Objective To investigate the association between extensive perivascular space(EPVS)burden in different locations and ischemic stroke(IS),its subtypes,and transient ischemic attack(TIA)through Mendelian randomization(MR)analysis.Methods The summary data from large-scale Genome-wide Association Studies(GWAS)and various MR methods were employed.We applied multivariable MR to mitigate potential confounding factors and conduct sensitivity analyses to enhance result robustness.Subsequently,meta-analysis was utilized to integrate causal relationships between EPVS burden in different locations and IS from various sources.Additionally,reverse MR was employed to observe the impact of various IS types on EPVS burden.Finally,linkage disequilibrium score regression was conducted to assess genetic correlations between exposures and outcomes.Results EPVS burden in both the white matter(OR=1.12,95％CI:1.01-1.25;P=0.04)and basal ganglia(OR=1.57,95％CI:1.30-1.89;P＜0.01)are significant risk factors for IS.EPVS burden in the basal ganglia is also a risk for IS(small-vessel)(OR=4.56,95％CI:2.57-8.27;P=5.95× 10-7).After IS and TIA there seems to be a potential increase in extensive basal ganglia perivascular space burden.Conclusions Extensive white matter perivascular space burden and extensive basal ganglia perivascular space burden may serve as important indicators to predict IS.

Objective To investigate the association between extensive perivascular space(EPVS)burden in different locations and ischemic stroke(IS),its subtypes,and transient ischemic attack(TIA)through Mendelian randomization(MR)analysis.Methods The summary data from large-scale Genome-wide Association Studies(GWAS)and various MR methods were employed.We applied multivariable MR to mitigate potential confounding factors and conduct sensitivity analyses to enhance result robustness.Subsequently,meta-analysis was utilized to integrate causal relationships between EPVS burden in different locations and IS from various sources.Additionally,reverse MR was employed to observe the impact of various IS types on EPVS burden.Finally,linkage disequilibrium score regression was conducted to assess genetic correlations between exposures and outcomes.Results EPVS burden in both the white matter(OR=1.12,95％CI:1.01-1.25;P=0.04)and basal ganglia(OR=1.57,95％CI:1.30-1.89;P＜0.01)are significant risk factors for IS.EPVS burden in the basal ganglia is also a risk for IS(small-vessel)(OR=4.56,95％CI:2.57-8.27;P=5.95× 10-7).After IS and TIA there seems to be a potential increase in extensive basal ganglia perivascular space burden.Conclusions Extensive white matter perivascular space burden and extensive basal ganglia perivascular space burden may serve as important indicators to predict IS.

Objective:To evaluate the diagnostic value of neck imaging reporting and data systems (NI-RADS) based on MRI in extracavity local recurrent nasopharyngeal carcinoma (ELRNPC) and posttreatment changes (PTC).Methods:From April 2015 to September 2020, 33 cases of ELRNPC and 37 cases of PTC confirmed by pathology or follow-up were retrospectively enrolled at Zhongshan City People′s Hospital. Two radiologists independently evaluated the conventional MRI findings using NI-RADS criteria in the first step, then evaluated with conventional MRI and diffusion weighted imaging (DWI) sequences in the second step. All images were re-evaluated by one senior radiologist in the same steps after three months. Inter- and intra-reader agreements were assessed with Cohen′s Kappa test. Receiver operating characteristic curves were generated to assess the diagnostic values of NI-RADS categories between ELRNPC and PTC. The area under the curve (AUC) was compared by Delong test.Results:Inter- and intra-reader agreements of Kappa value were 0.742 and 0.909 for conventional MRI and 0.807 and 0.934 for conventional MRI with DWI. In the differential diagnosis of ELRNPC and PTC, the AUC, sensitivity, and specificity of NI-RADS categories based on conventional MRI were 0.932 (95%CI 0.846-0.978), 87.9% (95%CI 71.8%-96.6%), 94.6% (95%CI 81.8%-99.3%), and of NI-RADS based on conventional MRI with DWI were 0.991 (95%CI 0.933-1.000), 93.9% (95%CI 79.8%-99.3%), 97.3% (95%CI 85.8%-99.9%), respectively. There was a statistical difference between the AUCs of the two categories ( Z=2.20, P=0.028). Conclusions:For both the NI-RADS based on MRI with or without DWI, the differential diagnostic value of ELRNPC and PTC is excellent, while the consistency and diagnostic performance are more substantial when combined with DWI.

Objective:To investigate the current situation of standardized patient programs and standardized patient educators in China, and to analyze the existing problems in the implementation.Methods:Questionnaire survey was used in this study. The questionnaire was made by Delphi method, and distributed via E-mails or through the internet to medical colleges, affiliated hospitals and general hospitals across the country. Microsoft Office Excel 2016 was used for data reduction and analysis and cartography.Results:A total of 94 medical colleges and hospitals of 27 provinces and municipalities participated in the survey, of which 43.62% had carried out standardized patient programs. The primary factor affecting the program implementation was the lack of standardized patient educators. The existing trainers were mainly clinicians or nurses, and the main way of training the educators was to send them to other universities for learning. A majority of respondents (94.68%) think it is necessary to establish and formulate a unified national certification system for standardized patient educators.Conclusion:The development of standardized patient program is unbalanced in China, and the lack of standardized patient educators has become the primary factor restricting the development. In order to make standardized patients a greater role in medical education, we should encourage different types of personnel to join in the standardized patient training team, to clarify the responsibilities of standardized patient educators, to standardize the process of trainers training, and to establish the certification system of standardized patient educators.

Objective To explore the value of static and dynamic MRI before and after operation of pelvic organ prolapse (POP). Methods 29 patients with POP (POP group)and 12 normal women (control group)underwent static and dynamic MRI.The morphologic changes of pelvic floor were observed on MR images.The measurements of bladder,uterus,Douglas pouch to pubococcygeal line (B-PCL,U-PCL,D-PCL),the puborectal hiatus line (H-line),muscular pelvic floor descent (M-line),the levator hiatus size (LHS),the levator plate angle (LPA),the iliococcygeus angle (ICA)and the urethral inclination angle (UA)were recorded on dynamic MR images.Results 19 cystoceles,28 uterine prolapses,4 rectoceles and 14 hernias of Douglas pouch were detected with MRI.29 cases of pelvic floor relaxation,27 cases of levator ani muscle defect and 24 cases of pubocervical fascial defect were found.The values of B-PCL,U-PCL, D-PCL,H-line,M-line,LHS,LPA,ICA and UA of POP group were larger than control group (P<0.01).The positions of pelvic organ returned to normal in 9 cases of 21 postoperative cases,while 12 cases remained prolapses.There was no displacement of mesh in 8 cases of mesh implant.The values of B-PCL,U-PCL,D-PCL,UA after operation were smaller than those before operation (P<0.05).Conclusion Static and dynamic MRI can evaluate morphological and functional changes of pelvic floor before and after operation of POP comprehensively,and may reveal those invisible pelvic floor dysfunction and postoperative remnant defects.

Objective To establish a simple,rapid and sensitive nucleotide polymorphisms genotyping method in order to conduct the routine clinical detections under the simple laboratory condition by this method.Methods Based on the ligase-agarose gel electrophoresis,the oligonucleotide detection probes of mutational sites was designed.The detection underwent the detection probe connecting,purification and universal amplification,finally the mutation genotypes of detection sites were judged by the ap-peared bands in the agarose gel electrophoresis(AGE).With the 3 SNP sites EGFR,c.2573T>G(L858R),EGFR,c.2582T> A (L861Q)and EGFR,c.2155 G>T(G719C)in epidermal growth factor receptor(EGFR)gene as the detection objects,the plasmid template and plasma circulating DNA sample in lung cancer were performed the detection.Results The established method was easy to operate with higher specificity and sensitivity.After 20-30 cycles of PCR amplification,the genotype of detection sites was clearly estimated according to the amplification band.When detecting the mixed alleles in the heterogeneous sample,minimal 2.5%mutation alleles could be detected out.This method and the direct sequencing method could respectively detect 6 cases and 2 cases of heterozygotes mutation in the SNP site of L858R among 62 samples of lung cancer.Conclusion The established detection method for SNP genotyping is suitable to the routine mutation detection on the heterogeneous samples under the simple laboratory condi-tion.

Objective To explore the MRI findings of ovarian cancer peritoneal carcinomatosis (PC).Methods MRI findings of 34 cases with advanced ovarian cancer and PC confirmed by operation and pathology were reviewed retrospectively.MRI protocols included T1 WI,T2 WI,MRH,DWIBS,and gadolinium-enhanced 3D THRIVE sequences.The type of ovarian tumor and MRI manifestations of PC were analyzed.Results All of the ovarian tumors and PC lesions were high signal intensity in DWIBS.All of the ovarian tumors were shown as mixed cystic solid masses,including type Ⅱa in 12 cases,type Ⅱb in 7 cases,and type Ⅱc in 1 5 cases.The MR manifestations of PC were described as follow:linear thickening of the peritoneum (n=2),irregular linear thickening of the peritoneum (n=27);smudged thickening of the omentum (n=1 9),cake-like thickening of the omentum (n=1 1);fouling-appearance of the mesentery (n=4);plaque,nodule and mass in the abdominal cavity (n= 34),cystic mass (n=8).PC lesions were detected in the Douglas’space in 31 cases,paravesical interspace in 24 cases,omentum in 20 cases,paracolic gutter in 9 cases, right subdiaphragmatic / parahepatic space in 1 1 cases,and left subdiaphragmatic / parasplenic space in 10 cases.The primary and PC tumors invaded the rectum in 26 cases,sigmoid in 22 cases,and uterus in 1 6 cases.Ascites and lymphadenectasis in abdomen were seen in 33 and 7 cases,respectively.Conclusion Ovarian cancer PC can be diagnosed accurately by combing DWIBS and con-ventional MRI.

OBJECTIVETo investigate changes in renal function, urine N-acetyl-beta-D-glucosaminidase enzyme (N-AG),liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure (ARF) associated with fish gall bladder poisoning.

METHODSEleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes.

RESULTSAll patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P < 0.05). Kidney biopsy showed that the main damage site was the proximal renal tubule. All eleven patients recovered and were discharged from the hospital.

CONCLUSIONSIngestion of fish gall bladder leads to kidney damage, as well as liver, heart and gastrointestinal tract injury. The mechanism of acute renal function failure is the serious tubular damage, confirming the location of kidney damage. Necrosis of the proximal tubules plays an important role in the development of ARF. Immediate hemodialysis is the most effective treatment.

Adult ; Aged ; Animals ; Female ; Fishes ; Foodborne Diseases ; etiology ; Gallbladder ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; etiology