Objective To predict a value of ischemia modified albumin (IMA) levels for assessing secondary cerebral infarction in patients with transient ischemic attack (TIA) in anterior circulation.Methods 105 patients with TIA in anterior circulation admitted to the hospital within 3 hours were retrospectively studied.Combined with ABCD2 score,the correlations of IMA levels at 3 h,6 h and 12 h with secondary cerebral infarction after anterior circulation TIA were analyzed.Results IMA level was 75.28 u/L within 3h after TIA,and the sensitivity and specificity of TIA in anterior circulation were 66.7％ and 76.2％ respectively.In the total of 105 patients,16 cases (15.2％) suffered from secondary cerebral infarction within 7d,and 21 cases (20.0％) within 8～30d.The serum IMA levels were (87.43±19.89)U/L,(63.88±12.51)U/L and (61.21±12.28)U/L at 3h,6h and 12h after TIA,respectively.A simple analysis showed that there was a linear correlation between the IMA level and ABCD2 scores (P=0.000,r=0.666).Kaplan-Meier survival curve analysis showed that the increased IMA level within 3h,and moderate to high ABCD2 score were the risk factors for secondary cerebral infarction after TIA in anterior circulation (P=0.012,0.041).Conclusions Early detection of IMA has a clinical value similar to ABCD2 score to predict secondary cerebral infarction in patients with TIA in anterior circulation.

Objective To investigate the effects of methyprednislone on the expression of tumor alveolar septal cell apoptosis in autoimmune emphysema rats,in order to provide a theoretical basis for Chronic obstructive pulmonary disease(COPD)pathogenesis and it’s treatment.Methods 24 rats were randomly divided into three groups:normal control group (n=8 ),model group (n=8 )and intervention group (methylprednisolone sodium succinate,n=8).Intraperitoneal injection of primary cultured human umbilical vein endothelial cells were given to establish the autoimmune emphysema models,intervention group was injected with methylprednisolone at the meantime,and normal control group was received adjuvant only.Pathological changes were observed in lung tissues stained by hematoxylin eosin,mean liner intercept(MLI)and mean alveolar numbers(MAN)were measured.The localization of VEGF and VEGFR-2 in lung tissues were detected by immunohistochemical analysis.Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)technique was carried out to detect the alveolar septal cells apoptosis. Results The MLI in model group was higher than that in normal control group,while MAN was lower(P<0.05 );MLI in intervention group was lower than that in model group,but the MAN was higher (P<0.05 ).The localization of VEGF and VEGFR-2 in lung tissues in model group were lower than that in normal control group,and those in intervention group were higher than that in model group,the difference were all statistically significant(P<0.05 ).AI of alveolar septal cell in model group was higher than that in normal control group,which in intervention group was higher than that in model group,the difference were all statistically significant(P<0.05).Conclusion The decreasing of VEGF and VEGFR-2 in lung tissues may cause alveolar septal cell apoptosis and contribute to the pathogenesis of autoimmune emphysema of rats.Methyprednislone can alleviate the form of autoimmune emphysema in rats,which may be ralated to the regulation of VEGF and VEGFR-2 expression and inhibition of alveolar septal cell apoptosis.

Objective To investigate the effects of changes of miR-126 and spouty related EVH,domain containing proteinl(SPRED1) after transient ischemic attack(TIA)on prognostic value for pathogenesis of secondary cerebral infarction.Methods Retrospective analysis of the clinical data of 106 patients with TIA was performed.The expression levels of miR-126,SPRED1 and vascular endothelial growth factor(VEGF)in peripheral blood were detected at 3 h,6 h and 12 h after TIA onset respectively.The specificity and sensitivity of miR 126 and SPRED1 in the diagnosis of TIA were analyzed.The miR-126 and SPRED1 levels versus ABCD2 score were compared for evaluating their predictive value in the diagnosis of secondary cerebral infarction within 30 days after TIA onset.Results The miR-126 level was declined after TIA onset at 3 h(9.41±1.04),especially at 12 h(6.59 ±2.78),versus in healthy control (9.35±1.76)(t =-7.764,P=0.000).The SPRED1 level after TIA onset was increased at 3 h(58.05 ± 17.53)pg/L,12 h(82.64 ± 18.60)pg/L versus in healthy control(52.38 ± 13.24)pg/L(t=12.374,P =0.000).A closely negative correlation was found between levels of miR 126 and SPRED1 at 12 h point but not at 3 h and 6 h(r=-0.278,P=0.004).Both miR-126 and SPRED1 levels at 12 h after TIA were implied to sensitivity and specificity evaluation.Additionally,VEGF was significantly increased at 3 h (345.61 ± 76.76) pg/L,6 h (461.65 ±103.87)pg/L and 12 h (519.22 ± 103.55)pg/L after TIA onset as compared with healthy control (107.77± 26.04) pg/L(t =26.569,29.756,34.699,all P =0.000).The decrease of miR-126 and increase of SPRED1 at 12h after TIA indicated high incidences of cerebral infarction but their significance was less than ABCD2 score.Combination of miR 126,SPRED1 and ABCD2 score significantly improved the prediction for cerebral infarction(Z=2.105,P =0.035).Conclusions After the onset of TIA,levels of miR-126 and SPRED1 expression in combination of ABCD2 score can improve predictive value for cerebral infarction development.

Objective To investigate the application potentiality of dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) in showing vascular patterns of hepatic tumors.Methods Total of 65 hepatic tumors were examined with two-dimensional contrast-enhanced ultrasound (2D-CEUS) and dynamic 3D-CEUS and make statistical comparison between two imaging modes in aspects of enhancement patterns,spatial relationships of tumors and vascularity of different hepatic tumors.Results Dynamic 3D-CEUS showed the same enhancement patterns with 2D-CEUS.However,Dynamic 3D-CEUS was superior to 2D-CEUS in the display of spatial relationships of hepatic tumors and vascularity(P ＜0.05).The vascularity between benign and malignant hepatic tumors was statistically significant (P ＜ 0.05).Conclusions Dynamic 3D-CEUS is a useful technique in the differential diagnosis of hepatic tumors as well as 2D-CEUS,and dynamic 3D-CEUS displays the spatial relationship of hepatic tumors and vascularity more visually and comprehensively,which provides additional beneficial information for the diagnosis and therapy of hepatic tumors.

Objective:To explore the value of symptom-oriented clinical lateral thinking training in gynecology internship teaching.Methods:We enrolled a total of 166 medical students of the five-year program of grades 2017 and 2018 who would participate in internships at the First Department of Gynecology of Renmin Hospital of Wuhan University. They were randomly divided into experimental group and control group, with 43 students of grade 2017 and 37 students of grade 2018 in the experimental group and 46 students of grade 2017 and 40 students of grade 2018 in the control group. The experimental group was taught using a symptom-oriented clinical lateral thinking training mode, and the control group was taught using a traditional teaching mode. At the end of the internship, the teaching quality was evaluated by means of an exam and satisfaction survey. The data were analyzed using the t test with the use of SPSS 24.0. Results:For both grades 2017 and 2018, the two groups had similar scores of theoretical knowledge, but the experimental group had significantly higher scores of medical history taking, physical examination, and medical record analysis compared with the control group ( P<0.05); for example, among students of grade 2017, the score of medical record analysis was (37.34±1.08) in the experimental group and (32.18±1.32) in the control group. The experimental group had significantly higher degrees of satisfaction than the control group in terms of doctor-patient communication ability, effective information acquisition ability, clinical case analysis ability, self-learning ability, literature search and review ability, team cooperation ability, and learning interest motivation (all P<0.05). Conclusions:The symptom-oriented clinical lateral thinking training mode can help students master the diagnosis and treatment principles of gynecological diseases, improve their abilities of clinical analysis, doctor-patient communication, effective information acquisition, self-learning, and literature search and review, and motivate their interest in learning.

Objective:To analyzes epidemiological characteristics of COVID-19 and provide evidence for adjustment for COVID-19 prevention and control strategies.Methods:The data of COVID-19 cases in Wuchang district reported as of 19 March, 2020 were obtained from National Notifiable Disease Report System of Chinese Disease Prevention and Control Information System. The software’s of Excel 2010, SPSSS 22.0, Arc GIS10.2 and Joinpoint regression program 4.8.0.0 were used for statistical analysis.Results:A total of 7547 COVID-19 cases had been reported as of 19 March, 2020 in Wuchang district, including 5 448 confirmed cases (72.19 %), 2009 clinical diagnosed cases (26.62 %) and 90 asymptomatic cases case (1.19 %). The age of the cases was (56.65±16.25) years and age ranged from 2 days to 105 years among confirmed cases, 2634 were males (48.35 %) and 2814 were females (51.65 %), 2 492 were retirees (45.74 %). A total of 545 health workers were infected with SARS-CoV-2 (7.22 % of all cases) including 365 confirmed cases and 5 cases have died. A total of 430 cases of death were reported with case fatality rate of 7.89 % (430/5 448), case fatality rate of males (10.9 %, 266/2 634) was higher than that of females (5.82 %, 164/2 814). The first phase of epidemic peak was from January 24 to January 26, the second phase of epidemic peak was from February 1 to February 5 and there was no one of new confirmed case in one day for the first time on March 18. The first four Streets with the highest incidence rates of confirmed cases were Huanghelou Street (1 043.77/100 000), Ziyang Street (627.97/100 000), Yangyuan Street (503.67/100 000) and Shuiguohu Street (486.02/100 000). Compared with females, aged ≤50 years and mild cases of clinical classification respectively, males ( RR=0.690, 95 %CI: 0.322-1.478), aged >50 years ( RR=11.745, 95 %CI: 6.878-20.058), severe cases ( RR=2.317, 95 %CI: 1.789-3.000) and critical cases of clinical classification ( RR=10.794, 95 %CI: 7.997-14.569), and gender time-dependent covariate ( RR=1.392, 95 %CI: 1.053-1.840) were major influencing factors of prognosis of COVID-19 confirmed cases. Conclusions:The gender, ages and occupation of distribution were wide among COVID-19 cases in Wuchang district. Males, aged >50 years, severe cases and critical cases of clinical classification were influencing factors of prognosis of COVID-19 confirmed cases. The standardized management of discharged cases, asymptomatic infected cases and close contact persons were main measures to reduce incidence rates of COVID-19 cases.

Objective To investigate the value of ischemic modified albumin (IMA) and microRNA-126 (miR-126) in diagnosis of posterior circulation transient ischemic attack (PTIA) and in prediction of secondary cerebral infarction.Methods The clinical materials of 112 patients with PTIA were retrospectively analyzed.Serum IMA and miR-126 levels were measured at 3,6 and 12 h,and the correlation between serum IMA,miR-126 levels and PTIA as well as secondary cerebral infarction was analyzed by ABCD2 score.Results Serum IMA level was (54.19 ± 10.10) U/L in 80 healthy controls,and were (85.81 ±20.21),(62.98 ±12.79),(57.66 ±13.39) U/L at 3,6 and 12 h,respectively,in 112 patients with PTIA.and its levels of miR-126 at 6,12 h after PTIA attack were significantly decreased compared with (9.35 ± 1.76) in the healthy controls(P =0.036,P =0.001).In the patients with PTIA,the level of IMA at 3 h was negatively correlated with the level of miR-126 at 12 h (r =-0.3 13,P =0.0 00).When IMA and miR-12 6 levels were 6 7.5 2 U / L and 8.64,the sensitivity and specificity were 73.20,96.20,82.10,81.20,respectively.The followed up was lasted for 30 days in 112 patients with PTIA,and there were 11 cases (9.82％) with secondary cerebral infarction within 7 days,17 cases (15.18％) within 8 to 30 days.The relative risk rate of IMA level at 3 h and miR-126 level at 12 h in secondary ischemic stroke after PTIA were Rr =8.45,9.84;CI:1.10 to 65.03,1.13 to 86.02;P =0.040,0.039.Conclusion The early detection of IMA and miR-126 levels is of great value in diagnosis of PTIA and in prediction of secondary cerebral infarction.

Objective To investigate the value of ischemic modified albumin (IMA) and microRNA-126 (miR-126) in diagnosis of posterior circulation transient ischemic attack (PTIA) and in prediction of secondary cerebral infarction.Methods The clinical materials of 112 patients with PTIA were retrospectively analyzed.Serum IMA and miR-126 levels were measured at 3,6 and 12 h,and the correlation between serum IMA,miR-126 levels and PTIA as well as secondary cerebral infarction was analyzed by ABCD2 score.Results Serum IMA level was (54.19 ± 10.10) U/L in 80 healthy controls,and were (85.81 ±20.21),(62.98 ±12.79),(57.66 ±13.39) U/L at 3,6 and 12 h,respectively,in 112 patients with PTIA.and its levels of miR-126 at 6,12 h after PTIA attack were significantly decreased compared with (9.35 ± 1.76) in the healthy controls(P =0.036,P =0.001).In the patients with PTIA,the level of IMA at 3 h was negatively correlated with the level of miR-126 at 12 h (r =-0.3 13,P =0.0 00).When IMA and miR-12 6 levels were 6 7.5 2 U / L and 8.64,the sensitivity and specificity were 73.20,96.20,82.10,81.20,respectively.The followed up was lasted for 30 days in 112 patients with PTIA,and there were 11 cases (9.82％) with secondary cerebral infarction within 7 days,17 cases (15.18％) within 8 to 30 days.The relative risk rate of IMA level at 3 h and miR-126 level at 12 h in secondary ischemic stroke after PTIA were Rr =8.45,9.84;CI:1.10 to 65.03,1.13 to 86.02;P =0.040,0.039.Conclusion The early detection of IMA and miR-126 levels is of great value in diagnosis of PTIA and in prediction of secondary cerebral infarction.

Objective: To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS). Methods: This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3^rd, 7^th, 14^thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization. Results: The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3^rd [(3.4±1.2) vs.(4.2±1.4)], 7^th[(3.0±1.8) vs.(4.1±1.6)] and 14^thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P<0.01). Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05). Conclusions Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS.