrolled patients,22 (29.3％) were classified as type Ⅰ,16 (21.3％) as type Ⅱ and 37 (49.3％) as type Ⅲ.Type Ⅰ patients (n=6,27.3％) had significantly lower ratio of patients with early symptom improvement than type Ⅱ patients (n=l 1,68.8％) and type Ⅲ patients (n=25,67.5％,P＜0.05).Type Ⅰ patients had significantly higher ratio of symptomatic intracranial hemorrhage,higher mortality rate within 7 d of intravenous thrombolysis and higher mRS scores 90 d after intravenous thrombolysis than type Ⅱ patients and type Ⅲ patients (P＜0.05).After 90 d of follow up,good prognosis was found in 56 patients (74.7％) and poor prognosis in 19 patients (25.3％);the sites of MCA lesions,thrombolysis time,and NIHSS scores on admission and 24 h after intravenous thrombolysis between the two groups were significantly different (P＜0.05).Multivariate Logistic analysis revealed that sites of MCA lesions (OR=2.633,95％CI:1.119-6.197,P=0.027),thrombolysis time (OR=7.603,95％ CI:1.561-37.043,P=0.012),and NIHSS scores on admission (OR=3.622,95％CI:1.068-12.285,P=0.039) were the risk factors of prognoses.Conclusions Different lesion sites of MCA may indicate different effects and prognoses in patients with intravenous thrombolysis.And,MCA lesion sites,thrombolysis time and NIHSS scores on admission are independent risk factors for prognoses in cerebral infarction patients with intravenous thrombolysis.

Objective To investigate the influence of estimated glomerular filtration rate (eGFR) in rehabilitation of motor function and short-term prognoses in patients with acute middle cerebral artery (MCA) infarction. MethodsSeventy-four patients with acute MCA infarction, admitted to Department of Neurology from March 2016 to September 2018, and then, accepted rehabilitation training for 4 weeks in Department of Rehabilitation medicine, were recruited. Modification of Diet in Renal Disease was used to evaluate the eGFR instead of renal function; according to the results, these patients were divided into normal renal function group and mild-moderate renal dysfunction group. National Institute of Health Stroke Scale (NIHSS) was used to assess the neurologic function. Fazekas scale was used to assess degrees of leukoaraiosis. Fugl-Meyer Motor Function Assessment (FMA) was used to assess motor functions before rehabilitation treatment and 90 d after onset. Modified Barthel Index (MBI) was used to assess activity of daily living 90 d after onset. According to MBI scores, the patients were divided into good prognosis group (MBI scores>60) and poor prognosis group (MBI scores≤60); multivariate Logistic regression analysis was used to confirm the risk factors affecting prognoses 90 d after onset.ResultsAmong 74 enrolled patients, 40 were classified as normal renal function group and 34 as mild-moderate renal dysfunction group; patients in the mild-moderate renal dysfunction group had significantly higher level of blood urea nitrogen, proportion of silent lacunar cerebral infarction and Fazekas scale scores, and had statistically lower FMA scores and MBI 90 d after onset than normal renal function group (P<0.05). Among the 74 patients, good prognosis was found in 32 patients and poor prognosis in 42 patients; multivariate Logistic regression analysis found that age, eGFR (OR=0.944,P= 0.011, 95％CI: 0.903-0.987), baseline NIHSS scores, and Fazekas scale scores were risk factors affecting prognoses 90 d after onset.ConclusionIn acute MCA infarction patients, eGFR can influence the rehabilitation of motor function and short-term prognoses.

OBJECTIVE：To provid e reference for the medicinal resources and clinical application of Tibetan medicine “Dida”. METHODS：Delphi method was adopted. By reviewing literatures ，confirming consultation scope ，inviting experts engaged in clinical，scientific research ，teaching and production of Tibetan medicine. Two methods ，online inquiry and on-site questionnaire ， were used for expert consultation to evaluate the differences and problems existing in the utilization of “Dida”medicinal resources until a consensus was reached ，consensus on the medicinal resources and clinical application of Tibetan medicine “Dida”was determined finally. RESULTS & CONCLUSIONS ：A total of 33 experts participated in the two rounds of consultation. According to the results of literature research ，the first round set up 16 inquiry indicators ；and then according to expert opinions to modify the index system ，the second round set up 18 inquiry indicators. After two rounds of inquiry ，a consensus was finally reached on 16 items on the original name ，quality standards and clinical application of Tibetan medicine “Dida”，and 2 items related to the characteristics and compatibilities of “Dida”had not reach common views. The consensuses of 16 items mainly cover the original name of “Dida”and the evolution of geographic information ，the rational selection of “Dida”medicinal materials ，the effectiveness and safety of clinical use of “Dida”.