Objective:To assess the efficacy and toxicities of carboplatin+etoposide(CE)regimens combined with abiraterone+prednisone(AAP)in patients with metastatic castration-resistant prostate cancer(mCRPC)after progression with docetaxel+prednisone(DP)regimens chemotherapy and novel hormone therapy(NHT).Methods:Retrospective analysis of mCRPC treated with DP regimens chemotherapy and/or NHT after progression,received CE regimens with AAP every 3 weeks for one cycle×6 cycles.The outcome were prostate specific an-tigen(PSA)response rate,time to PSA progression(TTPP),radiographic progression-free survival(rPFS),30%reduction in PSA,90%reduc-tion in PSA,the objective response remission rate and overall survival(OS).Results:From March 2019 to February 2024,37 eligible mCRPC patients were admitted to Cancer Hospital of Huanxing Chaoyang District Beijing and National Cancer Center/National Cancer Clinical Re-search Center/Cancer Hospital.After progression,CE regimens combined with AAP regimens was used for treatment.The median follow-up was 12.0(3.0-57.0)months.The median treatment cycle was 4 cycles.The PSA response rate was 42.1%.The median TTPP was 4.0 months;the median rPFS was 8.9 months and the median OS was 15.0 months.The objective remission rate was 24.3%,the proportion of 30%de-crease in PSA was 59.5%,and the proportion of 90%decrease in PSA was 16.2%.As for treatment side effects,10 cases had grade 3 or higher adverse reactions.Conclusions:CE regimens combined with AAP for mCRPC patients who failed DP regimens chemotherapy and/or NHT initially showed good clinical efficacy and tolerability.Additional sample size and follow-up time are needed to further validate the effic-acy.

【Objective】 To develop an assay to determine β-lactam antibiotics using microcolumn gels and to study the β-lactam antibiotics present in the blood of patients and their clinical significances. 【Methods】 446 patients with a history of taking β-lactam antibiotics from January 2019 to June 2019 were randomly selected from Trauma Emergency Center, Department of Arthrosis, Department of Spine and Department of Bone Oncology of our hospital, and 4 mL(per capita) venous blood was collected. Irregular antibody screening, anti-globulin detection and drug antibody determination were performed by microcolumn gel method. The data of gender, age, disease, blood transfusion history and medication were collected. The test results and clinical data were retrospective analyzed. 【Results】 The yielding rate of antibody was 0.45%(2/446) in patients with a history of taking β -lactam antibiotics. 16.38%(73/446) of the samples were positive in direct antiglobulin test, and 64.38%(47/73) of them did not agglutinate with RBCs treated with drugs. The yielding rate of specific antibodies against drug was 4.93%(22/446), and the titer ranged from 2 to 128(8). 1 case of auto-IgM antibody, 1 case of blood group related antibody and 2 cases of non-specific protein adsorption were detected. The yielding rate of drug antibody in patients with blood transfusion history reached to 12.10 %(22/124), so it was also high in patients with bone tumor. 【Conclusion】 Direct antiglobulin assay is helpful for the detection of β-lactam antibodies. The negative results of antibody screening cannot completely exclude the presence of drug antibodies. The yielding rate of drug antibody can be greatly improved by specific drug antibody detection, and it was higher in transfused patients relative to non-transfused one.

Objective:To investigate the correlation between antiplatelet agents and the risk of ruptured intracranial aneurysm.Methods:Patients with intracranial aneurysm admitted to the Department of Neurology, East Hospital Area of Qingdao Municipal Hospital from June to December 2018 were selected retrospectively. The baseline data of patients and the characteristics of intracranial aneurysms were collected. The independent correlation between antiplatelet agents and the risk of ruptured intracranial aneurysm was identified by the univariable analysis and multivariate logistic regression analysis. Results:A total of 90 patients with intracranial aneurysm were included in the study. There were 31 males (34.44%) and 59 females (65.56%). The median diameter of the aneurysm was 4 mm. Forty-six patients taking antiplatelet agents before being diagnosed with intracranial aneurysm, of which 36 taking aspirin, 3 taking clopidogrel, and 7 taking aspirin+ clopidogrel. There were 31 patients (34.44%) with ruptured aneurysm and 59 (65.56%) with unruptured aneurysm. There were statistical differences in the proportion of patients with age <60 years ( P<0.05), diabetes ( P<0.1), ischemic heart disease ( P<0.05), history of previous stroke or transient ischemic attack ( P<0.01), internal carotid artery aneurysm ( P<0.01), anterior communicating artery aneurysm ( P<0.05), posterior communicating artery aneurysm ( P<0.01) and taking antiplatelet agents before diagnosis ( P<0.1) between the ruptured group and the unruptured group. Multivariate logistic regression analysis showed that age <60 years (odds ratio[ OR] 4.116, 95% confidence interval [ CI] 1.337-12.673; P=0.014), anterior communicating artery aneurysm ( OR 5.015, 95% CI 1.155-22.559; P=0.032) and posterior communicating artery aneurysm ( OR 68.796, 95% CI 6.762-699.951; P<0.001) were the independent risk factors for ruptured intracranial aneurysm, and taking antiplatelet agents was an independent protective factor for ruptured intracranial aneurysm ( OR 0.320, 95% CI 0.104-0.992; P=0.048). Conclusions:Taking antiplatelet agents, especially aspirin, does not increase the risk of ruptured intracranial aneurysm, but may be a protective factor of ruptured intracranial aneurysm. Unruptured aneurysms are not contraindications for antiplatelet therapy in patients with clear indications.

Objective To investigate the features and its risk factors for cognitive impairment in patients with lacunar infarct (LI) and white matter lesion (WML).Methods The inpatients with LI and WML aged 65 to 75 years old were enrolled.Their demographic and clinical data were collected.LI and WML were diagnosed by magnetic resonance imaging (MRI).Montreal Cognitive Assessment Scale (MoCA) was used to evaluate cognitive function.Self-Rating Depression Scale and Hamilton Anxiety Scale were used to exclude patients with depression and anxiety.The patients were divided into either a cognitive impairment group or a normal cognitive function group.The demographic and clinical data of both groups were compared.Multivariate logistic regression analysis was used to analyze and determine the independent risk factors for cognitive impairment.The characteristics of cognitive impairment of LI and WML were compared.Results A total of 130 patients with LI or WML were enrolled,92 of them had cognitive impairment,and 38 had normal cognitive function; 85 had LI,and 45 had WML; 53 were males and 77 were females.Univariate analysis showed that years of education in the cognitive impairment group (7.54 ±4.65 years vs.11.29 ±3.17 years; t =4.286,P=0.001) was significantly lower than that of the normal cognitive function group,while the constituent ratios of hypertension (54.6％ vs.16.2％ ;x2 =4.477,P =0.018),hyperlipidemia (53.1％ vs.16.2％ ;x2 =5.263; P =0.044),diabetes mellitus (46.9％ vs.10.8％;x2 =3.827,P=0.017),as well as LI (43.8％ vs.21.5％;x2 =3.928,P=0.015) and WML (26.9％ vs.7.7％ ;x2 =4.072,P =0.009) were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that years of education (odds ratio [OR],1.305,95％confidence interval [CI] 1.104-7.975; P =0.001),diabetes mellitus (OR 1.328,95％ CI 1.292-3.422;P =0.015),hypertension (OR 1.978,95％ CI 1.034-5.443; P =0.028,LI (OR 1.224,95％ CI 1.004-2.007; P =0.013),and WML (OR 1.489,95％ CI 1.202-3.778; P =0.010) were the independent risk factors for cognitive impairment.The total MoCA score (21.61 ± 5.33 vs.19.19 ± 7.07; t =1.841,P =0.038) and cube copy (0.43 ± 0.50 vs.0.31 ± 0.47; t =1.104,P =0.010),clock drawing test (2.53 ±0.89 vs.2.04 ± 1.22; t =2.229,P =0.008),letters identification (0.85 ±0.36 vs.0.62 ±0.50; t =2.585,P==0.000),and 100 minus 7 consecutively (2.62 ±0.79 vs.2.19 ± 1.17; t =2.113; P=0.001) of the WML group were significantly lower than those of the LI group.Conclusions The patients with LI and WML often had cognitive impairment,and the cognitive impairment in patients with WML was more serious.Years of education,hypertension and diabetes were the independent risk factors for cognitive impairment in patients with LI and WML.Visuospatial executive function and attention damage in patients with WML were severer than those of the patients with LI.

Objective To explore the association of risk factors with amnestic versus nonamnestic of mild cognitive impairment.Methods All the subjects with mild cognitive impairment (MCI) aged 65-75 years were recruited from Neurology Department of 3 third-class hospitals of Qingdao,admitted from January 2011 to September 2011.They were systematically evaluated with mini-mental state examination( MMSE )and Montreal cognitive assessment (MoCA),then health conditions were collected.According to Petersen's standards,patients were divided into 89 cases with amnestic mild cognitive impairment(aMCI) and 51 cases with non-amnestic mild cognitive impairment (non-aMCI)groups to compare different risk factors between them.Results There were statistical differences in high total cholesterol (P=0.011),diabetes mellitus (P=0.009),MoCA score (P=0.040) between aMCI and non-aMCIgroups.MoCAscore (OR=1.081,95％CI:1.001-1.204,P=0.040) in the aMCI group was lower than that in non aMCI group.Diabetes mellitus ratio (OR=0.258,95％CI:0.096-0.695,P=0.009) was higher in non-aMCI group than in aMCI group.The level of total-cholesterol(OR=13.345,95％CI:1.127-158.085,P=0.011) in aMCI group was higher than that in non-aMCI group.The high total cholesterol was a independent risk factor for aMCI.Conclusions Different risk factors appear to exert different effects for aMCI and nonaMCI.

Objective To investigate the relationship between hypertension,other vascular risk factors and mild cognitive impairment and its subtype.Methods A total of 297 outpatients and inpatients were collected from the Departments of Neurology in 4 municipal hospitals in Qingdao from April 2011 to September 2011.The unified questionnaires of cognitive impairment status in the departments of neurology in Qingdao city were developed.The risk factors for mild cognitive impairment and its subtype were investigated.Results Univariate analysis showed that low levels of education (odds ratio [ OR] 0.239,95％ confidence interval [ CI] 0.129 -0.442; P =0.000),hypertension (OR 1.928,95％ CI 1.107 - 3.358; P =0.019) and hyperlipidemia (OR 1.812,95％ CI 1.041 -3.155; P =0.034) were all the risk factors for mild cognitive impairment; Multivariate logistic regression analysis showed that low levels of education (OR 0.807,95％ CI 0.742 - 0.878; P =0.000) and hypertension (OR 1.788,95％ CI 1.004 -3.146; P =0.048 ) were the independent risk factors for mild cognitive impairment; and hypertension (OR 2.091,95％ CI 1.030 -4.242; P=0.041) was an independent risk factor for non-amnestic mild cognitive impairment,and was mainly impaired visuospatial and executive abilities (P =0.026).Conclusions Hypertension is an independent risk factor for mild cognitive impairment and its subtype-non-amnestic mild cognitive impairment,and it mainly impairs executive ability.

Objective To investigate the risk factors and clinical features of mild cognitive impairment (MCI) in patients with ischemic cerebral small vessel disease (SVD) for early diagnosis and prevention.Methods Montreal Cognitive Assessment Scale (MoCA) was used to screen MCI.The related risk factors and other clinical data were collected,and other neuropsychological tests were conducted.SVD was divided into leukoaraiosis (LA),lacunar infarction (LI),and LA + LI.Results A total of 143 patients with SVD were enrolled (68 in an MCI group,75 in a non-MCI group).Univariate analysis showed that there was no significant difference in the constituent ratio of age and gender between the MCI group and the non-MCI group,but the years of education in the MCI group was shorter than that in the non-MCI group,while the composition ratios of hypertension (69.11％ vs.45.33 ％;x2 =8.215,P =0.004),diabetes (57.35％ vs.40.00％;x2 =4.301,P =0.038),hyperlipidemia (48.53％ vs.24.00％ ; x2 =9.352,P =0.002),carotid atherosclerosis (41.18％ vs.21.33％ ;x2 =6.592,P =0.010),and smoking (32.35％ vs.14.67％ ;x2 =6.285,P =0.012),as well as the levels of uric acid (351.81 ± 83.21 mmol/L vs.323.03 ± 80.43 mmol/L; t =2.102,P =0.037) and total cholesterol (5.26 ± 1.26 mmol/L vs.4.56 ± 1.23 mmol/L; t =3.326,P =0.001) were significantly higher than those in the non-MCI group.Multivariate logistic regression analysis showed that hypertension (odds ratio OR]2.227,95％ confidence interval [CI],1.001-4.954; P =0.026),diabetes (OR 2.056,95％ CI 1.862-4.937; P =0.046),hyperlipidemia (OR 2.528,95％ CI 1.361-5.770; P =0.028),carotid atherosclerosis (OR 2.658,95％ CI 1.110-6.367; P =0.029),smoking (OR 2.566,95％ CI 1.017-6.474; P =0.046),and years of education (OR 0.825,95％ CI 0.745-0.914; P =0.000) were the independent risk factors for the occurrence of MCI in patients with SVD.The subscores in the MCI group,including MoCA total score (18.44 ± 5.60 vs.27.09 ± 1.37; t =-12.422; P =0.000),as well as visuoconstructional skills (2.65 ± 1.39 vs.4.49 ± 0.74; t =-9.762; P =0.000),attention (4.48 ± 1.70vs.5.89 ± 0.31; t =6.706,P=0.000),language (1.69 ± 0.80vs.2.41 ± 0.95 ; t =4.893,P=0.018),abstraction (0.85 ± 0.69 vs.1.71 ± 0.53; t=-7.081,P=0.000),delayed recall (1.29 ±1.01 vs.4.04 ± 0.99; t =13.824,P =0.000) were significantly lower than those in the non-MCI group,and there were no significant differences in naming and orientation scores.In the MCI group,the subscores such as theMoCA total score in the LA+LI group (17.04 ± 6.15 vs.21.04 ± 3.98; P＜0.05),as well as visuoconstructional skills (1.68 ± 1.16 vs.3.24 ± 1.13; P ＜ 0.05),attention (3.92 ± 2.03 vs.5.19 ±0.87; P ＜0.05),delayed recall (1.35 ± 1.01 vs.1.86 ± 1.58; P ＜0.05) were significantly lower than those in the LI group; the subscores such as the MoCA total score in the LA group (18.18 ± 5.31 vs.21.04 ± 3.98; ＜ =0.05),as well as visuoconstructional skills (2.56 ± 1.78 vs.3.24 ± 1.13; P＜0.05),language (0.64 ± 0.23 vs.1.24 ± 0.83; P ＜0.05),delayed recall (0.69 ± 0.58vs.1.86 ± 1.58;P＜0.01)were significantly lower than those in the LI group; the visuoconstructional skills in the LA + LI group was significantly lower than that in the LA group (1.68 ± 1.16 vs.2.56 ± 1.78; P＜0.05) and the LI group (1.68 ± 1.16 vs.3.24 ± 1.13; P＜ 0.05).Conclusions Hypertension,diabetes,hyperlipidemia,carotid atherosclerosis,smoking,and the low level of education were the independent risk factors for MCI in patients with SVD.After SVD,the cognitive impairment in MCI presented as multiple cognitive domains impairments,including visuoconstructional skills and delayed recall.Cognitive impairment differed among the different types of SVD.

Objective To investigate the differences of the vascular risk factors for anterior circulation and posterior circulation ischemic stroke.Methods The unified diagnosis and treatment questionnaires of ischemic stroke in Qingdao city were developed.The data of 943 consecutive patients with acute ischemic stroke treated in the Departments of Neurology in 11 hospitals with imaging facilities such as computerized tornography (CT) or magnetic resonance imaging (MRI) in Qingdao city and its surrounding counties from June 2008 to February 2009 were retrospectively collected.The risk factors for anterior circulation and posterior circulation ischemic stroke were analyzed.Results Univariate analysis showed that there were significant differences in the age,sex,history of coronary heart disease,hyperlipidemia,atrial fibrillation and basdine National Institutes of Health Stroke Scale (NIHSS) score between anterior circulation and posterior circulation ischermic stroke (all P ＜0.05).Multivariate logistic regression analysis showed that the age (odds ratio [ OR ] 1.025,95％ confidence interval [ CI ] 1.009-1.042) and the baseline NIHSS score (OR 1.052,95％ CI 1.019-1.086) tended to the interior circulation ischernic stroke,whereas coronary heart disease (OR 0.512,95％ CI 0.341-0.768) and hyperlipidemia (OR 0.585,95％ CI 0.386-0.884) tended to posterior circulation ischemic stroke,and hyperlipidemia was an independent risk factors for posterior circulation ischemic stroke.Conclusions Vascular risk factors exerted different effects on anterior circulation and posterior circulation ischemic stroke.

Objective To identify the thromolysis rate in patients with ischemic ccrebrovascular disease in Qingdao area and to analyze the causes of influcncing thrombolytic therapy and investigate their influencing factors. Methods We adopted a unified questionnaire about the status of diagnosis and treatment of stroke in Qigndao. The patients with acute stroke in the 11 departments of neurology of Qingdao municipal and county hospitals (all with thrombolytic conditios) from October 1,2008 to October 31,2009 were collected retrospectively. A face to face questionnaire survey was performed, their clinical data were collected and the factors of influencing thrombolytic therapy were analyzed. Results Actually 864 patients with ischemic eerebrovascular disease were investigated. Only 10 patients received thrombolytic therapy. The thrombolysis rate was 1.16%, and the thrombolysis rate within a 4.5-hour time widow was 6. 33 %. Logistic regression analysis showed that in addition to thrombolytic contraindications,the factors that influencing thrombolytic therapy in patients with acute ischemic stroke included the treatment in different level-hospitals (OR =0.061,95% CI O. 006-0. 703, P =0. 040) and the United States National Institutes of Health Stroke Scale (NIHSS) score (OR = 0.810,95% CI 0. 729-0.900, P = 0.000) at presentation. Conclusions The thrombolysis rate in patients with cerebrovascular disease in Qingdao area was relatively lower. In addition to thrombolytic contraindications, the factors that influencing thrombolytic therapy in ptients with acute ischemic stroke included the treatment in different level-hospitals and NIHSS score at presentation.

Objective To investigate the treatment delay in patients with acute cerebrovascular disease in different levels of hospital in Qingdao area and to analyze its influencing factors. Methods A total of 700 patients with acute cerebrovascular disease from the city, county and township hospitals in Qingdao were selected from June 2008 to February 2009. A questionnaire survey was used to investigate and analyze the visiting time in patients with stroke and its possible influencing factors. Results The average visiting rate in patients with acute cerebrovascular disease was 30% within 4.5 hours after the onset in Qingdao area. The average visiting rate of the township hospitals was lowest (26%), of the city hospitals was moderate (28%), and of the county hospitals was highest (36%). For the city hospitals, the male patients usually delayed the visiting. The patients with high school or higher education level, urban medical insurance, 120 transportation, and the National Institutes of Health Stroke Scale (NIHSS) ＜ 3 could usually he treated timely; For the county hospitals, the patients with secondary school or lower education level, 120 transportation, and NIHSS ＜3 could usually be treated timely. For the township hospitals, the patients with NIHSS ＞ 7 and unconsciousness could usually be treated timely. Conclusions The patients with acute cerebrovascular disease in the city, county and township hospitals in Qingdao area had significant treatment delay. Of those, 120 transportation and higher levels of education could decrease the treatment delay of patients. Therefore, perfecting stroke emergency network, raising people's level of education, and strengthening propaganda and education on stroke knowledge in all levels of hospitals are essential for timely treatment of stroke patients.