Objective To investigate the predictive value of labor progress angle (AOP), fetal head descent distance (HPD) and their change rates in the outcome of vaginal trial of cesarean scar uterus. Methods A total of 170 pregnant women who underwent vaginal trial production of scar uterus after cesarean section were selected as study subjects, and were divided into successful group and failed group based on the trial production outcomes. Advanced oxidation processes (AOP) and head-perineum distance (HPD) were measured by ultrasound during the active phase of the first stage of labor when the cervix dilated to 4 cm and at 1 hour after the cervix dilated to 4 cm, respectively. The AOP change rate and HPD change rate after 1 hour of progress were calculated. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of AOP, HPD and their change rates in the outcome of vaginal trial production of scar uterus after cesarean section. Delong test was used to compare the differences in area under curves (AUCs). Results Among 170 pregnant women with scarred uterus after cesarean section who were pregnant again, 139 cases (success group) were succeed in transvaginal delivery, while 31 cases failed trial delivery, and transferred to cesarean section (failure group). The AOP of the successful group was significantly larger than that of the failed group when the cervix was opened to 4 cm, and the HPD was significantly shorter than that of the failure group (P < 0.05). The AOP change rate and the change rate of HPD of the successful group were significantly higher than that of the failed group when the cervix dilated to 4 cm and at 1 hour (P < 0.05). The AUC of AOP and HPD in predicting the outcome of vaginal trial delivery of scar uterus after cesarean section were 0.846 and 0.812 respectively, and AUC predicted jointly by AOP and HPD showed no significant differences compared with AUC predicted separately (P>0.05). The AUC of the change rate of AOP and HPD in predicting the outcome of vaginal trial delivery of scarred uterus after cesarean section was 0.899 and 0.852 respectively, and the combined prediction of AOP change rate and HPD change rate had a higher AUC value than the AUC predicted separately. Its AUC value was higher than that of AOP combined with HPD (P < 0.05). Conclusion The AOP, HPD and their change rates when the uterine orifice expands to 4 cm in the active phase of the first stage of labor have predictive value for the outcome of vaginal trial production of scarred uterus after cesarean section.

Objective:To investigate the factors influencing fall risk scores in elderly individuals.Methods:A total of 4 419 individuals were randomly selected using the cluster sampling method from Beijing, Nanning(Guangxi), and Yinchuan(Ningxia).Data on demographic characteristics and fall-related incidents were gathered and analyzed for their correlation with fall risk scores.Results:The fall risk score showed significant associations with various factors, such as the history of falls within one year( β=-3.607, 95% CI: -3.881 to -3.332), care methods( β=2.442, 95% CI: 2.226 to 2.658), exercise( β=0.714, 95% CI: 0.443 to 0.986), retirement( β=-0.585, 95% CI: -0.819 to -0.351), age( β=0.173, 95% CI: 0.159 to 0.187), and use of walking aids( β=-3.737, 95% CI: -4.054 to -3.421). Conclusions:Fall risk scores in older adults are influenced by a variety of factors.Factors such as no history of falls within the past year, living independently, engaging in physical activity, and being employed may contribute to lower fall risk scores in older adults.

Objective:To explore the efficacy and safety of different anti-platelet regimens in the treatment of high-risk non-disabling ischemic cerebrovascular events (HR-NICE) guided by point-of-care testing of CYP2C19 gene. Methods:A single-centre, prospective, randomised, open-label, and blinded endpoint design was uesd in the study. From July 2020 to January 2022, HR-NICE patients were enrolled in the Stroke Green Channel and Department of Neurology of Xuzhou Central Hospital, and all patients were scraped the buccal mucosa for screening for CYP2C19 loss-of-function allele carriers by point-of-care testing . Patients with intermediate metabolism were defined as those who carried 1 loss-of-function allele and patients with poor metabolism were those who carried 2 loss-of-function alleles. This study reduced the test turnaround time to 1 hour by using a fully automated medical polymerase chain reaction analyzer for a point-of-care test of CYP2C19 genotype. CYP2C19 loss-of-function allele carriers were divided according to the random number table method into the conventional treatment group (clopidogrel 75 mg, once a day), the ticagrelor group (ticagrelor 90 mg, twice a day) and the intensive dose group (clopidogrel 150 mg, once a day) separately combined with aspirin (100 mg, once a day) dual antiplatelet for 21 days. Baseline information, Acute Stroke Org 10172 Treatment Trial staging, 90-day modified Rankin Scale score, occurrence of adverse events and severe adverse events were collected for all the 3 groups. The primary efficacy outcome was new stroke within 90 days, and the primary safety outcome was severe or moderate bleeding within 90 days. Results:A total of 716 patients were included: 240 in the conventional treatment group, 240 in the ticagrelor group and 236 in the intensive dose group. There was no statistically significant difference between the 3 groups at baseline (all P>0.05). There were 26 cases (10.8%) with new stroke events in the conventional treatment group, 11 cases (4.6%) in the ticagrelor group and 4 cases (1.7%) in the intensive dose group, with statistically significant differences among the 3 groups (χ 2=19.28, P<0.05), and the differences between the conventional treatment group and the ticagrelor group (χ 2=6.59, P=0.010) and between the conventional treatment group and the intensive dose group (χ 2=16.83, P<0.001) were statistically significant, whereas the difference between the ticagrelor group and the intensive dose group was not statistically significant ( P>0.05). In the 3 groups, there was 1 case (0.4%) of severe bleeding in the conventional treatment group, 6 cases (2.5%) in the ticagrelor group and none in the intensive dose group, which showed statistically significant differences (χ 2=7.23, P<0.05), and there was statistically significant difference between the ticagrelor group and the intensive dose group ( P=0.030). Among the patients with intermediate CYP2C19 metabolism, there were 13 cases (13/158, 8.2%) with 90-day recurrent stroke in the conventional treatment group, 4 cases (4/153, 2.6%) in the ticagrelor group, and 0 case (0/159) in the intensive dose group, with statistically significant difference (χ 2=16.04, P<0.001), and the differences between the intensive dose group and the conventional treatment group were statistically significant (χ 2=13.64, P<0.001), whereas there was no statistically significant difference between the intensive dose group and the ticagrelor group ( P>0.05). In the patients with 90-day recurrent stroke in the intensive dose group, there was 0 case (0/159) with intermediate metabolism and 4 cases (4/77,5.2%) with poor metabolism, with statistically significant differences ( P=0.011), whereas there were no statistically significant differences in the conventional treatment group and the ticagrelor group ( P>0.05). Conclusions:Screening carriers of CYP2C19 loss-of-function alleles by point-of-care testing can quickly and precisely guide the treatment of patients with non-cardiogenic HR-NICE. An intensive clopidogrel dose of 150 mg, once a day combined with aspirin was effective in reducing stroke recurrence with less occurrence of any bleeding and adverse events, and patients with intermediate CYP2C19 metabolism may be the best population to benefit.

Objective To investigate the efficacy of different doses of clopidogrel combined with aspirin in the treatment of high-risk non-disabling ischaemic cerebrovascular events(HR-NICE)under the precise guidance of point-of-care testing(POCT)of cy-tochrome P-450 2C19(CYP2C19)genotype.Methods The single-center,randomised,prospective,and blinded endpoint assess-ment was used.HR-NICE patients continuously enrolled in the stroke green channel and neurology ward of Xuzhou Central Hospital from January 2021 to January 2022,and all patients scraping of the buccal mucosa will be screened for CYP2C19 loss-of-function allele car-riers by POCT.According to the random number table method,they were divided into the intensive group(clopidogrel 150mg/d)and the conventional group(clopidogrel 75mg/d)combined with aspirin(100mg/d)dual antiplatelet for 21 days.Baseline information,acute stroke Org 10172 treatment trial(TOAST)staging and 90 days modified Rankin scale(mRS)score and occurrence of adverse events and severe adverse events were collected for the two groups.The primary efficacy outcome was new stroke within 90 days and the primary safety outcome was severe or moderate bleeding within 90 days.Results A total of 1301 patients were screened,of which 727 patients carried CYP2C19 loss-of-function allele,and 476 patients were included:236 patients in the intensive group and 240 patients in the conven-tional group.The differences between the two groups were not statistically significant at baseline(P>0.05);4 cases(1.7%)inthein-tensive group and 26 cases(10.8%)in the conventional group had a new stroke at 90 days.The differences between the two groups were statistically significant(χ2 = 16.827,P<0.001);0 case(0)in the intensive group and1 case(2.5%)in the conventional group had moderate to severe haemorrhage at 90 days.The differences between the two groups was not statistically significant(P>0.05).Conclu-sion In HR-NICE patients with CYP2C19 loss-of-function allele,the enhanced clopidogrel dose was more effective than the conven-tional dose in the treatment with the antiplatelet drug aspirin combined with clopidogrel,and had a consistent safety profile with no more adverse events such as bleeding.

Objective:To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection.Methods:This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes.Results:This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%, P>0.05) between cinepazide maleate group and control group. Conclusion:Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.

The acute ischemic stroke has become the first major disability and death disease in China.With the release of the results of five trials represented by the Dutch multicenter randomized clinical trials of intravascular treatment of acute ischemic stroke, mechanical thrombectomy has become the main means to treat the acute ischemic stroke caused by the occlusion of large intracranial vessels, ushering in a new era of mechanical thrombectomy for acute cerebral infarction.At present, the main devices of mechanical thrombectomy are Merci thrombectomy device, penumbra thrombectomy device, solitairetm fr stent, revive se stent, trevo stent and aperio ® stent.According to the location and conditions of vascular embolism, different types of thrombectomy devices should be selected, and different thrombectomy technologies, such as adapt technology, solumbra Technology, advance technology, save technology, swim technology, etc So as to improve the recanalization rate and reduce complications.

Objective:To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction.Methods:From October 2014 to December 2018, the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI) classificatio, mechanical thrombolytic number, postoperative vascular reocclusion rate, incidence of intracranial hemorrhage, NIHSS score 1 week later, good clinical result after 90 days(improved Rankin scale, mRs= 0-2) and other indicators.Results:After mechanical embolectomy, 16 stents were implanted (15 of them were Solitaire stents, 1 of them was Apollo stents), 12 patients with TICI=3, and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09). Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96 ± 3.24) hours. Computed tomography angiography(CTA) was reexamined 24 hours after operation, showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml). In 2 cases of decompressive osteotomy, NIHSS score was improved from preoperative (24.25±4.58) points to postoperative (7.44±5.09) points.After 90 days, 10 patients had a good prognosis (mRs ≤ 2) and 1 patient died (pulmonary infection).Conclusion:After mechanical thrombectomy of acute cerebral infarction, if there is severe stenosis or forward blood flow can not be maintained, use the Solitaire stent or other stent to remedy the placement, with fewer complications and better clinical effect.

Objective To evaluate the safety and effectiveness of mechanical thrombectomy with Solitaire stent in intracerebral relatively small artery occlusions,such as the anterior cerebral artery,the posterior cerebral artery, the middle cerebral artery M2-M3. Methods The clinical data of thirteen cases of acute cerebral infarction caused by occlusion of relatively small vessels ( anterior cerebral artery, posterior cerebral artery, middle cerebral artery M2-M3 ) caused by intravenous thrombolytic time window with relative small vascular occlusion in our hospital were reviewed and analyzed. The NIHSS score, occlusion of vascular recanalization,surgical complications,and clinical prognosis (3 months mRs) were analyzed before and after discharge,including 6 cases of M2-M3 occlusion in the middle cerebral artery,3 cases of anterior cerebral artery occlusion and 4 cases of posterior cerebral artery occlusion. Results In 13 cases, the time window of thrombectomy was 3. 5～7. 0 h,the time from onset to reflow was (4. 53±3. 21) h,and 13 cases of blood vessels were completely repassed,of which 11 cases were grade 3 TICI,and 2 cases of 2b grade in TICI classification. 2 cases of postoperative small lateral fissure and subarachnoid hemorrhage. The score of NIHSS was reduced from (19. 53±1. 62)points to (3. 15±0. 41)points at 2 weeks. The difference was statistically significant (t=1. 763, P<0. 01);the mRs scores of 90d were 0 points 7 cases(53. 85％),1 points 3 cases(23. 08％),2 points cases ( 23. 08％) ,death 0 case. Conclusion The patients with acute cerebral infarction caused by relatively small vascular occlusion, such as the anterior cerebral artery, the posterior cerebral artery and the middle cerebral artery ( M2-M3) are treated with stent embolectomy in the time window. The rate of vascular repassage is high and the complications are low, and the patient′s disability rate can be significantly reduced and the clinical prognosis is better.

Objective To evaluate the safety and effect of mechanical thrombectomy with the stent device in posterior circulation large intracerebral artery occlusions.Methods Arterial embolectomy with the stent device was carried out in 16 patients with posterior circulation large intracerebral artery occlusions(3.5 h than intravenous thrombolysis time window)in the NO.264th Hospital of People Liberation Army,including 8 cases with pure basilar artery occlusion,7 cases with bilateral vertebral artery intracranial segment and basilar artery occlusion,1 case with side of intracranial vertebral artery occlusion.The National Institutes of health neurological deficit score(NIHSS)score,Alberta stroke program early CT(ASPECTS)score,complications,clinical result were analyzed retrospectively.Results Among 16 cases,the time windows were from 7 to 18 h,the time from onset to reperfusion were(13.32±1.57)h.Successful recanalization was obtained in 15 patients(TICI=3),partial recanalization in 1 case(TICI=2a).Three cases with stent angioplasty.Survival in patients with NIHSS score decreased from(24.65±3.63)points on admission to(4.32±1.57)points after three weeks,with statistical difference(P＜0.01).For mRs score at 90 d: 6 cases(37.5％)with 0-1,4 cases(25％)with 2-3,2 cases(12.5％)with 4-5,4 cases died(25.0％,score ASPECTS 4-5).Conclusion The mechanical thrombectomy with the stent device within 24 h can get higher reperfusion rate,fewer complications,and significantly reduce the mortality rate and good clinical outcome in large intracerebral poster circulation artery occlusions patients.

Objective To study the expression of interleukin-6 (IL-6) and hepcidin in patients with diffuse large B-cell lymphoma (DLBCL) and their significance in anemia. Methods 45 DLBCL patients with or without anemia were analyzed. Peripheral blood samples were collected during diagnosis, and the concentrations of IL-6, hepcidin, serum ferritin and hemoglobin (Hb) were measured. 24 healthy volunteers were collected as controls. Results The levels of plasma hepcidin and IL-6 in patients with DLBCL were (347±171)μg/L and 0.27 ng/L (0-9.61 ng/L), respectively, and compared with those [(175 ± 92)μg/L] and 0 ng/L in healthy controls, the differences were statistically significant (both P<0.001). Plasma hepcidin levels in patients with high lactate dehydrogenase (LDH) (P=0.003), B symptoms (P=0.040) or age-adjusted international prognostic index (IPI)>1 (P=0.010) were increased. The levels of IL-6 in patients of male (P=0.003), stage Ⅲ-Ⅳ (P=0.008) or IPI>1 (P=0.004) were significantly higher. The level of hepcidin was highly correlated with serum ferritin (r=0.77, P<0.001), weakly correlated with IL-6 (r=0.31, P=0.030), and not correlated with Hb (r=-0.12, P=0.3). There was a negative correlation between IL-6 expression and Hb (r=-0.35, P=0.009). Multivariate analysis showed that IL-6 could predict anemia (P=0.03), whereas hepcidin could not (P=0.89). Conclusion The elevated hepcidin level is frequent in DLBCL, and the elevated IL-6 plays the major role in the development of anemia.