BACKGROUND: Severe stroke has high rates of mortality and morbidity. This study aimed to investigate the clinical course, causes of worsening, and outcomes of severe ischemic stroke. METHODS: This prospective, multicenter cohort study enrolled adult patients admitted ≤30 days after ischemic stroke from nine hospitals in China between September 2017 and December 2019. Severe stroke was defined as a score of ≥15 on the National Institutes of Health Stroke Scale (NIHSS). Clinical worsening was defined as an increase of 4 in the NIHSS score from baseline. Unfavorable functional outcome was defined as a modified Rankin scale score ≥3 at 3 months and 1 year after stroke onset, respectively. We performed Logistic regression to explore baseline features and reperfusion therapies associated with clinical worsening and functional outcomes. RESULTS: Among 4201 patients enrolled, 854 patients (20.33%) had severe stroke on admission. Of 3347 patients without severe stroke on admission, 142 (4.24%) patients developed severe stroke in hospital. Of 854 patients with severe stroke on admission, 33.95% (290/854) experienced clinical worsening (median time from stroke onset: 43 h, Q1-Q3: 20-88 h), with brain edema (54.83% [159/290]) as the leading cause; 24.59% (210/854) of these patients died by 30 days, and 81.47% (677/831) and 78.44% (633/807) had unfavorable functional outcomes at 3 months and 1 year respectively. Reperfusion reduced the risk of worsening (adjusted odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.12-0.49, P  <0.01), 30-day death (adjusted OR: 0.22, 95% CI: 0.11-0.41, P  <0.01), and unfavorable functional outcomes at 3 months (adjusted OR: 0.24, 95% CI: 0.08-0.68, P <0.01) and 1 year (adjusted OR: 0.17, 95% CI: 0.06-0.50, P  <0.01). CONCLUSIONS: Approximately one-fifth of patients with ischemic stroke had severe neurological deficits on admission. Clinical worsening mainly occurred in the first 3 to 4 days after stroke onset, with brain edema as the leading cause of worsening. Reperfusion reduced the risk of clinical worsening and improved functional outcomes. REGISTRATION ClinicalTrials.gov , NCT03222024.
Humans ; Male ; Female ; Prospective Studies ; Ischemic Stroke/mortality* ; Aged ; Middle Aged ; Aged, 80 and over ; Stroke ; Brain Ischemia

Objective:To analyze the growth characteristics of different genotypes of Japanese encephalitis virus (JEV) in different cell lines, and to provide scientific basis for the selection of cell lines in the study of JEV.Methods:BHK-21, Vero, C6/36, PK-15, DF-1, N2a, SH-sy5y and MDCK cell lines were selected. The proliferation ability of genotype 1 (NX1889 strain), genotype 3 (P3 strain) and genotype 5 (XZ0934 strain) JEV in these cell lines was evaluated by plaque assay and RT-qPCR.Results:Significant cytopathogenic effects (CPE) were observed in BHK-21, Vero, C6/36, DF-1, N2a and PK-15 cell lines across all three JEV genotypes. However, no significant differences in CPE characteristics were observed within the same cell line. SH-sy5y and MDCK cell lines did not show significant CPE, but virus proliferation was detected in SH-sy5y cell line, while MDCK cell line were found to be insensitive to JEV. No significant difference was observed in the proliferation curves of G1, G3 and G5 JEV in BHK-21, Vero and SH-sy5y cell lines. In C6/36 and PK-15 cell lines, the titer of G1 JEV was higher than that of G3 and G5. In DF-1 cell line, G5 demonstrated a higher titer than the other two genotypes, whereas in N2a cell line, G5 showed a lower titer than the other two.Conclusions:There are differences in the proliferation of three different genotypes of JEV in different cell lines, which can provide reference for the study of JEV in different directions.

Objective To investigate the clinical effects and complications of endoscopic tandem ligation and hemorrhoids ligation.Methods Clinical data of 120 patients with grade Ⅰ～Ⅲ internal hemorrhoids who were hospitalized due to hematochezia from November 2021 to March 2023 were retrospectively analyzed.According to the different surgical methods,60 patients who received endoscopic hemorrhoid ligation were divided into control group;60 patients who underwent endoscopic tandem ligation were divided into treatment group.The effective rate of hemorrhoidal hemorrhage,the effect of internal hemorrhoidal prolapse and the incidence of postoperative complications were compared between two groups within 6 months after operation.Results The effective rate of internal hemorrhoidal bleeding was 100.00％in both groups,and the efficacy of the treatment group in the treatment of degree Ⅱ internal hemorrhoidal prolapse was similar to that in the control group(P＞0.05),but the treatment group was significantly better than the control group in the treatment of degree Ⅲ internal hemorrhoidal prolapse(P＜0.01),the postoperative anal pain in the treatment group was significantly more than the control group(P＜0.05);There were no significant differences in postoperative perianal pain,urinary retention,and abnormal defecation between the two groups(P＞0.05).No thrombotic external hemorrhoids occured in two groups.Conclusion The short-term efficacy of endoscopic tandem ligation and hemorrhoidal ligation in the treatment of internal hemorrhoidal bleeding is similar and both achieved satisfactory results,the short-term efficacy of the two in the treatment of degree Ⅱ internal hemorrhoidal prolapse is similar,the short-term efficacy of the former in the treatment of degree Ⅲ internal hemorrhoidal prolapse is significantly better,the feeling of anal heaviness in the treatment group is more than that in the control group,and there is no striking difference in the other complications.

Objective To observe the value of gastric filling ultrasound(GFUS)for diagnosing dysphagia after surgical operation of hiatal hernia(HH).Methods Totally 71 HH patients who underwent laparoscopic HH repair and fundoplication surgery were retrospectively enrolled and divided into dysphagia group(n=23)and non dysphagia group(n=48)according to postoperative Saeed scores.GFUS parameters,including inner diameter of esophageal hiatus lumen(IDE),wall thickness of abdominal esophageal(WTE)and inner diameter of the esophageal lumen at the fold(FIDE)were compared between groups,and their value of diagnosing postoperative dysphagia were analyzed.Results In dysphagia group,IDE and FIDE were lower,while WTE was higher than those in non dysphagia group(all P＜0.05).Low IDE and high WTE were both independent risk factors of postoperative dysphagia in HH patients.The sensitivity,specificity and area under the curve(AUC)of IDE for diagnosing dysphagia after surgical operation of HH was 82.64％,66.69％and 0.773,of WTE was 82.59％,68.73％and 0.793,of their combination was 88.89％,77.59％and 0.843,respectively.The AUC of the combination of IDE and WTE was higher than that of IDE and WTE alone(Z=1.328,1.364,P=0.044,0.043).Conclusion Combination of GFUS parameters IDE and WTE was valuable for diagnosing dysphagia after surgical operation of HH.

Objective:To evaluate the performance of an artificial intelligent (AI)-based automated digital cell morphology analyzer (hereinafter referred as AI morphology analyzer) in detecting peripheral white blood cells (WBCs).Methods:A multi-center study. 1. A total of 3010 venous blood samples were collected from 11 tertiary hospitals nationwide, and 14 types of WBCs were analyzed with the AI morphology analyzers. The pre-classification results were compared with the post-classification results reviewed by senior morphological experts in evaluate the accuracy, sensitivity, specificity, and agreement of the AI morphology analyzers on the WBC pre-classification. 2. 400 blood samples (no less than 50% of the samples with abnormal WBCs after pre-classification and manual review) were selected from 3 010 samples, and the morphologists conducted manual microscopic examinations to differentiate different types of WBCs. The correlation between the post-classification and the manual microscopic examination results was analyzed. 3. Blood samples of patients diagnosed with lymphoma, acute lymphoblastic leukemia, acute myeloid leukemia, myelodysplastic syndrome, or myeloproliferative neoplasms were selected from the 3 010 blood samples. The performance of the AI morphology analyzers in these five hematological malignancies was evaluated by comparing the pre-classification and post-classification results. Cohen′s kappa test was used to analyze the consistency of WBC pre-classification and expert audit results, and Passing-Bablock regression analysis was used for comparison test, and accuracy, sensitivity, specificity, and agreement were calculated according to the formula.Results:1. AI morphology analyzers can pre-classify 14 types of WBCs and nucleated red blood cells. Compared with the post-classification results reviewed by senior morphological experts, the pre-classification accuracy of total WBCs reached 97.97%, of which the pre-classification accuracies of normal WBCs and abnormal WBCs were more than 96% and 87%, respectively. 2. The post-classification results reviewed by senior morphological experts correlated well with the manual differential results for all types of WBCs and nucleated red blood cells (neutrophils, lymphocytes, monocytes, eosinophils, basophils, immature granulocytes, blast cells, nucleated erythrocytes and malignant cells r>0.90 respectively, reactive lymphocytes r=0.85). With reference, the positive smear of abnormal cell types defined by The International Consensus Group for Hematology, the AI morphology analyzer has the similar screening ability for abnormal WBC samples as the manual microscopic examination. 3. For the blood samples with malignant hematologic diseases, the AI morphology analyzers showed accuracies higher than 84% on blast cells pre-classification, and the sensitivities were higher than 94%. In acute myeloid leukemia, the sensitivity of abnormal promyelocytes pre-classification exceeded 95%. Conclusion:The AI morphology analyzer showed high pre-classification accuracies and sensitivities on all types of leukocytes in peripheral blood when comparing with the post-classification results reviewed by experts. The post-classification results also showed a good correlation with the manual differential results. The AI morphology analyzer provides an efficient adjunctive white blood cell detection method for screening malignant hematological diseases.

Objective:This study contrasts the immune efficacy of the varicella zoster virus glycoprotein E (VZV gE)using Al/CpG combined adjuvants and AS01 adjuvant in BALB/c mice.Methods:BALB/c mice were immunized at 0 and 21 days respectively, and serum antibodies were detected using enzyme-linked immunosorbent assay. Detection of neutralizing antibodies in mouse serum using varicella zoster virus; enzyme-linked immunosorbent spot assay was used to detect cellular immune response.Results:Following two intramuscular immunizations, mice in the experimental groups (Shingrix, gE+ Al/CpG, and gE+ AS01) demonstrated elevated neutralizing antibody titers and an augmented count of lymphocytes releasing IFN-γ and IL-4. The gE+ Al/CpG group displayed the highest neutralizing antibody titer (1943), yet the AS01-adjuvanted groups (Shingrix and gE+ AS01) showed increased lymphocyte counts secreting IFN-γ and IL-4 compared to the Al/CpG group (gE+ Al/CpG). In comparison to the AS01 adjuvant, Al/CpG adjuvants triggered a humoral immune response favoring Th2 in mice. The proportions of CD4 + T and CD8 + T cells were not significantly different among the experimental groups. Conclusions:Al/CpG adjuvant combined with gE protein resulted in high neutralizing antibody titers, while the intensity of the induced cellular immune response was inferior to that of AS01 adjuvant.

Objective: To explore the buffering effect of positive childhood experiences (PCEs) on mental health risks among adolescents before and after COVID-19 epidemic. Methods: In October 2019 (before the outbreak of COVID-19), 1 322 students from grades 4 to 9 were recruited from primary and secondary schools in two counties of Chizhou city, Anhui Province. A questionnaire survey was conducted to collect general demographic information, PCEs, depressive symptoms, anxiety symptoms, self harm behavior, suicidal ideation. Follow up survey was conducted after school re opening (May 2020). Mental health status before and after the COVID-19 epidemic was compared among students with different PCEs by multiple logistic regression analyses. Results: The detection rates of depressive symptoms, anxiety symptoms, self harm behavior and suicidal ideation (22.6%, 16.0%, 40.0%, 29.9%) of the respondents after school re opening were significantly higher compared that before the epidemic (16.5%, 13.5%, 31.1 %, 22.6%). There were no significant differences in the detection rates of depressive symptoms, anxiety symptoms,self harm behavior and suicidal ideation between high PCEs group before and after the epidemic ( Z =-0.05,0.27,0.84,1.84, P >0.05). Multivariate Logistic regression analysis showed that the risk of depressive symptoms and self harm behavior in the low PCEs group after school re opening was 1.39 times higher than that before the epidemic (95% CI= 1.05 -1.84, P <0.05). The risk of non suicidal self injury behavior in the low PCEs group after school re opening was 1.31 times higher than that before the epidemic (95% CI= 1.05 -1.62, P <0.05). There were no significant differences in mental health detection rates in high PCEs group before and after the epidemic ( P >0.05). Conclusion During the time of COVID-19 epidemic, PCEs is associated with lower rates of depressive symptoms, anxiety symptoms, self harm behavior and suicide ideation in adolescents. The findings suggest that more support and help should be given to adolescents from the perspectives of family, school and peers, so as to reduce the adverse effects of public health emergencies on adolescents mental health.

OBJECTIVE：To inves tigate the application effect and safety of modified compound polyethylene glycol electrolyte powder（SF-PEG）in intestinal preparation method for patients with constipation undergoing colonoscopy. METHODS ：From Jan. 2020 to Aug. 2020，160 patients with constipation undergoing colonoscopy in anorectal department of the affiliated hospital of North Sichuan Medical College were randomly divided into observation group and control group ，with 80 cases in each group. The patients in the control group took 2 boxes of SF-PEG （mixed into 3 000 mL warm water ）orally at 3：00 a.m. on the day of examination，and finished within 2 hours. The patients in the observation group took 1 box of SF-PEG （mixed into 1 500 mL warm water）at 20：00 the night before the examination and 5：00 in the morning of the day of examination ，and drank it within 1 hour；1 bottle of Dimethylsiloxane powder （mixed into 75 mL warm water ）was taken orally at 7：00 a.m. on the inspection day. The satisfaction of intestinal preparation ，intestinal bubble score ，operation time of colonoscopy ，detection of polyps ，tolerance rate ， acceptance rate of repeating intestinal preparation of patients and incidence of adverse reactions were compared between the two groups. RESULTS ：The patients of 2 groups successfully completed bowel preparation and colonoscopy. The intestinal preparation total satisfaction rate ，intestinal bubble satisfaction rate ，polyp detection rate ，tolerance rate and repeating intestinal preparation acceptance rate of patients of observation group were significantly higher than control group （P＜0.05），while the incidence of nausea and vomiting and total incidence of adverse reactions were significantly lower than control group （P＜0.05），and the operation time of colonoscopy was significantly shorter than control group （P＜0.05）. CONCLUSIONS ：Oral administration of SF-PEG in batches combined with Dimethylsiloxane powder for bowel preparation in patients with constipation before colonoscopy have the advantages of high satisfaction with bowel preparation ，less intestinal bubbles ，short operation time ，high detection rate of polyps，high tolerance rate of patients ，high acceptance rate of repeating intestinal preparation and less adverse reactions. It is a safe and effect method for intestinal preparation.

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Objective:To explore the clinical characteristics of neurobrucellosis to improve the diagnoses and treatments of this disease.Methods:Six inpatients diagnosed with neurobrucellosis in our hospital from Junuary 2014 to December 2019 were chosen, and their epidemiological features, clinical manifestations, laboratory tests, treatments, and prognoses were analyzed.Results:Six patients were male, 2 had epidemiological history, one was with orchitis, one was with imaging abnormalities related to cerebral small vessel diseases; 3 patients had brucella malta in the cerebrospinal fluid and one had brucella malta in the blood; cerebrospinal fluid (CSF) rose bengal plate agglutination test was positive in 2 patients, and the next-generation sequencing results of CSF showed that they were brucella nucleic acid sequences. All 6 patients had good prognosis after antibiotic therapy.Conclusion:The clinical manifestations of neurological brucellosis are diverse; the combined application of cerebrospinal fluid culture, cerebrospinal fluid brucella agglutination test, and next-generation sequencing is of great value in the diagnosis of neurobrucellosis.