BACKGROUND: Preclinical studies have indicated that Angong Niuhuang Pills (ANP) reduce cerebral infarct and edema volumes. This study aimed to investigate whether ANP safely reduces cerebral infarct and edema volumes in patients with moderate to severe acute ischemic stroke. METHODS: This randomized, double-blind, placebo-controlled pilot trial included patients with acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores ranging from 10 to 20 in 17 centers in China between April 2021 and July 2022. Patients were allocated within 36 h after onset via block randomization to receive ANP or placebo (3 g/day for 5 days). The primary outcomes were changes in cerebral infarct and edema volumes after 14 days of treatment. The primary safety outcome was severe adverse events (SAEs) for 90 days. RESULTS: There were 57 and 60 patients finally included in the ANP and placebo groups, respectively for modified intention-to-treat analysis. The median age was 66.0 years, and the median NIHSS score at baseline was 12.0. The changes in cerebral infarct volume at day 14 were 0.3 mL and 0.4 mL in the ANP and placebo groups, respectively (median difference: -7.1 mL; interquartile range [IQR]: -18.3 to 2.3 mL, P = 0.30). The changes in cerebral edema volume of the ANP and placebo groups on day 14 were 11.4 mL and 4.0 mL, respectively ( median difference: 3.0 mL, IQR: -1.3 to 9.9 mL, P = 0.15). The rates of SAE within 90 days were similar in the ANP (3/57, 5%) and placebo (7/60, 12%) groups ( P = 0.36). Changes in serum mercury and arsenic concentrations were comparable. In patients with large artery atherosclerosis, ANP reduced the cerebral infarct volume at 14 days (median difference: -12.3 mL; IQR: -27.7 to -0.3 mL, P = 0.03). CONCLUSIONS: ANP showed a similar safety profile to placebo and non-significant tendency to reduce cerebral infarct volume in patients with moderate-to-severe stroke. Further studies are warranted to assess the efficacy of ANP in reducing cerebral infarcts and improving clinical prognosis. TRAIL REGISTRATION Clinicaltrials.gov , No. NCT04475328.
Aged ; Female ; Humans ; Male ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Ischemic Stroke/drug therapy* ; Pilot Projects ; Stroke/drug therapy* ; Treatment Outcome

Objective To investigate the factors affecting the hemorrhagic transformation(HT)and symptomatic intracranial hemorrhage(sICH)in patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)of anterior circulation after receiving endovascular treatment(EVT).Methods A total of 193 patients with AIS-LVO of anterior circulation,who were admitted to the Neurology Department of Anyang Municipal People's Hospital of China from January 2023 to November 2024,were enrolled in this study.There were 84 patients in the HT group and 42 patients in the sICH group.The baseline and clinical data,including gender,age,vascular risk factors(history of hypertension,diabetes,coronary artery disease,atrial fibrillation,coronary stent implantation,valve replacement,smoking),stroke history,pre-operative National Institutes of Health Stroke Scale(NIHSS)scores,laboratory indicators(preoperative D-dimer,neutrophil count,lymphocyte count,postoperative total CO2,and CO2 partial pressure),and perioperative indicators(procedure duration,surgical approach,anesthesia type,and preoperative intravenous thrombolysis),were collected.The clinical data were compared between non-HT group and HT group,as well as between non-sICH group and sICH group,and the independent risk factors for HT and sICH after receiving EVT treatment for AIS-LVO of anterior circulation were analyzed.Results The differences in coronary heart disease(x2=8.443,P=0.004),D-dimer(Z=-3.59,P＜0.001),preoperative NIHSS score(Z=-3.752,P＜0.001),surgical time(Z=-2.529,P=0.011),lesion site(x2=9.951,P=0.019),and moderate to severe stenosis or occlusion of other blood vessels(P=0.025)between the HT group and the non-HT group were statistically significant.The differences in the other baseline indicators and clinical data were not statistically significant(all P＞0.05).The multivariate logistic regression analysis showed that preoperative NIHSS score(OR=1.065,95％CI:1.021-1.110,P＜0.003),tandem lesions(OR=2.805,95％CI:1.306-6.024,P=0.008),coronary heart disease(OR=2.963,95％CI:1.421-6.174,P=0.004),and operation time(OR=1.009,95％CI:1.001-1.016,P=0.019)were the independent risk factors for HT after EVT.No statistically significant differences in baseline data,occlusion site,coexisting other vascular stenosis,and perioperative related indicators existed between the sICH group and the non-sICH group.Conclusion Preoperative NIHSS score,tandem lesion,coronary artery disease,and operation time are the independent risk factors for HT in patients with AIS-LVO of the anterior circulation after receiving EVT.

Objective To clarify the changes in the microRNA(miRNA)expression profile of rat alveolar lavage-fluid-derived exosomes after acute ozone exposure and analyze its potential relationship with lung injury.Methods Adult male Wistar rats were exposed to 0 ppm,0.5 ppm,and 2 ppm ozone for 6 h in a gas exposure chamber.After 24 h,the rats were anesthetized,the alveolar lavage fluid was collected,and exosomes were extracted.Differentially expressed miRNAs in exosomes were detected by miRNA-seq technology.miRDB databases were used to predict the target genes of the top 10 differentially expressed miRNAs among the groups,and Gene Ontology function enrichment and KEGG Pathway analyses were performed on the target genes.The differentially expressed miRNAs with high expression abundance and good uniformity were verified by quantitative reverse-transcription PCR(qRT-PCR).Results Compared with the findings in the 0 ppm group,there were 8 up-regulated and 55 down-regulated miRNAs in the 0.5 ppm group,and 32 up-regulated and 61 down-regulated miRNAs in the 2 ppm group.Compared with the findings in the 0.5 ppm group,90 exosomal miRNAs were up-regulated and 74 were down-regulated in the 2 ppm group.The target genes of top 10 differentially expressed miRNAs were mainly involved in regulating DNA binding,heterocyclic compound binding,and affecting transcription,and were closely related to cancer,MAPK,PIK3-AKT,TNF,ErbB,mitophagy,and FoxO signaling pathways.The qRT-PCR showed that the sequencing result were basically reliable.Conclusions Acute ozone exposure can lead to changes in the expression profile of exosomal miRNA in the alveolar lavage fluid of rats.Differentially expressed miRNAs may be involved in pathological processes,such as lung tissue inflammation and lung injury,caused by ozone exposure.

【Objective】 To investigate the effect of AIDET communication mode in informing blood donors of reactive viral markers results. 【Methods】 Blood donors who came FOR COUNSELLING AFTER NOTIFICATION OF THEIR REACTIVE SCREENING TEST RESULTS from Jan 2018 to Sep 2021 were selected as the subjects. They were divided into two groups according to the blood donation time and notification mode: control group who were notified by a conventional mode(n=128), from Jan 2018 to Dec 2019, and the experimental group(n=92) who were notified by AIDET mode, from Jan 2020 to Sep 2021. The anxiety state and degree of satisfaction to the notification were compared between the two groups. 【Results】 After attending COUNSELLING, the anxiety level of the experimental group was significantly lower, while the degree of satisfaction to the notification was significantly higher than that of the control group (P<0.05). 【Conclusion】 AIDET communication mode established a standardized and effective communication channel and reduced the anxiety of blood donors WHEN NOTIFYING THE REACTIVE SCREENING TEST RESULTS. Moreover, it can enhance the trust and satisfaction between donors and medical staff as well as the quality of notification, which is of great significance to promote the healthy and continuous development of voluntary blood donation.

Intracranial atherosclerosis (ICAS) is one of the main pathogenesis of acute ischemic stroke (AIS). Intravenous thrombolysis is a main therapeutic method, enjoying good effect, but the recanalization rate is low and the risk of re-occlusion is high. Endovascular therapy has developed rapidly in recent years due to its long time-window for treatment, high recanalization rate and few complications. This article reviews the pathogenesis, characteristics, main therapeutic methods, complications and rescue measures of AIS due to ICAS. And the development of intravascular therapy is highlighted.

Objective To compare the efficacy and safety of solitaire stent thrombectomy versus intravenous thrombolysis for treatment of elderly stroke patients with acute vertebrobasilar occlusion.Methods Clinical data of 76 patients with acute vertebrobasilar occlusion at the neurology department of Anyang People's Hospital from May 2014 to July 2017 were retrospectively analyzed.Patients were divided into two groups:solitaire stent thrombectomy group (n =30)and intravenous thrombolysis group (n =46).Recanalization rates,score improvement rate in National Institutes of Health Stroke Scale (NHISS)after 24 hours of treatment,symptomatic intracranial hemorrhage rate and mortality at 90 days after treatment were compared between the two groups.Results The recanalization rate,NIHSS score improvement rate at 24 hours after treatment and the improvement rate of Modified Rankin Scale(mRS)score at 90 days after treatment were significantly higher in the solitaire stent thrombectomy group than in the intravenous thrombolysis group[86.7％ (26/30)vs.45.7％(21/46),66.7％(20/30)vs.34.8％(16/46),53.3％ (16/30)vs.23.9％(11/46),x2 =6.543,3.900 and 3.761,P =0.012,0.041 and 0.046,respectively].No significant difference in incidence of intracranial hemorrhage was found between the two groups [6.7 ％ (2/30) vs.19.6 ％ (9/46),x2=0.813,P=0.357].The mortality at 90 days after treatment were significantly lower in the solitaire stent thrombectomy group than in the intravenous thrombolysis group [0.0％ (0/30)vs.30.4％ (14/46),P =0.017].Conclusions Solitaire stent thrombectomy versus intravenous thrombolysis has better efficacy and higher safety in treating acute stroke due to vertebrobasilar occlusion in elderly patients.

OBJECTIVE: To determine whether diffusion kurtosis imaging (DKI) is effective in monitoring tumor response to neoadjuvant chemotherapy in patients with osteosarcoma. MATERIALS AND METHODS: Twenty-nine osteosarcoma patients (20 men and 9 women; mean age, 17.6 ± 7.8 years) who had undergone magnetic resonance imaging (MRI) and DKI before and after neoadjuvant chemotherapy were included. Tumor volume, apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), and change ratio (ΔX) between pre- and post-treatment were calculated. Based on histologic response, the patients were divided into those with good response (≥ 90% necrosis, n = 12) and those with poor response (< 90% necrosis, n = 17). Several MRI parameters between the groups were compared using Student's t test. The correlation between image indexes and tumor necrosis was determined using Pearson's correlation, and diagnostic performance was compared using receiver operating characteristic curves. RESULTS: In good responders, MDpost, ADCpost, and MKpost values were significantly higher than in poor responders (p < 0.001, p < 0.001, and p = 0.042, respectively). The ΔMD and ΔADC were also significantly higher in good responders than in poor responders (p < 0.001 and p = 0.01, respectively). However, no significant difference was observed in ΔMK (p = 0.092). MDpost and ΔMD showed high correlations with tumor necrosis rate (r = 0.669 and r = 0.622, respectively), and MDpost had higher diagnostic performance than ADCpost (p = 0.037) and MKpost (p = 0.011). Similarly, ΔMD also showed higher diagnostic performance than ΔADC (p = 0.033) and ΔMK (p = 0.037). CONCLUSION: MD is a promising biomarker for monitoring tumor response to preoperative chemotherapy in patients with osteosarcoma.
Bone Neoplasms ; Diffusion ; Drug Therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Necrosis ; Osteosarcoma ; ROC Curve ; Tumor Burden

Objective: To understand the epidemiologic characteristics of outbreaks, caused by norovirus-GⅡ.2、GⅡ.17 and GⅡ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control. Methods: Incidence data of norovirus outbreaks in Guangdong from January 1(st) 2013 to November 30(th) 2017 were collected from Public Health Emergency Management Information System. RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus. Characteristics of norovirus GⅡ.2, GⅡ.17 and GⅡ.4/Sydney outbreaks were analyzed. Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting. Results: From January 1(st) 2013 to November 30(th) 2017, a total of 167 norovirus outbreaks were reported in Guangdong, and 115 outbreaks were caused by norovirus GⅡ.2, GⅡ.17 and GⅡ.4/Sydney respectively. The outbreaks caused by norovirus GⅡ.2 accounted for 39.68% (25/63) in primary schools, 28.57% (18/63) in child care settings, 25.40% (16/63) in middle schools and 6.35% (4/63) in universities. Outbreaks caused by norovirus GⅡ.17 accounted for 41.03% (16/39) in middle schools, 20.51% (8/39) at workplaces, 15.38% (6/39) in primary schools, 12.82% (5/39) in universities, 5.13% (2/39) in communities and child care settings respectively. The outbreaks caused by norovirus GⅡ.4/Sydney accounted for 53.85% (7/13) in universities, 15.38% (2/13) in child care settings and at workplaces respectively, 7.69%(1/13) in primary schools and middle schools respectively. The outbreaks caused by norovirus GⅡ.2 had 77.78% (49/63) of contact transmission, 17.46% (11/63) of food-borne transmission. The outbreaks caused by norovirus GⅡ.17 showed 53.85% (21/39) of food-borne transmission, 15.38% (6/39) of contract transmission, 12.82% (5/39) of water-borne transmission. The outbreaks caused by norovirus GⅡ.4/Sydney had 53.85% (7/13) of food-borne transmission, 38.46% (5/13) of the contact transmission. In terms of the clinical manifestations, the standardized proportion of vomit was 73.76% and the proportion of diarrhea was 42.85% in cases infected with norovirus GⅡ.2, the proportion of standardized of vomit was 76.37% and the proportion of diarrhea was 51.40% in cases infected with norovirus GⅡ.17, with the standardized proportion of vomit was 54.10% and the proportion of diarrhea was 55.95% in cases infected with norovirus GⅡ.4/Sydney. Conclusions: The outbreaks caused by norovirus GⅡ.2 through contact transmission mainly occurred in primary schools, child care settings and middle schools. The outbreaks caused by norovirus GⅡ.17 through food-borne transmission mainly occurred in middle schools and at workplaces. The outbreaks caused by norovirus GⅡ.4/Sydney food-borne transmission and contact mainly occurred in universities.
Adolescent ; Caliciviridae Infections/epidemiology* ; Child ; Child, Preschool ; Diarrhea/etiology* ; Disease Outbreaks ; Epidemics ; Gastroenteritis/epidemiology* ; Genotype ; Humans ; Norovirus/isolation & purification* ; Reverse Transcriptase Polymerase Chain Reaction ; Sentinel Surveillance ; Vomiting/etiology*

Objective To investigate infection status and distribution characteristics of human immunodeficiency virus (HIV)infection among voluntary blood donors in Xiangyang area in 2009-2014,and provide evidence for re-cruiting blood donors from low-risk population. Methods Blood specimens of 326 856 voluntary blood donors in Xiangyang area between January 2009 and December 2014 were detected anti-HIV with enzyme linked immunosor-bent assay(ELISA),positive specimens in HIV screening were performed confirmatory testing,epidemiological analysis was conducted on the positive detection results.Results 41 (0.13‰ )voluntary blood donors were con-firmed positive for HIV in Xiangyang area,positive rate among each year was significantly different (χ2 =27 801.87,P<0.01). Except marital status and infection routes,difference in positive rates among donors of dif-ferent gender,age,area,occupation,educational attainments,and number of blood donation were all significantly different(all P<0.01). Among HIV-infected voluntary blood donors,87.80% were male,41.46% and 31.71%were aged between 18-25 and 36-45 respectively,56.10% were through heterosexual transmission,and 43.90%were through male homosexual transmission. The percentage of workman and public service personnel infected with HIV were high,accounting for 21 .95% and 17.07% respectively,60.97% of confirmed positive HIV were from city area,56.10% only received junior middle school/technical secondary school education,65.85% of HIV-infec-ted persons were infected at the initial donation.Conclusion In order to ensure blood safety,blood center should in-crease publicity efforts,carry out health consultation before blood donation,and recruit blood donors from low-risk populations,nucleic acid detection should be carried out to shorten HIV detection window period.

Objective To investigate the present situation of institutes of rehabilitation medicine in Guangxi. Methods From March to July, 2015, all 287 hospitals in Guangxi were investigated with the Human Resource Statistics of Guangxi Rehabilitation Medicine Depart-ment and the Specialist Questionnaire of Guangxi Rehabilitation Medicine Department by E-mail through the local Health and Family Plan-ning Commissions. Results There were 125 rehabilitation medicine departments with 2146 personnels in Guangxi, 0.2 therapists per bed in average. The proportion was 1∶0.725 for rehabilitative physicians to therapists;1∶1.92∶3.14 for senior, intermediate and primary title for physicians;1∶8∶63 for therapists and 1∶5.6∶18.9 for nurses. About 91.3%of the department of rehabilitation medicine was in the tertia-ry hospitals and was able to provide the services of physical therapy, occupational therapy, speech therapy, swallowing rehabilitation, cogni-tive rehabilitation, psychological therapy and rehabilitation engineering, and so on. Conclusion Rehabilitation has made a big progress com-pared with that in 2009 in Guangxi, in term of institutes, human resources and the service ability. However, the distribution of institutions and human resources remains unbalanced.