BACKGROUND: Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations. METHODS: This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis. RESULTS: Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender. CONCLUSIONS In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.
Adult ; Blood Pressure/physiology* ; China/epidemiology* ; Follow-Up Studies ; Humans ; Hypertension ; Male ; Middle Aged ; Risk Factors ; Stroke

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective To explore the establishment of nursing work model and clinical application in anuria ward. Methods Established the nursing model of anuria ward in rehabilitation department, including the establishment of neurogenic bladder functional rehabilitation nursing specialist group. Define organizational structure, division of labor and responsibilities, conduct continuous personnel training, education and assessment, formulate standardized procedures for rehabilitation and nursing of neurogenic bladder function, implement bladder function assessment, bladder function training, health education, etc. Stage summary and continuous quality improvement. Results The scores of nurses' theoretical examination, skill assessment, nurses'own satisfaction and doctors'satisfaction were 79.6 ±2.1 and 78.5 ±3.5, 91.3 ±2.3, 93.2±1.8, 92.5 ±2.4, respectively. After the implementation of the model, the scores were 89.2 ±1.8, 87.6 ±2.7, 96.3 ±3.6 and 97.4 ±1.6, 98.6 ±1.3, respectively. Before and after the implementation of the model, the differences were statistically significant (t=-8.755--7.685, P<0.05). The number of days of indwelling urinary catheter, residual urinary volume of bladder, and urinary system infection cases before the implementation of the model were (31.63 ±8.47) days and (263.38 ±18.62) ml, (15.03±3.10) cases, (21.27 ±1.64) days, respectively; and (8.78 ±4.32) days, (79.39 ±17.36)ml, (5.36 ± 1.35) cases, (12.45 ± 1.78) days, respectively after the implementation. There was significant difference between the two groups (t =- 23.643--5.874, P < 0.05). Conclusions The establishment of nursing work model without urinary tube ward it can obviously improve the nurses'theory and skill operation level of bladder function rehabilitation nursing, nurses themselves and doctors, patients'satisfaction to nurses, and significantly reduce the number of days of indwelling catheter, urinary bladder residual urine, urinary tract feeling and hospitalization days. The nursing work mode of no urinary tube ward is normative and operable, and it is worth popularizing in clinic.

Objective To preliminarily investigate the role of Vitamin C in cecal ligation and puncture-induced septic brain injury.Methods Male specific pathogen free (SPF) Sprague-Dawley male rats were randomly assigned into control group,sham operation group,sepsis group and sepsis therapy group.The rats in sepsis group were prepared by cecal ligation and puncture.The rats in sepsis therapy group were injected sodium ascorbate through the tail vein 3 h after the cecal ligation and punature procedure.The animals in other groups were subjected only to subcutaneous bolus injection of 9 g/L saline only.Animals were evaluated by neurologic reflex scores before sacrifice and brain tissues were quickly removed at the indicated time points.Reactive oxygen species (ROS),superoxide dismutase (SOD),malondialdehyde (MDA),nitric oxide (NO),inducible nitric oxide synthase (iNOS) and catalase (CAT) were determined by using enzyme assay kits.Hematoxylin-eosin (HE) staining was used to observe morphological changes in brain tissues.Results The survival rate of the sepsis group (30％ at 7th day) was significantly lower than that of the control group (100％ at 7th day)and sham operation group(100％ at 7th day).The survival rate of the sepsis therapy group (45％ at 7th day)was significantly higher than that of the sepsis group(P ＜ O.05).The neurological reflex assessment began to decrease at 6 h in sepsis group and reached the lowest at 24 h (6.00 ± 0.53).The sepsis therapy group (7.62 ± 0.52) was significantly higher (P ＜ 0.05) than the sepsis group and began to recover at 72 h (8.63 ±0.52).ROS,SOD,MDA,NO and iNOS in the sepsis group and the sepsis therapy group reached a peak at 24 h,which decreased at 72 h.The value in sepsis therapy group was significantly decreased than that in the sepsis group,and the difference was statistically significant(P ＜0.05).CAT changed in the opposition.The SOD/CAT in sepsis group was the highest 24 h after the operation,while the ratio in sepsis therapy group was significantly improved.SOD/CAT and MDA were positively correlated(r =0.968,P ＜ 0.05).HE staining showed significant damage to the brain tissue structure in the sepsis group,however some improvement was observed in the sepsis therapy group.Conclusion Vitamin C can significantly improve the survival rate and encephalopathy prognosis in the cecal ligation and puncture SD rat models.The mechanism may be related to the reduction of oxidative stress.

Objective To investigate the clinical value of three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) sequence in preoperative evaluation of acoustic neuroma.Methods Totally 57 patients with acoustic neuroma confirmed by surgery and pathology were enrolled.All patients underwent preoperative routine head MR and 3D-SPACE sequence.The position,size and shape of the tumors were observed,and the display rate of surrounding cranial nerves was evaluated with 3D-SPACE sequence.The results were compared with those of conventional MRI and operation.Results All 57 patients were found with single tumor.The tumor in 1 patient (1/57,1.75％) limited in the internal auditory canal,and those in another 56 patients (56/57,98.25％) exceed the internal auditory canal crossing growth.The inner auditory canal fundus in 26 patients (26/57,45.61 ％) were completely filled by the tumors,while those in another 31 patients (31/57) were uncompletely filled.3D-SPACE sequence showed 21 patients (21/57,36.84％) with solid type lesions,35 patients (61.40％,35/57) with solid with cystic type lesions and 1 patient (1/57,1.76％) with cystic type lesion.The coincidence rate of lesion types showed with 3D-SPACE sequence and intraoperative findings was 85.96 ％ (49/57).The display rate of trigeminal nerve internal cisternal segment,lower cranial nerves cisternal segment,abducens nerve cisternal segment,facial nerve internal acoustic meatus segment,facial nerve cisternal segment and acoustic nerve cisternal segment was 100％ (57/57),100％(57/57),75.44％ (43/57),50.88％ (29/57),17.53％ (10/57) and 19.30％ (11/57),respectively,all significantly increased compared with those of conventional MRI (all P＜0.05).Conclusion 3D-SPACE sequence can accurately display the relationship between tumor and adjacent cranial nerves,therefore has important clinical value in preoperative evaluation of acoustic neuroma.

Abjective To observe the influence of moxibustion on the bone metabolism of persistent vegetative state patients. Methods A total of 60 patients with persistent vegetative state were divided randomly into the treatment group and control group, 30 in each. Both groups were treated with routine therapy, and the patients used moxibustion on the acupoints of zhongwan, xiawan , qihai and guanyuan. The treatment lasted 12 weeks. The changes of T-lymphoctyte subgroups, serum immunoglobulin were tested and compared before and 12th week after treatment. Result After 12th week treatment, the BMD of distal radius (0.563 ± 0.205 g/cm2 vs. 0.451 ± 0.114 g/cm2, t=2.615), the second lumbar vertebra (0.596 ± 0.108 g/cm2 vs. 0.533 ± 0.127 g/cm2, t=2.069) and the femoral neck (0.567 ± 0.214g/cm2 to 0.463 ± 0.163g/cm2, t=2.117) in the treatment group were significantly higher than those in the control group (Ps＜0.05). The PTH (6.41 ± 0.56 pmol/L vs. 6.72 ± 0.42 pmol/L, t=0.018), CT (217.48 ± 57.35 ng/L vs. 228.46 ± 52.44ng/L, t=0.012) and BGP (9.16 ± 1.57 g/L vs. 10.37 ± 2.37 g/L, t=0.023) in the treatment group were significantly higher than those in the control group (Ps＜0.05). Conclusions Moxibustion can help to treat the bone metabolism of persistent vegetative state patients and prevent the osteoporosis.

Objective To explore the real life experience of family caregivers among mild cognitive impairment (MCI) patients during health care so as to provide a reference for reducing family caregivers burden.Methods From March 2017 to March 2018,we selected 18 family caregivers of community MCI patients in Department of Neurology,rehabilitation and memory outpatient at the Affiliated Hospital of Medical School of Ningbo University as subjects by purposive sampling.Semi-structured interview,a phenomenological approach of qualitative research,was used to collect data,and Colazzi analysis was used to sort out,analyze data and refine theme.Results A total of four themes in real life experience of family caregivers of community MCI patients were extracted including family caregivers lacking knowledge about disease (fear,worry and stigma),family caregivers being with high pressure during health care,compromising and confronting actively,expecting to seek more social supports (eager to learn disease-related knowledge,hope to get relatives' understanding and help,gain community supports and environmental supports).Conclusions Community MCI health care brings negative influences on life of family caregivers.Medical staff,family members and community organization need to provide multi-path support to reduce mental pressure and social economic burden of family caregivers of community MCI patients so as to improve their quality of life.

Activated protein kinase ( AMPK) , an important energy receptor , plays a very important role in regulating organ-ism and the energy metabolism of the cell .AMPK has complex relationship with survival of different types of breast cancer cells .Ac-cording to different conditions , AMPK may exist both anti or promoting effect on tumor .In this review , we summarize the relationship between AMPK and breast cancer related signal pathways , AMP and breast cancer endocrine therapy , breast cancer chemotherapy , ra-diotherapy for breast cancer , treatment of triple negative breast cancer and multi drug resistance of the relationship , we also expound some drugs related to AMPK and used in clinical setting .

Objective As important transcription factors, SOX2, TWIST and SNAIL are closely related to breast cancer me?tastasis. The aim of this study was to explore the expressions of SOX2, TWIST and SNAIL in breast cancer and the relationship between the three factors. Methods We collected 74 specimens of breast cancer and another 74 from paired normal tissue from January 2012 to January 2013. Using immunohistochemistry, we determined and compared the expression of SOX2 in the breast cancer and normal tissues. We also detected the expressions of TWIST and SNAIL proteins and analyzed the relationship of SOX2, TWIST and SNAIL ex?pressions with the clinicopathological characteristics of breast cancer as well as the correlation between the three proteins. Results The expression of SOX2 was significantly higher in the breast cancer than in the normal tissues (25.7% vs 8.1%, P=0.004) and corre?lated with the grade, lymph node metastasis, and TNM stage of breast cancer ( P<0.05) , while the expressions of TWIST and SNAIL were significantly correlated with lymph node metastasis and clinical TNM stages of the malignancy ( P<0.05) . The protein expression of TWIST was correlated positively with those of SOX2 ( Cc=0. 325, P<0.005) and SNAIL (Cc=0.308, P<0.008), and so was that of SNAIL with that of SOX2 (Cc=0.275, P<0.018). Conclusion The SOX2 protein is highly expressed in breast cancer. The expres?sions of SOX2, TWIST and SNAIL are closely related to lymph node metastasis of the malignancy and the three factors are interacted coor?dinatively in the metastasis of breast cancer.

Sox-2(SRY related HMG box-2)is an essential embryonic stem cell gene and a necessary transcription factor for maintaining the proliferation and self-renewal capability of embryonic stem cell .Sox-2 is involved in complex cell signal transduction pathway network and adjusting biological behavior of cells .Expression of Sox-2 is adjusted by different factors in transduction , transla-tion and post-translation levels .In recent years , increasing evidences indicate Sox-2 has an important role in tumor development , growth, proliferation, and metastasis, which is involved in various biological behavior of tumor cells in many types of tumors .This pa-per reviews the role of Sox-2 in adjusting tissue and tumor development and complex cell signal transduction pathway network of Sox -2 and clinical values of Sox-2 in tumor diagnosis and treatment until now .