Objective:To analyze the clinical characteristics, treatments and prognoses of carotid artery dissection (CAD).Methods:Nine patients with CAD, admitted to Department of Neurology, Air Force Medical Center of PLA from May 2010 to April 2024, were chosen; the clinical and imaging data, treatments and prognoses (mRS score≤2: good prognosis) of the patients were retrospectively analyzed.Results:(1) Among the 9 patients with CAD, histories of hypertension, diabetes, head and neck trauma, and radiotherapy were noted 3, 2, 4 and 1 patients, respectively; and unclear past history was noted in 1 patient. Carotid ultrasound was performed in 9 patients: slow blood flow of the internal carotid artery with stenosis or occlusion in 7 patients and normal blood flow of the internal carotid artery in 2 patients were noted. MRA in 5 patients showed severe stenosis or subtotal occlusion in the internal carotid artery. DSA in 8 patients showed CAD plus severe stenosis or subtotal occlusion. (2) After ineffective antiplatelet therapy in 3 patients and ineffective anticoagulant therapy in 2 patients, carotid artery stenting (CAS) was performed; direct CAS was given in one patient, and anticoagulant therapy was given in 3 patients. (3) After 3 months of treatment, 9 patients had a good prognosis; carotid ultrasound in 4 patients showed vascular recanalization; MRA re-examination in 3 patients showed vascular recanalization. DSA re-examination in 1 patient showed vascular recanalization; CTA re-examination in 1 patient showed moderate stenosis of the right internal carotid artery.Conclusion:CAD causes are various; CAD should be considered in patients with neck trauma combined with stroke; endovascular treatment should be considered when antiplatelet/anticoagulant therapy are not effective.

Objective:To analyze the clinical characteristics, treatments and prognoses of carotid artery dissection (CAD).Methods:Nine patients with CAD, admitted to Department of Neurology, Air Force Medical Center of PLA from May 2010 to April 2024, were chosen; the clinical and imaging data, treatments and prognoses (mRS score≤2: good prognosis) of the patients were retrospectively analyzed.Results:(1) Among the 9 patients with CAD, histories of hypertension, diabetes, head and neck trauma, and radiotherapy were noted 3, 2, 4 and 1 patients, respectively; and unclear past history was noted in 1 patient. Carotid ultrasound was performed in 9 patients: slow blood flow of the internal carotid artery with stenosis or occlusion in 7 patients and normal blood flow of the internal carotid artery in 2 patients were noted. MRA in 5 patients showed severe stenosis or subtotal occlusion in the internal carotid artery. DSA in 8 patients showed CAD plus severe stenosis or subtotal occlusion. (2) After ineffective antiplatelet therapy in 3 patients and ineffective anticoagulant therapy in 2 patients, carotid artery stenting (CAS) was performed; direct CAS was given in one patient, and anticoagulant therapy was given in 3 patients. (3) After 3 months of treatment, 9 patients had a good prognosis; carotid ultrasound in 4 patients showed vascular recanalization; MRA re-examination in 3 patients showed vascular recanalization. DSA re-examination in 1 patient showed vascular recanalization; CTA re-examination in 1 patient showed moderate stenosis of the right internal carotid artery.Conclusion:CAD causes are various; CAD should be considered in patients with neck trauma combined with stroke; endovascular treatment should be considered when antiplatelet/anticoagulant therapy are not effective.

Objective:To investigate the role of serum hepatitis B virus RNA (HBV RNA) in predicting HBeAg serological conversion in children with chronic hepatitis B.Methods:175 children aged 1~17 years with chronic hepatitis B who received interferon α (IFNα) for 48 weeks were selected. Patients were divided into HBeAg seroconversion and non-conversion based on whether HBeAg seroconversion occurred at 48 weeks of treatment.T-test and Mann-Whitney U test were used to compare between groups; chisquare test or Fisher exact probability method was used to compare the frequency between groups of classified variables; and Pearson correlation was used to analyze the correlation between indicators. Univariate and multivariate logistic regression analyses were used to identify influencing factors associated with HBeAg serological conversion. The predictive effect of HBV RNA, HBV DNA, and HBsAg on HBeAg serological conversion was compared and analyzed by the receiver operating characteristic curve (ROC).Results:The seroconversion rate of HBeAg at 48 weeks was 36.0% (63/175). The reduction in HBVRNA levels from baseline to the 12th, 24th, 36th, and 48th weeks of antiviral therapy was significantly greater in the HBeAg serological conversion group than that in the non-conversion group, and the difference was statistically significant between the two groups (P < 0.05). Univariate and multivariate regression analyses showed that age and a decline in HBV RNA levels at week 12 were independent predictors of HBeAg serological conversion. The area under the ROC curve (AUROC) of HBV RNA decline at week 12 was 0.677(95% CI∶0.549-0.806, P = 0.012), which was significantly better than the same period of AUROC of HBV DNA (0.657, 95% CI∶0.527-0.788, P = 0.025) and HBsAg (0.660, 95% CI∶0.526-0.795, P = 0.023) decline. HBV RNA levels decreased (>1.385 log10 copies/ml) at week 12, with a positive predictive value of 53.2%, a negative predictive value of 72.2%, a sensitivity of 77.4%, and a specificity of 57.9% for HBeAg seroconversion. Conclusion:HBV RNA level lowering during the 12th week of antiviral therapy can serve as an early predictor marker for HBeAg serological conversion in children with chronic hepatitis B.

Objective:To summarize the diagnosis of a flying personnel with moyamoya disease.Methods:The clinical features of an aircrew with moyamoya disease which diagnosed in Air Force Medical Center were summarized and analyzed. Furthermore, the related literatures were reviewed.Results:The patient is a of 41-year-old male navigator. The Navigator usually felt dizzy in the training on the plateau. Also, his anti-anoxia ability was relatively weak. Digital subtraction angiography (DSA) showed the navigator was suffered from the moyamoya disease. Cerebral blood perfusion examination further confirmed moyamoya disease and indicated ipsilateral cerebral blood flow reduction. The conclusion of aviation medicine evaluation was flying qualification, and health level was class B.Conclusions:In most cases, the clinical symptoms of moyamoya disease are usually insignificant, and may not have cerebral infarction. So it’s easy to result in missed diagnosis. Therefore, more attention should be paid on aircrew’s cerebral blood perfusion examination upon his/her clinical symptoms.

Objective:To provide references for the diagnosis and aeromedical evaluation by analyzing the data of the flying personnel with cerebral arterial stenosis.Methods:The clinic and aeromedical evaluation data of the flying personnel, who were diagnosed as cerebral arterial stenosis when they hospitalized in Air Force Medical Center from September of 2009 to September of 2019, were reviewed.Results:Eight male flying personnel, aged 32-53 years old, were diagnosed as cerebral arterial stenosis. Five out of 8 flying personnel had the history of hypertension or smoking, and 2 suffered from arteritis. Among 3 neurological impairment cases, 1 was left carotid artery stenosis and 2 was middle cerebral artery stenosis or occlusion. Those 3 flying personnel were disqualified by aeromedical evaluation. The other 5 flying personnel without neurological impairment included 1 case of left subclavian artery stenosis with left renal artery stenosis, 1 case of intracranial stenosis of the left internal carotid artery, 2 cases of middle cerebral artery stenosis or occlusion, and 1 case of left anterior cerebral artery stenosis. Among them, 4 cases were diagnosed as silent brain infarction. The cerebral perfusion evaluation of those 4 cases indicated normal perfusion of the diseased vessels blood supply. Aeromedical waiver was decided upon the diagnosis as well as the considerations on the aircraft type they flied and their flight duty.Conclusion:The cerebral artery stenosis is living in flying personnel and atherosclerosis would be the main cause. Such clinical features as ischemic stroke or no neurological impairment may occur. The waiver should be considered according to the situations of cerebral perfusion and neurological impairment.

OBJECTIVE：To improve the quality standard of Xiangsha hezhong pills. METHODS ：Based on previous quality standard of Xiangsha hezhong pills ，the items of property observation and microscopic identification were revised. TLC identification methods were established for ginger-processed Magnolia officinalis ，Pogostemon cablin and Atractylodes Lancea （stir-fried with earth ）. HPLC methods were adopted for contents determination of hesperidin ，magnolol and honokiol. RESULTS ： The description of the appearance of Xiangsha hezhong pills should be modified to “yellow brown or brown water pill ”. The description of microscopical identification was adjusted slightly. TLC chromatogram of ginger-processed M. officinalis ，P. cablin and Atractylodes Lancea （stir-fried with earth ）all showed the same color spots in the same position as the corresponding substance control or reference medicinal material ，and the negative samples had no interference. The contents determination were performed on Phenomenex Luna C 18 column with mobile phase consisted of methanol-water （40 ∶ 60，V/V，hesperidin）or acetonitrile- 1％ glacial acetic acid （52∶48，V/V，magnolol and honokiol ）at the flow rate of 1.0 mL/min. The column temperature was 30 ℃. The detection wavelengths were set at 284 nm（hesperidin）or 294 nm（magnolol and honokiol ）. The linear ranges of hesperidin ， magnolol and honokiol were 0.201 8-2.018 μg，0.035 7-0.357 4 μg and 0.028 2-0.282 4 μg（all r＝0.999 9）. The detection limits were 2.0，0.72，0.45 ng；the limits of quantitation were 7.0，2.45，1.61 ng. RSDs of precision ，reproducibility，stability and durability tests were all lower than 3％. The average recoveries were 99.92％，100.49％ and 102.08％（all RSD ＜3％）. CONCLUSIONS ：The study verifies the description of character observation and microscopical identification ，adds TLC identification methods for ginger-processed M. officinalis ，P. cablin and Atractylodes Lancea （stir-fried with earth ）based on previous quality standard of Xiangsha hezhong pills. HPLC methods were adopted to determine the contents of hesperidin ，magnolol and honokiol ，and can effectively improve the quality control standard of the preparation.

Objective:To summarize the diagnosis of a flying personnel with moyamoya disease.Methods:The clinical features of an aircrew with moyamoya disease which diagnosed in Air Force Medical Center were summarized and analyzed. Furthermore, the related literatures were reviewed.Results:The patient is a of 41-year-old male navigator. The Navigator usually felt dizzy in the training on the plateau. Also, his anti-anoxia ability was relatively weak. Digital subtraction angiography (DSA) showed the navigator was suffered from the moyamoya disease. Cerebral blood perfusion examination further confirmed moyamoya disease and indicated ipsilateral cerebral blood flow reduction. The conclusion of aviation medicine evaluation was flying qualification, and health level was class B.Conclusions:In most cases, the clinical symptoms of moyamoya disease are usually insignificant, and may not have cerebral infarction. So it’s easy to result in missed diagnosis. Therefore, more attention should be paid on aircrew’s cerebral blood perfusion examination upon his/her clinical symptoms.

Objective:To provide references for the diagnosis and aeromedical evaluation by analyzing the data of the flying personnel with cerebral arterial stenosis.Methods:The clinic and aeromedical evaluation data of the flying personnel, who were diagnosed as cerebral arterial stenosis when they hospitalized in Air Force Medical Center from September of 2009 to September of 2019, were reviewed.Results:Eight male flying personnel, aged 32-53 years old, were diagnosed as cerebral arterial stenosis. Five out of 8 flying personnel had the history of hypertension or smoking, and 2 suffered from arteritis. Among 3 neurological impairment cases, 1 was left carotid artery stenosis and 2 was middle cerebral artery stenosis or occlusion. Those 3 flying personnel were disqualified by aeromedical evaluation. The other 5 flying personnel without neurological impairment included 1 case of left subclavian artery stenosis with left renal artery stenosis, 1 case of intracranial stenosis of the left internal carotid artery, 2 cases of middle cerebral artery stenosis or occlusion, and 1 case of left anterior cerebral artery stenosis. Among them, 4 cases were diagnosed as silent brain infarction. The cerebral perfusion evaluation of those 4 cases indicated normal perfusion of the diseased vessels blood supply. Aeromedical waiver was decided upon the diagnosis as well as the considerations on the aircraft type they flied and their flight duty.Conclusion:The cerebral artery stenosis is living in flying personnel and atherosclerosis would be the main cause. Such clinical features as ischemic stroke or no neurological impairment may occur. The waiver should be considered according to the situations of cerebral perfusion and neurological impairment.

Objective To explore the direction value of endovascular pressure differences in endovascular management of subclavian steal syndrome (SSS).Methods Eleven SSS patients accepted endovascular management,admitted to our hospital from January 2016 to December 2017,were collected in this study.Before and after operation,pressure-sensing wire was used to measure endovascular pressure differences (mean distal stenosis pressure minus mean proximal pressure),digital substraction angiography (DSA) was used to assess the stenotic rate,transcranial doppler (TCD) was used to assess the steal degrees,and electronic sphygmomanometer was used to measure the systolic pressure differences between bilateral brachial arteries.The pressure differences before and after endovascular management were compared.Before operation,the relations of pressure differences with stenotic rate,steal degrees and systolic pressure differences between bilateral brachial arteries were analyzed.After operation,the relations of pressure differences with stealing and clinical symptom improvements were analyzed.The predictive values of pressure differences and residual stenosis in clinic success were compared.Results (1) After operation,the blood stealing disappeared and the clinical symptoms improved in 10 patients;although residual stenotic rate of one patient decreased obviously,blood stealing and clinical symptoms still existed after operation;the clinic success rate was 90.9％(10/11).(2) Pressure differences before surgery ([11.2±5.7] mmHg) were significantly higher as compared with those after the surgery ([2.5±5.3] mmHg,P＜0.05).(3) Before operation,pressure differences were significantly correlated with stenotic rate (r=0.757,P=0.007) and bilateral systolic pressure differences (r=0.701,P=0.016).Six patients had pressure differences of 6-9 mmHg,enjoying degree I and Ⅱ of stealing,and 5 patients had pressure differences ≥ 10 mmHg,enjoying degree Ⅲ of stealing.(4) After operation,pressure difference was 18 mmHg in one patient without clinic success,but pressure differences were ≤ 3 mmHg in 10 patients with clinic success.(5) Significant difference was noted between the two clinic success indexes (residual stenotic rate ≤ 30％ by DSA and pressure differences ≤ 3 mmHg,P＜0.05).Conclusion Endovascular pressure differences can reflect the hemodynamic changes before and after endovascular management;as compared with residual stenosis,it is better to predict the clinic success after operation;it is useful to guide the endovascular management in the SSS patients.

Objective: To explore the intervention effect of improved nursing measures in the treatment of patients with dystonia with deep brain stimulation in MRI localization. Methods: Twenty patients with dystonia treated with deep brain stimulation from January 2013 to December 2015 were selected as the control group. Twenty patients with dystonia treated by deep brain stimulation surgery with improved nursing from January 2016 to December 2018 were in the experimental group. The primary success rate of MRI localization, examination time related indexes and incidence of adverse reactions after intravenous anesthesia were observed in the 2 groups. Results: The primary success rate of MRI localization in the experimental group (95.00%,19/20) was higher than that in the control group (55.00%,11/20), and the difference was statistically significant (χ²=8.533, P<0.01).The total examination time of the experimental group (33.60±8.27) min was significantly shorter than that of the control group (44.30±13.43) min, and the difference was statistically significant (t=-3.663, P<0.05).The incidence of total adverse reactions to MRI localization after intravenous anesthesia was lower in the experimental group (5%, 1/20) than in the control group (30%, 6/20), and the difference was statistically significant (χ² =4.329, P < 0.05). Conclusions Improved nursing measures can effectively improve the success rate of MRI stereotactic brain target location in patients with dystonia, providing a guarantee for accurate calculation of surgical targets, enabling the operation to achieve the best results, early detection of changes in vital signs during examination, and the close cooperation of the medical team is the guarantee for the smooth completion of MRI examination.