Objective:To investigate the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with minor ischemic stroke (MIS) and tiny unruptured intracranial aneurysm (UIA).Methods:Patients with MIS and tiny UIA admitted to the Department of Neurology, Weifang People's Hospital from October 1, 2022 to February 29, 2024 were included retrospectively. MIS was defined as baseline National Institutes of Health Stroke Scale (NIHSS) score ≤3. Tiny UIA was defined as UIA with a diameter of ≤3 mm. According to the antiplatelet therapy regimen, the patients were divided into an aspirin alone group and an aspirin+clopidogrel DAPT group. The main outcome measure was the clinical outcome at 90 days after onset. The modified Rankin Scale (mRS) score 0-1 was defined as a good outcome and >1 was defined as a poor outcome. Secondary outcome measures included aneurysm rupture, cerebral hemorrhage, and recurrence of cerebral ischemic events. Multivariate logistic regression analysis was used to identify the independent influencing factors for poor outcome. Results:A total of 183 patients with MIS and tiny UIA were included, including 108 males (59.0%), median aged 68 years (interquartile range, 61-73 years). All the UIAs were solitary. The mRS score of all patients before onset was 0; 152 patients (83.1%) had good outcome at 90 days after onset, 31 (16.9%) had poor outcome, and no UIA occurred rupture bleeding. Of the 94 patients (51.4%) who received aspirin monotherapy, 14 patients (14.9%) experienced recurrent cerebral ischemic events during follow-up, and 73 (77.7%) had good outcome. Of the 89 patients (48.6%) who received DAPT, 5 (5.6%) experienced recurrent ischemic events during follow-up, and 79 (88.8%) had good outcome. The recurrence rate of cerebral ischemic events in the aspirin group was significantly higher than that in the DAPT group ( χ2=4.227, P=0.040), while the good outcome rate was significantly lower than that in the DAPT group ( χ2=4.006, P=0.045). Multivariate logistic regression analysis showed that baseline NIHSS score was an independent risk factor for poor outcome (odds ratio 4.597, 95% confidence interval 1.864-11.339; P=0.001), while DAPT was an independent protective factor for good outcome (odds ratio 0.265, 95% confidence interval 0.079-0.892; P=0.032). Conclusion:Compared with aspirin monotherapy, the short-term combination of aspirin and clopidogrel in patients with MIS and tiny UIA may improve the outcome, reduces the recurrence of cerebral ischemic events, and has good safety.

The lung is an important organ in systemic toxicity test of medical devices and is significant in safety evaluation. Based on the authors' understanding of medical devices, this study provides a brief analysis of the lung examination and common problems in systemic toxicity, so as to provide references for the pre-clinical safety evaluation of medical devices. It should be noted that a reasonable risk assessment should be made after comprehensive assessment for specific medical device products.
Equipment Safety ; Humans ; Lung ; Risk Assessment

Objective To explore the associations between vitamin D receptor ( VDR) Fok- Ⅰ and Apa- Ⅰ polymorphisms and myasthenia gravis (MG) in Chinese Han population.Methods Polymorphisms of VDR Fok- Ⅰ and Apa-Ⅰ were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.The frequencies of genotypes and hyplotypes were compared among 286 normal controls and 267 MG patients in different subgroups classified by gender,age of onset,presence of thymoma,and Osserman classification sat maximal severity in the follow-up.The association between the genotypes and maximal severity of MG and short-term glucocorticoid treatment were also investigated.Results There were no significant differences in frequencies of genotypes and hyplotypes of both Fok-Ⅰ and Apa-Ⅰ between MG group and control group,and among subgroups of MG.The Fok- Ⅰ showed no statistical difference between the patients with better and less improvement after short-term treatment of glucocorticoid.The frequency of Apa-Ⅰ alleles in the patients with better improvement (55/186,29.6% ) significantly differed from the less improved group ( 7/48,14.6%,OR = 2.46,95% CI 1.04-10.43,x2 = 4.400,P = 0.036).The patients with the genotype A A/Aa were more likely to improve better after the treatment(48/93,51.6%) than in the worse group(7/24,29.2%,OR =2.59,95% CI 0.98-14.60,x2 =3.858,P= 0.049).Conclusions Alleles and genotypes of VDR-Fok- Ⅰ and Apa-Ⅰ were not found to be related with MG onset and severity.MG patients with VDR-Apa-A allele may have better improvement short-term treatment of glucocorticoid.

ObjectiveTo compare the effect of hospital initiative management or patients self management in asthma control and pulmonary function, and improve the control level of asthma. Methods Forty moderate asthma patients enrolled successfully from July to December in 2009 were divided into 2 groups by random digits table:hospital initiative management group (group A) and patient self management group (group B) with 20 cases each, and received the asthma treatment with hospital initiative management or patient self management for 1 year. The acute attack time, emergency visit time, hospitalization time,pulmonary function and Saint George respiratory questionnaire (SGRQ) were compared between two groups.ResultsAfter 1 year management, there were 19 patients in good compliance, satisfaction score was (9.300 ± 0.801 ) scores, 13 total control, 6 partial control and 1 uncontrol in group A, while there were 11 patients in good compliance, satisfaction score was (7.800 ± 1.542) scores, 6 total control, 8 partial control and 6 uncontrol in group B. The compliance, satisfaction and control in group A were much better than those in group B (P＜0.01 or ＜0.05). The forced expiratory volume in 1 second (FEV1)[(2.56 ±0.30) L]and peak expiratory flow (PEF)[(6.26±0.39) t/s]were elevated while SGRQ[(21.55 ±6.35) scores]in group A were better than those in group B[(2.38 + 0.31 ) L, (5.83 ± 0.52 ) L/s,(29.80 ± 12.04) scores](P ＜ 0.05 or ＜ 0.01 ). ConclusionThe compliance, asthma control, pulmonary function and respiratory quality are improved by hospital initiative management, so it is helpful to promote this management model in China via a close cooperation between general hospital and community hospital.

Objective To approach the normal manifestations of the hypopharynx of the adults at the level of cricoid cartilage as seen on CT images, and to evaluate their clinical value. Methods Eighty-four CT images of the normal hypopharynx were reviewed. The hypopharynx was divided into three regions:(1) the piriform sinus, (2) the retropharynx area, and (3) the postcricoid region. The postcricoid region of hypopharynx was subdivided into three levels as follows : (1) the upper margin slice of the cricoid cartilage at the cricoarytenoid joint level, (2) the middle portion slice of the cricoid cartilage, and (3)the inferior margin slice of the cricoid cartilage. The anteroposterior and transverse diameters, and anterior and posterior wall thicknesses in the postcricoid region were measured. Depiction of the layers of the musculature and adjacent fat planes was evaluated. Statistical comparisons of measured results were made by using ttest and x2 test. Results The posterior wall tended to be (0. 9±0. 4) mm thicker than the anterior wall. The average transverse extension of the postcricoid musculature was (4. 5±0. 3)mm shorter in female than that in male at CT images. There were statistically significant differences related to sex (at the upper margin level of the cricoid cartilage : the transverse extension was (38. 6±3. 3)mm in male, (34. d±2. 5) mm in female, t = 6. 26,P < 0. 05 ; at the middle portion level of the crieoid cartilage: (33.6±3. 6) mm in male,(28.9±2.8) mm in female t =6.36, P <0.01;at the inferior margin level of the cricoid cartilage:(28.6 ±3. 1) nun in male, (24. 0 ±2. 1) mm in female, t = 7.52, P <0. 01). The transverse diameter tended to taper (10. 1±2. 4) mm from the upper cricoid slice level to the lower cricoid slice levelDemonstration of the intramural fat planes of the postcricoid region decreased from the upper [ 81.0%(68/84)] to the lower region [23.8% (20/84)] of the cricoid cartilage. In fat planes around the postcricoid region at all levels, the posterior fat plane was seen least frequently, and the left-sided fat plane was seen most frequently. There was a statistically significant difference at every level(at the upper margin level of the cricoid cartilage, the visibilities of the left-sided, the right-sided, and the posterior fat plane around the postcricoid region were 77.4% (65/84), 72. 6% (61/84), and 28. 6% (24/84) ,x<'2> =24. 64,P <0.01 ; at the middle portion level of the cricoid cartilage, the visibilities were 89.3% (75/84), 75.0%(63/84), and 34.5% (29/84) ,x<'2> =24. 76, P <0. 01 ; at the inferior margin level of the cricoid cartilage:the visibilities were 95.2% (80/84), 88. 1% (74/84), and 52. 4% (44/84), x<'2> = 13.59, P < 0. 01.Conclusion Knowledge of the normal appearances and variations of the hypopharynx at the level of cricoid cartilage is essential in detecting abnormalities in this area.