Objective To analyze the clinical value of susceptibility weighted imaging(SWI)and arterial spin labeling imaging(ASL)in the prediction of hemorrhage transformation after thrombolysis in acute ischemic stroke.Methods A total of 80 patients with acute ischemic stroke admitted to Guangdong Tongjiang Hospital from December 2021 to November 2023,before and within 24 h after thrombolytic therapy,were enrolled,and all of them underwent computed tomography(CT),magnetic resonance imaging(MRI),SWI and ASL sequential scanning.The brush sign and asymmetrical cortical venous sign of patients were analyzed,and the diagnostic value of SWI and ASL for cerebral hemorrhage transformation after thrombolysis was compared.Eleven patients with cerebral hemorrhage transformation after thrombolysis were included in hemorrhagic transformation group,while the other 69 patients without hemorrhagic transformation were included in non-hemorrhagic transformation group.Logistic regression analysis was conducted to explore the influencing factors of hemorrhagic transformation after thrombolysis.Results The positive rates of brush sign and asymmetric cortical vein sign were 71.25%(57/80)and 68.75%(55/80)by SWI scanning before thrombolysis in 80 patients with acute ischemic stroke,while those were 16.25%(13/80)and 15.00%(12/80)after thrombolysis.The differences between brush sign and asymmetric cortical venous sign detected by SWI before and after thrombolysis were statistically significant(P<0.05).SWIversus ASL had sensitivity of 90.91%(10/11)versus72.73%(8/11),specificity of 95.65%(66/69)versus88.41%(61/69),and accuracy of 95.00%(76/80)versus86.25%(69/80)in the diagnosis of cerebral hemorrhage transformation after thrombolysis,revealing that SWI had higher sensitivity and specificity than ASL.The univariate analysis of cerebral hemorrhage transformation showed that the age,atrial fibrillation,NIHSS score and CMBs grade in two groups differed significantly(P<0.05);and the multivariate analysis identified atrial fibrillation,NISHH score and CMBs grade as independent risk factors of cerebral hemorrhagic transformation after thrombolysis.Conclusion SWI has high sensitivity in detecting brush sign and asymmetric cortical venous sign,which is of great value for predicting cerebral hemorrhage transformation after acute thrombolysis,and can be used as a routine examination sequence for acute ischemic stroke.

Objective To analyze the clinical value of susceptibility weighted imaging(SWI)and arterial spin labeling imaging(ASL)in the prediction of hemorrhage transformation after thrombolysis in acute ischemic stroke.Methods A total of 80 patients with acute ischemic stroke admitted to Guangdong Tongjiang Hospital from December 2021 to November 2023,before and within 24 h after thrombolytic therapy,were enrolled,and all of them underwent computed tomography(CT),magnetic resonance imaging(MRI),SWI and ASL sequential scanning.The brush sign and asymmetrical cortical venous sign of patients were analyzed,and the diagnostic value of SWI and ASL for cerebral hemorrhage transformation after thrombolysis was compared.Eleven patients with cerebral hemorrhage transformation after thrombolysis were included in hemorrhagic transformation group,while the other 69 patients without hemorrhagic transformation were included in non-hemorrhagic transformation group.Logistic regression analysis was conducted to explore the influencing factors of hemorrhagic transformation after thrombolysis.Results The positive rates of brush sign and asymmetric cortical vein sign were 71.25%(57/80)and 68.75%(55/80)by SWI scanning before thrombolysis in 80 patients with acute ischemic stroke,while those were 16.25%(13/80)and 15.00%(12/80)after thrombolysis.The differences between brush sign and asymmetric cortical venous sign detected by SWI before and after thrombolysis were statistically significant(P<0.05).SWIversus ASL had sensitivity of 90.91%(10/11)versus72.73%(8/11),specificity of 95.65%(66/69)versus88.41%(61/69),and accuracy of 95.00%(76/80)versus86.25%(69/80)in the diagnosis of cerebral hemorrhage transformation after thrombolysis,revealing that SWI had higher sensitivity and specificity than ASL.The univariate analysis of cerebral hemorrhage transformation showed that the age,atrial fibrillation,NIHSS score and CMBs grade in two groups differed significantly(P<0.05);and the multivariate analysis identified atrial fibrillation,NISHH score and CMBs grade as independent risk factors of cerebral hemorrhagic transformation after thrombolysis.Conclusion SWI has high sensitivity in detecting brush sign and asymmetric cortical venous sign,which is of great value for predicting cerebral hemorrhage transformation after acute thrombolysis,and can be used as a routine examination sequence for acute ischemic stroke.

Objective:To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods:The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children′s hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children′s general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed. The t test and Wilcoxon rank sum test were used for statistical analysis of the quantitative data and Chi-square test were used for comparison of rates. Results:Among the 452 patients, 264 were males and 188 were females, aged from 2 days to 17 years. There were 233 cases (51.5%) in the ≤1 year old group, 79 cases (17.5%) in the>1-3 years old group, 29 cases (6.4%) in the >3-5 years old group, 65 cases (14.4%) in the >5-10 years old group, and 46 cases (10.2%) in the>10 years old group. The main distributions of onset seasons were 55 cases (12.2%) in December, 47 cases (10.4%) in February, 46 cases (10.2%) in November, 45 cases (10.0%) in January, 40 cases (8.8%) in March. There were 335 cases (74.1%) CA-MRSA and 117 (25.9%) cases HA-MRSA. Among all cases, 174 cases (38.5%) had basic diseases or long-term use of hormone and immunosuppressive drugs. During the period of hospitalization, 209 cases (46.2%) received medical interventions. There were 182 patients (40.3%) had used antibiotics (β-lactams, glycopeptides, macrolides, carbapenems, oxazolones, sulfonamides etc) 3 months before admission. The most common clinical disease was pneumonia (203 cases), followed by skin soft-tissue infection (133 cases), sepsis (92 cases), deep tissue abscess (42 cases), osteomyelitis (40 cases), and septic arthritis (26 cases), suppurative meningitis (10 cases). The proportion of pneumonia in the ≤1 year old group was higher than the >1-3 years old group,>3-5 years old group,>5-10 years old group,>10 years old group (57.5% (134/233) vs. 30.4% (24/79), 31.0% (9/29), 38.5% (25/65), 23.9% (11/46), χ 2=17.374, 7.293, 7.410, 17.373, all P<0.01) The proportion of skin and soft tissue infections caused by CA-MRSA infection was higher than HA-MRSA (33.4% (112/335) vs. 17.9% (21/117), χ 2=10.010, P=0.002), and the proportion of pneumonia caused by HA-MRSA infection was higher than CA-MRSA (53.0% (62/117) vs. 42.1% (141/335), χ 2=4.166, P=0.041). The first white blood cell count of the ≤1 year old group was higher than that children > 1 year old ((15±8)×10 9/L vs. (13±7)×10 9/L, t=2.697, P=0.007), while the C-reactive protein of the ≤1 year old group was lower than the 1-3 years old group,>5-10 years old group,>10 years old group (8.00 (0.04-194.00) vs.17.00 (0.50-316.00), 15.20 (0.23-312.00), 21.79(0.13-219.00) mg/L, Z=3.207, 2.044, 2.513, all P<0.05), there were no significant differences in procalcitonin (PCT) between different age groups (all P>0.05). After the treatment, 131 cases were cured, 278 cases were improved, 21 cases were not cured, 12 cases died, and 10 cases were abandoned. The 452 MRSA isolates were all sensitive to vancomycin (100.0%), linezolid (100.0%), 100.0% resistant to penicillin, highly resistant to erythromycin (85.0%, 375/441), clindamycin (67.7%, 294/434), less resistant to sulfonamides (5.9%, 23/391), levofloxacin (4.5%, 19/423), gentamicin (3.2%, 14/438), rifampicin (1.8%, 8/440), minocycline (1.1%, 1/91). The antimicrobial resistance rates were not significantly different between the CA-MRSA and HA-MRSA groups (all P>0.05). Conclusions:The infection of MRSA is mainly found in infants under 3 years old. The prevalent seasons are winter and spring, and MRSA is mainly acquired in the community. The main clinical diseases are pneumonia, skin soft-tissue infection and sepsis. No MRSA isolate is resistant to vancomycin, linezolid. MRSA isolates are generally sensitive to sulfonamides, levofloxacin, gentamicin, rifampicin, minocycline, and were highly resistant to erythromycin and clindamycin. To achieve better prognosis. clinicians should initiate anti-infective treatment for children with MRSA infection according to the clinical characteristics of patients and drug sensitivity of the isolates timely and effectively.

Objective To explore the clinical significance of B7 family homology factor-3 (B7-H3),an expression membrane type of myeloid-derived suppressor cell (MDSC),in patients with acute pancreatitis (AP).Methods A total of 63 patients with AP initially treated in the Emergency Department at the First Affiliated Hospital of Soochow University from January,2014 to December,2015 were selected.Of them,25 suffered from mild AP (MAP),20 had moderate AP (MSAP) and 18 had severe AP (SAP).Another 20 healthy subjects with matching age and gender served as the control group.All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2013 in China.Patients with other underlying diseases that might influence the clinical outcomes were excluded,including those with tumors,autoimmune diseases,viral infections,trauma and other disorders.A flowcytometer was used to detect the expression rate of MDSC in peripheral venous blood and the expression of B7-H3 on MDSC membrane.The continuous monitoring was carried out for 24 h,48 h and 72 h in patients with AP.Results Compared with healthy subjects,the MDSC cells in patient groups 24 hours after AP onset increased notably (P ＜0.01) especially the highest increase in the SAP group,followed by the MSAP group and the lowest in the MAP group.There were significant differences in pairwise comparisons (P ＜ 0.05).From successive observation of each group,there was no significant difference in MDSC between the MAP group and the MSAP group 24 hours,48 hours and 72 hours after AP onset.However,MDSC reached its peak 48 hours after AP onset,but it declined 72 hours after AP onset in the SAP group (P ＜ 0.05).B7-H3 expressed significantly 24 hours after AP onset,but there was no expression of B7-H3 in the healthy group.Meanwhile,B7-H3 was expressed most highly in the SAP group,followed by the MSAP group and lowest in the MAP group.There were significant differences in expression of B7-H3 found in pairwise comparisons (P ＜ 0.05).The successive observation showed that there was no significant difference in B7-H3 expression between the MAP group and the MSAP group 24 hours,48 hours and 72 hours after AP onset.However,there was a trend of increase in B7-H3 expression as time prolonged found among 24 hours,48 hours and 72 hours after AP onset in the SAP group (P ＜ 0.05).Conclusions The expressions of MDSC and B7-H3 were high in AP,and there were significant differences in both expressions among MAP,MSAP and SAP groups.These phenomena offer clues in further understanding about the immunological disorders during AP giving better guidelines for clinical practice.