Objective To compare the safety and efficacy of carotid artery stenting (CAS) and carotid endarterectomy(CEA) for the treatment of carotid stenosis. Methods The electronic databases (PubMed, EMbase, Cochrane Central Register of Controlled Trials, CNKI, VIP and Wanfang) were searched in order to retrieve randomized controlled trials (RCTs) about comparing CAS and CEA for the treatment of carotid stenosis. Cochrane collaboration's RevMan 5.0.24 were used for analyzing data. Results Twelve RCTs totalling 6903 patients (3460 patients were randomized to CAS and 3443 randomized to CEA) with symptomatic or asymptomatic stenosis were included in the meta-analysis. There were significantly higher 30-day relative risks after CAS than after CEA for death or any stroke [RR=1.64, 95%CI (1.33-2.03), P＜0.00001] and for stroke [RR=1.70, 95%CI (1.34-2.14), P＜0.00001]. The relative risks of myocardial infarction [RR=0.62, 95%CI (0.39-0.97), P=0.04] and cranial neuropathy [RR=0.07, 95%CI (0.03-0.16), P＜0.00001] was significantly less after CAS than after CEA. The relative risks of death [RR=1.27, 95%CI (0.82-1.96), P=0.29] or disabling stroke within 30 days [RR=1.33, 95%CI (0.78-2.28), P=0.29] and any stroke or death at 1 year after the procedures [RR=0.96, 95%CI (0.63-1.46), P=0.84] did not differ significantly between CAS and CEA operation. Conclusions CEA remains the first choice for treatment of carotid stenosis for patients with low surgery risk. For patients with high surgery risk and unsuitable for surgery, CAS has more advantages. It is reasonable to view CAS and CEA as complementary rather than competing modes of therapy.

Objective:To systematically evaluate the effect of cognitive behavior therapy for insomnia on sleep quality of pregnant women.Methods:The PubMed, Cochrane Library, Embase, Web of Science, CNKI, CBM, VIP and Wanfang databases were searched from the establishment of the database to August 2021 for relevant studies on the impact of cognitive behavior therapy for insomnia on the sleep quality of pregnant women. Relevant randomized controlled trials were included. The data were analyzed by RevMan5.3 software inthisstudy.Results:A total of 8randomized controlled trials were included. The results indicated that cognitive behavior therapy for insomniacould improve the sleep quality of pregnant women ( SMD = -0.75, 95% CI -1.20 - -0.30, P<0.05). Face-to-facecognitive behavior therapy for insomniasignificantly improved sleep quality ( SMD = -1.14, 95% CI -1.85 - -0.42, P<0.05). Conclusions:Existing evidence indicates that cognitive behavior therapy for insomnia can enhance the sleep quality of pregnant women. Face-to-face cognitive behavior therapy for insomniahas better effect.

Objective To explore the life quality of postoperative patients after a hypertensive cerebral hem-orrhage in the basal ganglia and the factors influencing it, so as to provide evidence for improving the life quality of such patients. Methods A total of 128 patients were studied retrospectively. Their gender, age, occupation, mari-tal status, education level, place of residence and family size were tabulated, as well as whether or not they were liv-ing with their children, smoking or drinking alcohol. Their household income was recorded along with their clinical condition during surgery ( midline shift, blood loss, operative time, whether a hernia occurred, consciousness, and whether bleeding broke into the ventricles. The SF-36 health measurement scale was used to evaluate the patients′life quality, and the factors influencing it were analyzed. Results Univariate analysis showed that: ( 1) Their physio-logical functioning ( PF) and global health ( GH) were mainly affected by age, marital status, family size, midline shift, quantity of cerebral hemorrhage, occurrence of herniation, consciousness and whether the hemorrhage broke in-to the ventricles. (2) Their physiological role (RP) was influenced by marital status, education background, household monthly income, midline shift, consciousness and whether the hemorrhage broke into the ventricles. (3) Pain (BP) was mainly affected by marital status and family size. (4) Social functioning (SF) was closely related to marital status, family size, consciousness and whether hemorrhage broke into the ventricles. (5) Their mental health (MH) was main-ly affected by the amount of bleeding, whether they were living with their children, the operation′s duration and whether the hemorrhage broke into the ventricles. (6) Their emotions (RE) were influenced by their consciousness and whether bleeding broke into the ventricles. (7) Their vitality (VT) was affected by their marital status, smoking, consciousness and whether the bleeding broke into the ventricles. Multivariate analysis showed that whether the hemorrhage broke into the ventricles was the most influential factor. Family size was also influential. Conclusions Age, number of family members, whether they are living with their children, and whether hemorrhage broke into the ventricles are all influen-tial in predicting the life quality of survivors of hypertensive cerebral hemorrhage in the basal ganglia.

Objective To evaluate the effects of sevoflurane preconditioning on postoperative cognitive dysfunction in aged rats.Methods One hundred and twenty healthy male Sprague-Dawley rats,aged 18 months,weighing 400-450 g,were randomly divided into 3 groups (n =40 each) using a random number table:control group (group C),operation group (group O),and sevoflurane preconditioning group (group Sev).In group C,the rats were only anesthetized with pentobarbital sodium and did not undergo operation.In group O,the rats were anesthetized with pentobarbital sodium and underwent 30 min of exploratory laparotomy.In group Sev,the rats inhaled 2.4％ sevoflurane for 30 min and then inhaled air for 30 min,and the other procedures were similar to those previously described in group O.At 30 min before operation and on 1st,3rd,5th and 7th days after operation,Morris water maze test was performed to record the escape latency,time of staying at the original platform quadrant and frequency of crossing the original platform.At 30 min before operation and on 1st and 7th days after operation,10 rats in each group were sacrificed and hippocampi were isolated to detect the apoptotic rate and intracellular [Ca2 +] i (using flow cytometry) and the ultrastructure of hippocampal neurons was observed with transmission electron microscope.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,the frequency of crossing the original platform was decreased,and the apoptotic rate and intracellular [Ca2 +] i were increased after operation in O and Sev groups (P ＜0.05).Compared with group O,the escape latency was significantly shorten,the time of staying at the original platform quadrant was prolonged,the frequency of crossing the original platform was increased,and the apoptotic rate and intracellular [Ca2+]i were decreased after operation in group Sev (P ＜ 0.05).Microscopic examination showed no abnormality in the ultrastructure of hippocampal neurons in group C,and the pathological changes of the ultrastructure of hippocampal neurons were obvious in group O,and were significantly attenuated in group Sev.Conclusion 2.4％ sevoflurane preconditioning can reduce postoperative cognitive dysfunction in aged rats,and regulation of imbalance of calcium homeostasis and reduction of cell apoptosis are involved in the mechanism.

Objective To observe the effects of Yiqi Huoxue Tongluo Jiedu fang (YHTJF) on pneumocyte apoptosis after lung ischemia/reperfusion (I/R) injury (LIRI) in mice and to investigate whether c-Jun N-terminal protein kinase (JNK) is involved in the mechanism of apoptosis.Methods Seventy C57BL/6J male mice were randomly divided into seven groups:normal control group (C group),carboxyl methyl cellulose-Na+normal control group (CMC-Na+C group),CMC-Na+sham group (CMC-Na+S group),CMC-Na+I/R group (CMC-Na+I/R group) and CMC-Na+YHTJF-low,-middle,-high dose groups (CMC-Na+YL,CMC-Na+YM,CMC-Na+YH groups).C group did not undergo any processing;in CMC-Na+S group,only was chest opened without clipping the lung hilum;in the rest of the four groups,they all underwent opening of the chest and clipping the lung hilum for 30 minutes,then the clipping of artery was relieved and left lung reperfusion was carried out for 3 hours.After operation,the mice were sacrificed,the lung tissues were harvested.Under light and electron microscopes,the lung morphological and ultra-structural changes were observed,and the changes of index of quantitative evaluation for alveolar damage (IQA) were determined.The terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) was applied to evaluate the apoptosis index (AI) of the lung tissues.The protein and mRNA expressions of JNK and glucose regulating protein 78 (GRP78) in lung tissues were detected by Western Blot and reverse transcription-polymerase chain reaction (RT-PCR);the correlations between lung AI and the expressions of mRNA and protein of JNK and GRP78,IQA were analyzed.Results Compared with CMC-Na+S group,IQA,AI and mRNA and the protein expressions of JNK and GRP78 in CMC-Na+I/R group were obviously higher [IQA:(74.00 ± 7.31)％ vs.(7.00 ± 1.23)％,AI:(64.40 ± 11.97)％ vs.(5.60 ± 1.14)％,JNK mRNA (gray value):1.143 ± 0.284 vs.0.152 ± 0.128,GRP78 mRNA (gray value):0.897 ± 0.129 vs.0.284 ± 0.044,JNK protein (A value):0.428 ± 0.074 vs.0.073 ± 0.052,GRP78 protein (A value):1.075 ± 0.145 vs.0.589 ± 0.060].Compared with CMC-Na+I/R group,the IQA,AI,protein and mRNA expressions of JNK and GRP78 in CMC-Na+YL,CMC-Na+YM,CMC-Na+YH groups were all lower,and the degree of reduction in group CMC-Na+YM was the most remarkable,greater than that in CMC-Na+YL or CMC-Na+YH group [IQA:(26.20 ± 3.35)％ vs.(34.00±5.34)％,(41.20±9.18)％,AI:(29.40±3.05)％ vs.(48.20±3.83)％,(39.20±6.14)％,JNK mRNA (gray value):0.681 ± 0.130 vs.0.804 ± 0.153,0.938 ± 0.11,GRP78 mRNA (gray value):0.450 ± 0.105 vs.0.747 ± 0.231,0.566 ± 0.115,JNK protein (A value):0.188 ± 0.049 vs.0.261 ± 0.065,0.209 ± 0.063,all P ＜ 0.01],compared with the CMC-Na+I/R group,the expression of GRP78 protein was obviously higher in CMC-Na+YH,CMC-Na+YL,CMC-Na+YM groups and the most remarkably high was in CMC-Na+YH group (A value:1.429 ±0.226 vs.1.130±0.169,1.128 ±0.177,all P ＜ 0.01).The apoptosis of each group was mainly in the pulmonary vascular endothelial cells and alveolar epithelial cells,and brown particles were positive cells under light microscope.Under transmission electron microscope:nuclear pyknosis and margination under the nuclear membrane,cytoplasm condensed,lamellar bodies decreased and emptying increased,cell membrane microvilli decreased or disappeared,mitochondria swelling,inflammatory cells increased in alveolar septum and adhering onto the capillary walls could be seen in CMC-Na+I/R group.Compared with CMC-Na+I/R group,the lung tissue ultrastructural damage alleviated,ultrastructure of alveoli clearly seen,nuclear chromatin relatively uniform,cytoplasm increased,type Ⅱ alveolar epithelial cell surface microvilli relatively plenty,lamellar corpuscle number increased,mitochondria swelling ameliorated in CMC-Na+YH,CMC-Na+YL,CMC-Na+YM groups and the most remarkable one was CMC-Na+YM group.AI was significantly positive correlated with the mRNA and protein expressions of JNK,GRP78 and IQA (r =0.907,0.928,0.880,0.712,0.911,all P ＜ 0.01).Conclusions YHTJF may effectively alleviate the cell apoptosis in mice LIRI,and its mechanism may be related to the inhibition of JNK pathway.

Objective: To evaluate the effectiveness for the construction of "mosquito-free village" in Xuejia Village, Pujiang County, Zhejiang Province, so as to provide the guidance for the construction of "mosquito-free village" in other rural areas. Methods: Density of adult mosquitoes in Xuejia Village was investigated using light trap method and density of larval mosquitoes was investigated using larval straw method from April to November each year. Totally 30 households of villagers were randomly selected, and their awareness rates of mosquito control knowledge, mosquito control behavior forming rates and satisfaction rates were surveyed through questionnaires. Investment during construction (from August 2016 to December 2018) and maintenance period (from 2019 to 2023) of "mosquito-free village" were investigated through data review and interviews. Long-term effects of "mosquito-free village" construction in Xuejia Village were evaluated in terms of mosquito density from 2016 to 2023, effectiveness of health education for villagers, satisfaction and investment. Results: Compared with the year 2016, the densities of adult and larval mosquitoes in Xuejia Village were significantly decreased from 2017 to 2023. The average monthly density of adult mosquitoes in 2023 decreased by 98.34%, and the average monthly 100 household index of larval mosquitoes decreased by 98.45% compared to 2016. The average monthly density of adult mosquitoes from 2019 to 2023 was less than or equal to one mosquito per light trap in a night, and the average monthly 100 household index of larval mosquitoes was less than or equal to five places per 100 households. The awareness rate of mosquito control knowledge was 93.33%, the behavior forming rate was 86.67%, and the satisfaction rate was 90.00%. By December 2023, the total investment during construction and maintenance period was 450 thousand Yuan, with an average annual investment of 60.7 thousand Yuan and average annual investment of 206.61 Yuan per household. The average annual investment during maintenance period was 36.2 thousand Yuan, and the average annual investment per household was 109.70 Yuan. Conclusion The mosquito density, effectiveness of health education for villagers and satisfaction of "mosquito-free village" in Xuejia Village all meet the evaluation criteria of "mosquito-free village", and the investment is reasonable, making it suitable for promotion to other rural areas.

Objective To investigate the effect of contrast-enhanced ultrasonography (CEUS) on the treatment of knee synovial lesions in rheumatoid arthritis (RA).Methods The results of routine ultrasonography (US) and CEUS were observed in 37 patients with RA.Among them 26 knees were underwent review after treatment.The results before and after treatment were compared.Results Routine US showed that the synovial thickness of patella,medial and lateral condylar and the depth of suprapatellar bursa effusion in 37 knee joints were (0.47 ± 0.26)cm,(0.31 ± 0.15)cm,(0.36 ± 0.21)cm and (0.72 ± 0.42)cm before treatment,and (0.36± 0.16)cm,(0.28 ± 0.17)cm,(0.30 ± 0.19)cm and (0.41 ± 0.19)cm in 26 knee joints after treatment,respectively,the differences were statistically significant(P ＜0.05).The synovial blood flow classification of patella,medial and the lateral condyle in the 26 knee joints had difference between before and after treatment (P ＜0.05).CEUS showed that the peak intensity decreased,the area under the curve reduced,the time from peak to one half decreased,the wash in slope decreased and the time to peak prolonged in synovial after treatment,the differences of the parameters between before and after treatment were statistically significant(P ＜0.05).The area of synovial had some influence on the CEUS parameters and could improve the reliability of the evaluation to CEUS for treatment.Conclusions CEUS is an objective method to evaluate the efficacy of RA,which provides a reliable basis for clinical treatment of RA.

Objective To compare four therapies for elderly patients with cerebellar hemorrhage breaking into the ventricles.Methods Clinical data of 158 elderly patients with severe spontaneous cerebellar hemorrhage breaking into the ventricles were retrospectively analyzed.There were 28 cases in the conservative management (CM) group and 130 cases in the surgical therapy (ST) group with an external ventricular drainage (EVD) subgroup (n=40),an external ventricular drainage combined with intraventricular fibrinolysis (EVD + IVF) subgroup (n =43),and a clot evacuation (CE) subgroup (n=47).The mortality at 1 month and modified Rankin Scale (mRS) at 6 months were employed to evaluate clinical effectiveness.In addition,statistical analysis of correlative factors for prognosis was conducted.Results The 1-month mortality (x2 =7.529,P =0.006) and 6-month mRS in the CM group (x2 =4.819,P =0.028) were significantly higher than those in the ST group.There was no significant difference in mortality after one month among the three ST subgroups (x2 =0.143,P=0.931),whereas significant differences were observed in 6-month mRS among them (x2 =7.209,P=0.027),and the scale in the EVD+IVF subgroup was significantly lower than in the CE and EVD subgroups.The incidence of complications such as pulmonary infections and stress ulcers in the CM group was significantly higher than in the ST group.Statistical differences were found in the incidence of pulmonary infections among the three ST subgroups (x2 =6.694,P=0.035),and the incidences in the EVD subgroup and the EVD+IVF subgroup were lower than the incidence in the CE subgroup.Nevertheless,there was no significant difference in the incidence of stress ulcers among the three ST subgroups (x2 =0.547,P=0.776).Conclusions EVD+ IVF is an effective treatment for cerebellar hemorrhage breaking into the ventricles in elderly patients,especially for those who cannot withstand a craniotomy or those who have primary diseases.It may speed up the absorption of hematoma,and decrease the operative risk and the incidence of postoperative complications.

Objective:To explore the mechanism of miR-205-5p/E2F1 signal axis in regulating the glioma U251, U87 radiotherapy resistance.Methods:X-ray gradual ascending and intermittent induction method was used to irradiate the glioma U251 cells to establish U251/TR, U87/TR radiation-resistant cell lines. Then, the morphology, migration, invasion and proliferation abilities of cells (U251/TR, U87/TR radiation-resistant cells and U251, U87 radiation-sensitive cells) were analyzed. Luciferase gene detection system and point mutation technique were employed to analyze the mechanism of miR-205-5p and E2F1 gene activity on U251 and U87 radiation-resistant cell lines.Results:Compared with the radiation-sensitive U251 cells, the radiation-resistant cells U251/TR, U87/TR showed increased proliferation activity, enhanced migration and invasion abilities and decreased apoptosis under X-ray irradiation. miR-205-5p mimics transfection could down-regulate the expression of E2F1 factor in U251/TR cells, inhibit cell proliferation, invasion and migration and increase the radiosensitivity of U251/TR cells. miR-205-5p mimics transfection combined with with E2F1 down-regulation exerted anti-tumor effect and decreased cell tolerance by suppressing the Wnt/β-catenin signaling pathway activity.Conclusions:The glioma radiation-resistant cell line U251/TR, U87/TR can be established by X-ray gradual ascending and intermittent induction method. The miR-205-5p/E2F1 signal axis exerts tumor-suppressing effect through the classical Wnt/β-catenin signaling pathway, which can be used as an therapeutic target to increase the radiosensitivity of glioma.

Objective:To investigate the epidemic characteristics and current situation of animal plague in Zhejiang Province, in order to provide data support for prevention and control of the plague in the whole province.Methods:A retrospective study was carried out to collect surveillance data of animal plague in Zhejiang Province from 2006 to 2020 from the "Pubonic Plague Control Management Information System". Descriptive epidemiological methods were used to analyze the density of domestic and wild rodents, the distribution of rodent species and flea species, and the serological and pathogenic test results of host animals.Results:From 2006 to 2020, the annual average density of domestic rodent in Zhejiang Province was 3.99%, which was lower than that in 2006, 2007, 2008, 2009, 2019 and 2020. The annual average density of wild rodents was 4.52%, which was lower than that in 2013, 2016, 2017, 2018, 2019 and 2020. From 2006 to 2020, a total of 173 432 rodents were captured, belonging to 3 orders, 5 families, 12 genera and 17 species; in the composition of rodent species, Rattus norvegicus was the most, accounting for 32.15% (55 765/173 432). A total of 107 736 rodents were examined, the number of flea-infected rodent was 3 885, and the flea-infested rate was 3.61%; the total number of flea collected was 9 039 and the total flea index was 0.083 9. A total of 172 235 serological samples were tested at various monitoring sites in Zhejiang Province, and 10 positive samples were detected, there were 7 copies of Apodemus agrarianus, 2 copies of Smelly Shrew and 1 copy of Rattus norvegicus, with titers ranging from 1 ∶ 40 - 1 ∶ 320; a total of 163 618 copies of rodent liver and spleen organs were cultured, and no Yersinia pestis was isolated. Conclusions:Positive host animals have been detected in Zhejiang Province for many years. It is necessary to further standardize plague surveillance and make emergency preparations to prevent relapse and import of the epidemics.