Cerebral small vessel disease (CSVD) refers to the syndromes of clinical,cognitive,radiographic and pathological manifestations caused by intracranial small vessel disease.Due to the insidious onset of CSVD,unknown etiology,diverse clinical manifestations,and better short-term prognosis,it is easily ignored,resulting in misdiagnosis,missed diagnosis,and non-standard diagnosis and treatment.This article reviews the advances in research on clinical manifestations,imaging features,diagnosis and treatment of CSVD.

Objective The current study was designed to find out the effect of Glucosidorum Tripterygii Totorum(GTT) on the serum level of soluble interleukin-2 receptor(sIL-2R) in patient with ankylosing spondylitis(AS).Method 29 patients with active AS were selected to take GTT(1mg per kg) three times a day for one year.After that,its curative effect was evaluated.The serum level of sIL-2R of these patients was measured by sandwich ELISA method and was compared with that of normal subjects.Result The serum level of sIL-2R in active AS patients was obviously higher than that of the non-active AS patients.(P<0.01).The total effective rate of GTT on AS was 89.6％,while clinical relief rate 27.6％,obvious effective rate 44.8％,effective rate 17.2％ and non-effective rate 10.4％.The patients' serum level of sIL-2R after therapy was significantly lower than that before therapy except patients with no effect.(P<0.05).Conclusion GTT has positive curative effect on active AS patients and could cause obvious decrease of the serum level of sIL-2R.The serum level of sIL-2R can be used as an important index of activity of AS and as a guide of therapy.

Objective To explore the effect of analgesia management on the analgesic effect and the quality of delivery of labor analgesia. Methods The 80 cases were divided into two groups according to the odd number of labor analgesia, the control group without anesthesia nurse labor analgesia, only the anesthesiologist operation, given routine obstetric care. Anesthesia nursing group for labor analgesia by anesthesiologists and nurse by anesthesia on maternal perinatal period health education and pain management, pain score was compared between the two groups (at full dilatation), mode of delivery, postpartum hemorrhage, neonatal asphyxia. Results The total score of pain in the nursing group was 3.9±0.2, while that of the control group was 8.4±0.8, and the difference was statistically significant (t=-38.5872,P=0.000); anesthesia nursing group cesarean delivery, delivery, were 1 cases, 27 cases, 12 cases; the control group were 9 cases, 21 cases, 10 cases, the difference was statistically significant (χ2=7.31, P<0.05) ; the amount of bleedingof anesthesia nursing group (175.5±42.5) ml; the control group was (226.4±52.5) ml, the difference was statistically significant (t=8.621, P<0.05); the incidence of neonatal asphyxia anesthesia nursing group 1 cases (2.5%); the control group was 3 cases (7.5%), the difference was not statistically significant (χ2=0.263, P>0.05). Conclusions During the perinatal period, the labor management and nursing intervention of the parturient women with labor analgesia are significantly reduced, the cesarean section rate is significantly reduced, and the complication rate is reduced.

Anorectal malformations (ARM)comprise a broad spectrum of congenital disorders that account for 25 ％ of gastrointestinal malformations.Despite numerous technical advances for treatment of ARM,complications such as fecal incontinence and constipation still occur and can greatly deteriorate patients' quality of life.It is recognized that lumbosacral spinal cord anomalies in ARM has been an important factor affecting the fecal function after procedure.Researchers have found that lumbosacral myelodysplasia is the common seen complication of ARM and neural cells decreased in lumbosacral spinal cord by the study on animals and human.Due to numerous factos affecting nerve innervation on annrectus and pelvic floor muscle,this review summarizes the nervous system complications and abnormal intervention of human and rats ARMs.The developments of study on ARM complications and intervention are detailed.Then the new direction of the research about the anorectal malformation nervous system is put forward,and the new strategy of improving the prognosis of anorectal malformation surgery is explored.

Objective To investigate the plasma PAF-AH level in initialed type 1 diabetes patients and the association between the PAF-AH gene polymorphism and type 1 diabetes mellitus. Methods155 initialed type 1 diabetes patients and 138 controls were selected in this study. Plasma PAF-AH was determined by PAF-AH Assay kit, and the PAE-AH gene G994t genotypes were detected by PCR. ResultsThe activity of plasma PAF-AH in the patients with type 1 diabetes was significantly lower than that in the controls[ (20.64 ± 6.23)nmol/(min · ml) vs (28.56 ± 4. 11)nmol/(min · ml), P ＜0.05). Compared with control group, the frequencies of the GT genotype on G994T polymorphism between type 1 diabetes patients and controls were not significantly different(8.4％ vs 7. 2％, P ＞0. 05). ConclusionThe activity of plasma PAF-AH in the patients with type 1 diabetes was significantly lower than controls. The G994T polymorphism of PAF-AH gene was not related to type 1 diabetes mellitus.

Objective: To understand the survival status and influencing factors of first-ever stroke patients, so as to provide evidence for improving the quality of life and prognosis of stroke patients. Methods: Demographic information, medical history, smoking history, and alcohol consumption history of newly diagnosed stroke cases first reported in 2017 in Xiaoshan District were collected through the Hangzhou Chronic Disease Surveillance and Management System. Patients were followed up for 5 years, with stroke death as the outcome event. The survival rate was calculated using the Kaplan-Meier method, and factors affecting survival time of first-ever stroke patients were identified using a multivariable Cox proportional hazard regression model. Results: A total of 3 886 patients first-ever stroke patients were included, the cases of cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, and stroke unspecified as to whether it was hemorrhagic or ischemic (unspecified) accounted for 86.93%, 11.45%, 1.06% and 0.57%, respectively. There were 2 047 males (52.68%) and 1 839 females (47.32%), with a mean onset age of (72.01±11.61) years. By the end of the follow-up on December 31, 2022, 906 patients died from stroke, with a median follow-up time of 62.00 (interquartile range, 35.00) months. The 1-year survival rate was 87.35% (95%CI: 86.30%-88.41%), the 3-year survival rate was 82.11% (95%CI: 80.88%-83.34%), and the 5-year survival rate was 76.64% (95%CI: 75.26%-78.02%), respectively. Multivariable Cox proportional hazard regression analysis showed that onset age of ≥75 years (HR=5.543, 95%CI: 3.822-8.039), being treated at township-level hospitals (HR=5.934, 95%CI: 4.027-8.743), history of hypertension (HR=1.566, 95%CI: 1.317-1.863), history of chronic ischemic heart disease (HR=1.611, 95%CI: 1.362-1.906), smoking history (HR=1.455, 95%CI: 1.190-1.778), alcohol consumption history (HR=1.323, 95%CI: 1.067-1.641), stroke subtype of intracerebral hemorrhage (HR=3.442, 95%CI: 2.923-4.053) and unspecified (HR=6.843, 95%CI: 4.353-10.756) were associated with higher mortality risk among first-ever stroke patients. Conclusion The 5-year survival rate of first-ever stroke patients was 76.64%, which was influenced by age of onset, hospital level for diagnosis and treatment, stroke subtype, medical history, smoking and alcohol consumption.

Objective: To investigate the trend in mortality of malignant tumors in Xiaoshan District, Hangzhou City from 2017 to 2022, so as to provide insights into formulation of the malignant tumor control strategy. Methods: Data on mortality of malignant tumors in Xiaoshan District from 2017 to 2022 were collected through Hangzhou Municipal Chronic Disease Monitoring Management System, and the cause of death composition ratio and crude mortality were calculated. The mortality of malignant tumors was standardized by the population of the sixth National Population Census in China in 2010. The trend in mortality of malignant tumors were evaluated with average annual percent change (AAPC). Results: There were 13 301 malignant tumor deaths reported in Xiaoshan District from 2017 to 2022, accounting for 31.26% of the total cause of death and ranking the first among the causes of death. The crude mortality was 186.36/105 and standardized mortality was 106.63/105. There was no significant trend in the crude mortality of malignant tumors in Xiaoshan District from 2017 to 2022 (P>0.05), while the standardized mortality showed a tendency towards a decline (AAPC=-1.409%, P<0.05). The crude and standardized mortality of malignant tumors were higher in men than in women (241.40/105 vs. 133.37/105; 132.66/105 vs. 79.35/105; both P<0.05). There was no obvious trend in the crude mortality of malignant tumors in men (P>0.05), and the standardized mortality showed a tendency towards a decline (AAPC=-3.017%, P<0.05). While there was no obvious trend in the crude and standardized mortality of malignant tumors in women (P>0.05). The crude mortality of malignant tumors showed a tendency towards a decline among residents at ages of 15 to 44 years and 65 years and older (AAPC=-3.933% and -2.413%, both P<0.05). The crude mortality of malignant tumors was higher in men than in women among residents at ages of 0 to 14 years, 45 to 64 years and 65 years and older (all P<0.05). The five most common causes of death included lung cancer, colorectal cancer, liver cancer, gastric cancer and pancreatic cancer, accounting for 66.96% of all malignant tumors. The crude mortality of colorectal cancer from 2017 to 2022 showed a tendency towards a rise (AAPC=2.815%, P<0.05). Conclusions The standardized mortality of malignant tumors showed a tendency towards a decline in Xiaoshan District from 2017 to 2022. Management of malignant tumors should be given a high priority among men at ages of 45 years and older, and lung cancer, colorectal cancer, liver cancer, gastric cancer and pancreatic cancer were leading causes of death.

Objective: To investigate the mortality, probability of premature death and trends due to malignant tumors, cardio-cerebrovascular diseases, diabetes and chronic respiratory diseases in Xiaoshan District, Hangzhou City from 2015 to 2021, so as to provide the basis for the formulation of chronic diseases prevention and control strategies. Methods: The deaths of the four diseases in Xiaoshan District from 2015 to 2021 were collected from Zhejiang Provincial Chronic Diseases Surveillance Information Management System. The crude mortality, standardized mortality and probability of premature death were calculated. The trends in mortality and probability of premature death were analyzed using average annual percent change (AAPC), and the attainment of probability of premature death due to the four diseases was evaluated using the targets of probability of premature death control in 2025 and 2030. Results: Totally 36 130 deaths due to the four diseases were reported in Xiaoshan District from 2015 to 2021. The crude mortality and standardized mortality were 445.20/105 and 237.81/105, which appeared a tendency towards a decline (AAPC=-1.427% and -4.051%, both P<0.05), and the probability of premature death decreased from 9.99% to 7.82%, (AAPC=-4.123%, P<0.05). The standardized mortality of malignant tumors, cardio-cerebrovascular diseases and chronic respiratory diseases appeared a tendency towards a decline (AAPC=-3.017%, -4.999%, and -6.024%, all P<0.05), while there was no significant trend in the standardized mortality of diabetes (AAPC=-0.847%, P>0.05). The probability of premature death due to malignant tumors appeared a tendency towards a decline (AAPC=-4.167%, P<0.05), while there was no significant trends seen in the probability of premature death due to diabetes, cardio-cerebrovascular diseases and chronic respiratory diseases (AAPC=0.638%, -5.250% and -2.022%, all P>0.05). The average probability of premature death due to the four diseases decreased by 4.00% each year, and decreased by 6.64% in 2025 and 5.42% in 2030 as predicted, which were both lower than the target values of 7.99% and 6.99%. Conclusions The mortality and probability of premature death due to the four diseases appeared a tendency towards a decline in Xiaoshan District from 2015 to 2021, with the probability of premature death of malignant tumors decreased significantly. It is predicted that the probability of premature death of the four diseases can reach the target in 2025 and 2030.

Objective: To investigate the trends in incidence of malignant tumors in Xiaoshan District, Hangzhou City from 2015 to 2020, so as to provide the evidence for improving the control strategy for malignant tumors. Methods: Data on incidence of malignant tumors in Xiaoshan District from 2015 to 2020 were collected through Hangzhou Municipal Chronic Disease Monitoring Management System. The crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were calculated, and the trends in incidence of malignant tumors were analyzed using average annual percent change (AAPC). Results: The crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were 476.95/105, 333.30/105, 257.01/105, 28.30% and 425.79/105 in Xiaoshan District from 2015 to 2020, which all appeared a tendency towards a rise (AAPC=4.36%, 3.82%, 3.99%, 3.79% and 5.20%, all P<0.05). The crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were 491.47/105, 313.31/105, 251.51/105, 28.78% and 338.82/105 among men, and both the crude incidence and truncated age-standardized incidence for 35 to 64 years appeared a tendency towards a rise (AAPC=3.00% and 1.73%, both P<0.05), while the crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were 462.98/105, 348.46/105, 262.13/105, 27.74% and 504.91/105 among women, which all appeared a tendency towards a rise (AAPC=5.77%, 5.72%, 5.79%, 5.65% and 7.48%, all P<0.05). The incidence of malignant tumors appeared a tendency towards a rise with age, and the crude incidence of malignant tumors showed a tendency towards a rise among people at ages of 15 to 44 years and 45 to 64 years (AAPC=9.85% and 4.88%, both P<0.05). Lung cancer, thyroid cancer, colorectal cancer, breast cancer and gastric cancer were the five most common cancers, accounting for 59.63% of all malignant tumors, and the incidence of lung cancer, thyroid cancer, colorectal cancer and breast cancer all showed a tendency towards a rise (AAPC=5.90%, 13.01%, 4.60% and 4.47%, all P<0.05). Conclusions The incidence of malignant tumors showed a tendency towards a rise in Xiaoshan District from 2015 to 2020. The rise in the incidence of malignant tumor was higher in females than in males, and malignant tumors tended to develop at a young age. Lung cancer, thyroid cancer, colorectal cancer, breast cancer and gastric cancer are major malignancies that threaten human health in Xiaoshan District.

Objective To evaluate GGT in combination with B ultrasound for the diagnosis of biliary atresia (BA) infants suffering from obstructive jaundice.Methods A retrospective analysis was made on 69 sick infants including 55 BAs and 14 non-BAs as identified by intraoperative cholangiography.The preoperative laboratory GGT and ultrasound data were collected and analyzed.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were compared.Results BA patients had significantly higher GGT than Non-BA patients (t =-4.164,P ＜ 0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of GGT ＞ 306 U/L were 69.1％,92.9％,97.4％,43.3％,73.9％,respectively.In BA group,abnormal gallbladder was significantly associated with proadening portal vein,broadening hepatic artery compared with Non-BA patients (x2 =9.995,P ＜0.05).The accuracy of abnormal gallbladder on ultrasound was 78.3％.When two method combined for the diagnosis of BA,the sensitivity,specificity,positive predictive value,negative predictive value were 92.7％,92.9％,98.1％ and 76.5％ and accuracy can reach 92.8％.Conclusions For obstructive jaundice infants with GGT ＞ 306 U/L and abdominal gallbladder ultrasound finding intraoperative cholangiography should be carried out to make definite diagnosis of BA.