Objective: To compare the effect of urapidil at different doses on blood pressure and prognosis of patients with acute ischemic stroke (AIS) so as to provide data evidence for its clinical use.Methods: Totally 62 patients with AIS were divided into 3 groups in a prospective study: 20 cases in high dosage group, 21 cases in middle dosage group and 21 cases in low dosage group.All the patients were treated with urapidil and urokinase, and the initial dose of urapidil was 25 mg, 15 mg and 5 mg, respectively.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the patients before and after the treatment were observed, and the US national institutes of health stroke scale (NIHSS), modified Rankin scale (mRS) and activity of daily living scale (ADL) were also evaluated in the follow-ups.Results: The time of blood pressure up to standard in the middle dosage group and low dosage group was longer than that in the high dosage group.At the same time, the time of blood pressure up to standard in the low dosage group was longer than that in the middle dosage group, and the difference had statistical significance (P＜0.05).After the treatment, SBP and DBP at T1 in all the groups were notable lower than those at T0,and those at T2 and T3 were lower than those at T1, and the differences had statistical significance (P＜0.05).After the treatment, the SBP and DBP levels in the high dosage group were lower than those in the middle dosage group and low dosage group, and those in the middle dosage group were lower than those in the low dosage group, and the differences had statistical significance (P＜0.05).The NIHSS, mRS and ADL scores of the middle dosage group were lower than those of the low dosage and the high dosage group (P＜0.05), and there was no significant difference between the latter two groups (P＞0.05).Conclusion: With the initial dose of 15 mg, urapidil can ensure good prognosis on the premise of effective decompression.

Objective To express EV71 VP1 in prokaryotic expression system,initially evaluate the ability of blocking EV71 infection and the neutralizing activity of its polyclonal antibody.Methods Construct the prokaryotic expression plasmid pET30a (+)-VP1.Induced expression in Transetta (DE3) with IPTG and identified by Western blot.After purified with HisBind Protein Purification Kit,its ability of blocking EV71 infection and the neutralizing activity of its polyclonal antibody were analyzed.Results Plasmid PET-30a(+)-VPI was constructed successfully and the objective protein was expressed effectively.The ELISA titer of the polyclonal antibody was 1:3200 while neutralizing titer was 1:16 and the recombination protein lost the ability of blocking EV71 infection.Conclusion The recombination protein can stimulate mice to produce antibodies and the polyclonal antibody shew neutralizing activity but the recombination protein lost the binding activity to receptors probably due to the wrong advanced structure.

Objective To confirm the clinical diagnosis of complete androgen insensitivity syndrome (CAIS) by molecular genetic testing in a large family. Methods PCR was performed to amplify the coding region of androgen gene, followed by direct sequencing in the patients with CAIS and relatives in this family. Results A missense mutation Arg773His was identified in the patients (homozygous) and carriers(heterozygous). Conclusions Mutation Arg773His in the AR gene leads to CAIS in this family. Molecular genetic testing of CAIS facilitates not only prenatal genetic diagnosis but also preimplantation genetic diagnosis and offers genetic counseling for future pregnancies to abandon the transmission of the mutated X chromosome to the coming generation.

Objective: To understand the pathogen spectrum of severe hand, foot and mouth disease (HFMD), and analyze the genetic characteristics of enterovirus A71(EV-A71) in Xianyang in 2018. Methods: Totally 67 specimens of severe cases of HFMD were collected. Enteroviruses associated with HFMD were detected by real-time PCR and the genotypes of enteroviruses were identified by VP4 region of enteroviruses. The nucleotide and amino acid sequences of VP1 region of EV-A71 were analyzed. Results: A total of 30 samples were positive for enterovirus among samples from 67 severe cases with HFMD, including 9 cases of EV-A71, 11 cases of coxsackievirus A6 (CV-A6), 5 cases of coxsackievirus A16 (CV-A16), 2 cases of coxsackievirus A10 (CV-A10) and 2 cases of coxsackievirus A4 (CV-A4). The nucleotide and amino acid homologies of EV-A71 among 4 strains reached 96.7%-99.9% and 99.3%-100% respectively. The 4 strains of EV-A71 belonged to C4a subtypes by phylogenetic analysis. The six amino acid composite model was KADSTV in 4 strains of EV-A71. The EF region and GH region in antigenic determinants of 4 strains of EV-A71 kept consistent with representative reference strains, however, the EV-A71 SZK222 and SZK497 strains developed mutation at site 93 (I93V) of BC loop region. Conclusions EV-A71 and CV-A6 are major agents of severe HFMD in Xianyang in 2018. The genotype of EV-A71 belonged to C4a subtype and the VP1 gene did not show more mutations.

OBJECTIVE To analyze the data of non-invasive prenatal testing based on specific loci of circulating cell-free fetal DNA (cffDNA). METHODS Selected loci of target chromosomes were analyzed by sequence capture and sequencing. Meanwhile, 600 loci were selected from other chromosomes for determining the concentration of cffDNA. RESULTS A total of 768 specific loci were captured on chromosomes 21 and 18, and used to determine whether the two were abnormal. When the minimum concentration of detected cffDNA was set at 3% and the threshold of Z score was set to [-6,6], the specificity of the analysis was 99.37% and the sensitivity was 100%. CONCLUSION A reliable, convenient and low-cost analytical method has been developed. The method requires less sequencing data for non-invasive prenatal testing, and can accurately detect abnormalities of fetal chromosomes 21 and 18, and simultaneously determine the concentration of cffDNA.

Objective:To analyze drug-related problems (DRPs) of hospitalized elderly patients with limited life expectancy.Methods:A total of 261 patients aged ≥ 70 years with limited life expectancy according to the 1-year mortality prediction index, who were admitted in the geriatric ward of Peking Union Medical College Hospital from January 2015 to December 2021 were included. According to Strand system, the categories, medications and interventions of DRPs were analyzed.Results:Among 261 patients, 187 (71.6%) had 672 DRPs. The most common DRPs were related to drug safety, including 271 (40.3%) adverse drug reactions and 149 over dosages (22.2%). A total of 207 drugs were involved in DRPs, and the top 5 classes with higher frequency of DRPs were antiinfectives for systemic use(20.7%,139/672), nervous system drugs(19.4%,130/672), alimentary tract and metabolism drugs(16.5%,111/672), cardiovascular system drugs(16.1%,108/672), and blood and hemopoietic organs drugs(13.7%,92/672). The recommendations were given by pharmacists for all 672 DRPs, and 643 were accepted by physicians (95.7%). The therapy need to be adjusted in 564 recommendations and the medications need to be monitored in 108 recommendations. In recommendations of therapy adjustment, 49.6%(280/564) were related to deprescribing. The deprescribing with higher frequency included antiinfectives for systemic use(29.6%, 83/280), lipid modifying agents(7.9%,22/280) and antithrombotic agents(7.9%,22/280). Patients with severe disability had significantly higher average DRPs(2 vs. 1) and average deprescribing(1 vs. 0) than patients without severe disability( Z=-4.83, Z=-3.61, all P<0.001). Conclusion:Drug safety is the most common DRP in limited life expectancy elderly inpatients, particularly for those with severe disability.

Objective:To explore the value of 5G-based robotic remote ultrasound diagnosis system in musculoskeletal joint injuries.Methods:From March to December 2020, 58 volunteers at a training base who felt musculoskeletal pain or paresthesia were selected and performed both robotic remote ultrasound (remote ultrasound group) and conventional ultrasound (portable ultrasound group). The two types of examinations were compared, the consistency of the two diagnosis results was analyzed by the Kappa test, and the the difference of the diagnosis results was compared by McNemar test.Results:Among the 58 volunteers, 40 cases were positive by both methods and 11 volunteers had 2-3 positive results. There were 59 positive results in the remote ultrasound group and 64 positive results in the portable ultrasound group. The positive rate of the examination sites from high to low was knee joint>foot and ankle joint >hand and wrist joint >shoulder joint>elbow joint, calf and hip. The diagnosis results of the two groups were in good consistency (Kappa=0.782, P<0.001), and there was no statistically significant difference in the diagnosis results between the two groups (χ 2=3.2, P=0.063). Five more diseases with positive results were detected in the portable ultrasound group: 1 meniscus injury, 1 medial collateral ligament injury, 1 soft tissue injury around the metatarsal, 1 biceps tendinitis with effusion and 1 cubital ulnar nerve subluxation. Conclusions:The 5G-based robotic remote ultrasound system has good consistency with conventional ultrasound in the diagnosis of musculoskeletal injures. It can be applied to the ultrasound diagnosis of musculoskeletal joint injuries in remote areas.

Objective:To explore the value of 5G robotic remote ultrasound in the diagnosis of plateau pulmonary edema(HAPE).Methods:A total of 27 patients who quickly entered Nagqu, Tibet at an altitude of 4 600 m-5 600 m from March to December 2021 and developed one of the clinical symptoms of HAPE were collected. All patients were examined by 5G remote robotic ultrasound and lung CT respectively. Kappa test was used to analyze the consistency of the two diagnostic results, and McNemar test was used to compare the difference in diagnostic results. The ROC curve was used to analyze the sensitivity and specificity of remote lung ultrasound scores in the diagnosis of HAPE.Results:Among the 27 patients, 16 showed thickening of pleural line, increasing of B line, lung consolidation, pleural effusion, etc. Meanwhile, 11 showed no abnormality. Additionally, 8 cases had diffuse pulmonary fluid in both lungs, and 8 cases had localized pulmonary fluid. ROC curve showed that the area under the curve of lung ultrasound score for the diagnosis of HAPE was 0.947 (95% CI=0.78-0.99, P<0.001). The sensitivity and specificity were 0.933 and 0.917, respectively. Lung CT diagnosis was positive in 15 cases. Lung CT showed thickening of lung texture, ground glass, small nodular shadow, fine reticulate shadow, etc. The diagnostic results of the two techniques were in good agreement (Kappa=0.924, P<0.001), and there was no significant difference between the two methods ( P>0.05). Conclusions:5G remote robotic ultrasound has high consistency with CT in the diagnosis of HAPE and is an alternative early diagnosis method for HAPE. It may have clinical application value in scattered medical resources and remote plateau areas.

Objective:To explore the value of conventional ultrasonography combined with cervical compression in the diagnosis of orbital venous malformation (OVM).Methods:A total of 43 patients with suspected OVM were admitted in sequentially from January 2019 to July 2022 in the Third Medical Center of PLA General Hospital. All patients were examined by ultrasonography combined with cervical compression and demonstrated by operation or digital subtraction angiography (DSA). The conventional ultrasound features of OVM were summarized, and the value of conventional ultrasonography combined with cervical compression in the diagnosis of OVM was discussed.Results:The features of the conventional ultrasound combined with cervical compression for diagnosis of OVM were as follows: the interior of lesion was mainly tubular structure, and the compression test was positive. After cervical compression, the lesion enlarged and the inner diameter of the internal tubular structure widened. Doppler flow imaging showed that the interior of lesion was mainly venous blood flow. Compared with the results of postoperative pathology or DSA, the sensitivity, specificity, accuracy and positive predictive value of ultrasonography combined with cervical compression were 0.952, 1.000, 95.3% and 100%, respectively. The results of Fisher exact diagnosis showed that there was no significant difference between ultrasonography and operation or DSA of OVM( P>0.05). Conclusions:Conventional ultrasound combined with cervical compression can be used as an effective method for the diagnosis of OVM.

Background It has been found that fluoride may cause cell damage by inducing intracellular calcium overload. Store-operated calcium entry (SOCE) plays an important role in maintaining intracellular calcium homeostasis, but the effect of fluoride on renal SOCE is unknown. Objective To explore the renal toxicity and the expression levels of the key proteins of SOCE, stromal interaction molecule 1 (STIM1) and calcium release-activated calcium modulator 1 (ORAI1) in the kidney tissues of mice exposed to fluoride subchronically. Methods Twenty male ICR mice were randomly divided into four groups with five mice in each group, including 0 (control group), 0.3, 3, and 30 mg·L⁻¹ fluoride groups. The mice were given drinking water containing designed fluoride for 12 weeks. Body weight and liver and kidney organ coefficients of the mice were measured after the exposure; histopathological changes of the mouse kidney were observed; 24 h urine was collected at the end of 12 weeks of exposure to determine the levels of urine creatinine (UCr), urine calcium (UCa), albumin (ALB), and β2-microglobulin (β2-MG); the protein expression levels of STIM1 and ORAI1 in the kidney were detected by Western blotting; the fluorescence co-localization of STIM1 and ORAI1 was used to further verify the expression levels of STIM1 and ORAI1. Results After the exposure, there were no differences in body weight as well as liver and kidney organ coefficients among the groups (P > 0.05). Under optical microscope, the renal tubular cell showed degeneration, apical protrusion, shedding, and dilation in the 3 and 30 mg·L⁻¹ fluoride groups. There was no statistical difference in UCr among the mice in each group (P > 0.05). Compared with the control group, the levels of UCa adjusted by UCr in the 3 and 30 mg·L⁻¹ fluoride groups were (0.075±0.014) and (0.081±0.012) mol·mol⁻¹ (represent by UCr per mol), which had a rising trend but showed no statistical difference. No difference was identified in the level of ALB among the groups (P > 0.05). The levels of β2-MG showed difference in different exposure groups, and the level of urine β2-MG in the 30 mg·L⁻¹ fluoride group was (0.077±0.014) g·mol⁻¹, higher than that in the control group (P<0.05). Based on the results of Western blotting, the protein expression levels of STIM1 and ORAI1 showed significant differences among the groups (F=18.411, 6.853; P=0.001, 0.013); compared with the control group, the expression levels of STIM1 protein increased in the 3 and 30 mg·L⁻¹ fluoride groups (P < 0.05), and the protein expression level of ORAI1 in the 30 mg·L⁻¹ fluoride group was increased (P < 0.05). The fluorescence co-localization results of STIM1 and ORAI1 showed that the expressions of STIM1 and ORAI1 were up-regulated in the 3 and 30 mg·L⁻¹ fluoride groups. Conclusion Subchronic exposure to fluoride through drinking water can up-regulate the expression levels of STIM1 and ORAI1 in renal tissues and induce renal injury.