Evoked Potentials ; Social Isolation ; Attention ; Humans

Objective To explore the impact factors on early neurological deterioration(END)in patients with cerebral infarction combined with coronavirus disease 2019(COVID-19).Methods The clinical characteristics and laboratory of patients with acute ischemic stroke and COVID-19 in Brain Hospital Affiliated to Nanjing Medical University were retrospectively analyzed from December 15,2022 to January 15,2023.According to whether or not END occurred,all patients were divided into END group and non-END group.The clinical data of two groups were analyzed.Results A total of eligible 56 patients were included in this study,with 16 cases in END group and 40 cases in non-END group.The average age of END group(74.31±12.04)was older than non-END group(67.18±8.15)(P＜0.05).The proportion of previous history of coronary heart disease and diabetes were higher than non-END group(all P＜0.05).In terms of laboratory examination,the number of monocytes,C-reactive protein,glycated hemoglobin,lactate dehydrogenase,myoglobin,albumin,D-dimer,and fibrin degradation products in END group were significantly higher than that in non-END group(all P＜0.05).Logistic analysis showed that C-reactive protein is an independent risk factor for cerebral infarction combined with COVID-19(OR =1.084,95%CI:1.002-1.173,P＜0.05).Area under the ROC curve was0.825(95%CI:0.709-0.941,P＜0.001).Conclusions For patients with cerebral infarction combined with COVID-19,early neurological deterioration is more likely to occur in elderly patients with multiple underlying diseases,abnormal coagulation and inflammation indicators.Increased C-reactive protein has good predictive ability.

Objective To observe the feasibility of 5.0T MR for cardiac imaging.Methods Three patients with heart diseases and 17 healthy volunteers were prospectively enrolled.Cardiac MR(CMR)cine sequence and black blood sequence imaging were performed using 5.0T and 3.0T MR scanner,respectively.The image quality and artifacts degrees were compared between 5.0T and 3.0T CMR images,and the consistency of left ventricular parameters obtained using 5.0T and 3.0T scanners was analyzed.Results No significant difference of image quality nor artifacts degrees was found between 5.0T and 3.0T CMR images(all P＞0.05).The left ventricular end diastolic volume(EDV),end systolic volume(ESV),ejection fraction(EF),stroke volume(SV)and end diastolic mass(EDM)derived from cine images acquired at different fields were in a good agreement(all ICC＞0.75,all P＜0.001).Conclusion 5.0T MR could be used for cardiac imaging,with image quality of cine and black blood sequences comparable to that of 3.0T MR.

Objective:To explore the status of coronavirus disease 2019 (COVID-19) vaccines, safety and the influencing factors of adverse reactions in maintenance hemodialysis (MHD) patients.Methods:The study was a retrospective study. The MHD patients vaccinated with COVID-19 vaccines in Tianjin city from January 2020 to July 2022 were enrolled in the study. The data of general information, vaccination situation, adverse reactions, and laboratory tests before and after vaccination were collected. Logistic regression analysis was used to analyze the risk factors of adverse reactions after vaccination.Results:A total of 7 375 patients were registered to receive hemodialysis treatment in Tianjin city, of whom 1 036 patients (14.05%) vaccinated with COVID-19 vaccines were enrolled from 53 hemodialysis centers in the study, with age of (54.00±13.27) years old (17-88 years old), and 676 males (65.25%). There were 171 patients (16.51%) receiving the first dose of vaccines only, 464 patients (44.79%) receiving two doses of vaccines, 401 patients (38.71%) receiving three doses of vaccines, and 67 patients (6.47%) had adverse reactions. No serious adverse reaction occurred. The number of neutrophils after vaccination was lower than that before vaccination ( P < 0.05), while the number of lymphocytes, alanine aminotransferase, glutamic oxaloacetic aminotransferase, and serum albumin after vaccination were higher than those before vaccination (all P < 0.05). Logistic regression analysis showed that age ( OR=0.967, 95% CI 0.946-0.990, P=0.005), previous allergic history ( OR=0.013, 95% CI 0.001-0.151, P < 0.001), serum uric acid ( OR=1.004, 95% CI 1.001-1.008, P=0.020), numbers of vaccinations administered ( OR=0.505, 95% CI 0.330-0.774, P=0.002), leukocytes ( OR=0.766, 95% CI 0.628-0.935, P=0.009) and lymphocytes ( OR=0.082, 95% CI 0.045-0.148, P < 0.001) were independently correlated with the incidence of adverse reactions. Conclusions:The proportion of MHD patients vaccinated with COVID-19 vaccines is 14.05%. The incidence of adverse reactions is 6.47%, and there is no serious adverse reaction. Age, previous allergic history, serum uric acid, and numbers of vaccinations administered, leukocytes and lymphocytes are independently correlated with the incidence of adverse reactions in MHD patients.

Objective:To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) for hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS).Methods:Consecutive patients with AIS without performing intravenous thrombolysis and mechanical thrombectomy admitted to the Cerebrovascular Disease Treatment Center, the Affiliated Brain Hospital of Nanjing Medical University from December 2015 to December 2020 were enrolled. The clinical, imaging and laboratory examination data were collected. HT was defined as the first imaging examination of AIS patients without finding bleeding signs, but the imaging reexamination after hospitalization found intracranial hemorrhage. Multivariate logistic regression analysis was used to determine the independent correlation between NLR and HT. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for HT. Results:A total of 805 patients with AIS were included. The median age was 67 years (interquartile range, 63-71 years), the median National Institutes of Health Stroke Scale (NIHSS) score was 4 (interquartile range, 2-9), the median NLR was 3.84 (interquartile range, 2.66-5.30). Seventy-ywo patients (8.9%) had HT. There were significant differences in age, baseline systolic blood pressure, baseline NIHSS score, time from onset to admission, time from onset to blood collection, time from onset to imaging reexamination, NLR, atrial fibrillation, history of previous stroke and transient ischemic attack and stroke etiology between the HT group and the non-HT group (all P<0.05). Multivariate logistic regression analysis showed that NLR was an independent risk factor for HT in patients with AIS after adjusting for confounding factors (odds ratio 1.355, 95% confidence interval 1.099-1.672; P=0.005). The ROC curve analysis showed that the area under the curve of NLR predicting HT was 0.852, and the optimal cut-off value was 4.75. Its sensitivity and specificity of predicting HT were 88.3% and 71.8% respectively. Conclusion:High NLR is an independent risk factor for HT in patients with AIS during hospitalization, and had better predictive value for HT risk.

Aiming at the teaching characteristics of Medical Organic Chemistry in medical colleges and universities and the learning features of students, this article takes information technology as the medium and fully integrates autonomous learning mode of "teaching" and "learning" into the teaching process. In the teaching of Medical Organic Chemistry for students in grade 2017of Air Force Medical University, we adopted flipped classroom that is autonomous learning based on information resources-, student-centered micro-class assisted teaching, and self-learning mode such as self-designed experimental teaching based on network. The comprehensive scores of students of grade 2017 were compared with those of students of grade 2016 who adopted traditional teaching mode. The results showed that this mode of "teaching" and "learning" combined with "dominant-subject" can fully mobilize students' learning enthusiasm and initiative in Medical Organic Chemistry. It is more conducive for students to mastering learning methods, integrating knowledge and improving their ability to analyze and solve practical problems. The application of autonomous "teaching" and "learning" mode has effectively addressed the problems of insufficient interest of medical students in chemistry learning and problems of only one teaching mode for them. To a certain extent, it improves the quality and efficiency of Medical Organic Chemistry teaching.

Objective: The current study reported a case series to illustrate the early computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) in pediatric patients. Materials and Methods: All pediatric patients who were diagnosed with COVID-19 and who underwent CT scan in Zhongnan Hospital of Wuhan University from January 20, 2020 to February 28, 2020 were included in the current study. Data on clinical and CT features were collected and analyzed. Results: Four children were included in the current study. All of them were asymptomatic throughout the disease course (ranging from 7 days to 15 days), and none of them showed abnormalities in blood cell counts. Familial cluster was the main transmission pattern. Thin-section CT revealed abnormalities in three patients, and one patient did not present with any abnormal CT findings. Unilateral lung involvement was observed in two patients, and one patient showed bilateral lung involvement. In total, five small lesions were identified, including ground-glass opacity (n = 4) and consolidation (n = 1). All lesions had ill-defined margins with peripheral distribution and predilection of lower lobe. Conclusion Small patches of ground-glass opacity with subpleural distribution and unilateral lung involvement were common findings on CT scans of pediatric patients in the early stage of the disease.

Objective: To identify predictors of pulmonary fibrosis development by combining follow-up thin-section CT findings and clinical features in patients discharged after treatment for COVID-19. Materials and Methods: This retrospective study involved 32 confirmed COVID-19 patients who were divided into two groups according to the evidence of fibrosis on their latest follow-up CT imaging. Clinical data and CT imaging features of all the patients in different stages were collected and analyzed for comparison. Results: The latest follow-up CT imaging showed fibrosis in 14 patients (male, 12; female, 2) and no fibrosis in 18 patients (male, 10; female, 8). Compared with the non-fibrosis group, the fibrosis group was older (median age: 54.0 years vs. 37.0 years, p = 0.008), and the median levels of C-reactive protein (53.4 mg/L vs. 10.0 mg/L, p = 0.002) and interleukin-6 (79.7 pg/L vs. 11.2 pg/L, p = 0.04) were also higher. The fibrosis group had a longer-term of hospitalization (19.5 days vs. 10.0 days, p = 0.001), pulsed steroid therapy (11.0 days vs. 5.0 days, p < 0.001), and antiviral therapy (12.0 days vs. 6.5 days, p = 0.012). More patients on the worst-state CT scan had an irregular interface (59.4% vs. 34.4%, p = 0.045) and a parenchymal band (71.9% vs. 28.1%, p < 0.001). On initial CT imaging, the irregular interface (57.1%) and parenchymal band (50.0%) were more common in the fibrosis group. On the worst-state CT imaging, interstitial thickening (78.6%), air bronchogram (57.1%), irregular interface (85.7%), coarse reticular pattern (28.6%), parenchymal band (92.9%), and pleural effusion (42.9%) were more common in the fibrosis group. Conclusion Fibrosis was more likely to develop in patients with severe clinical conditions, especially in patients with highinflammatory indicators. Interstitial thickening, irregular interface, coarse reticular pattern, and parenchymal band manifested in the process of the disease may be predictors of pulmonary fibrosis. Irregular interface and parenchymal band could predict the formation of pulmonary fibrosis early.

The 2017 edition of expert consensus onclassification and clinical strategy of constipation was released in March 2018. This artide makes a joint interpretation of it with the Guideline for surgical diagnosis and treatment of constipation ( 2017 edition). The similarities and differences between the two mainly include: (1) The concept of constipation is basically the same, the main difference is that the consensus puts forward the association between constipation and mental disorders. (2) For constipation in terms of etiology, examination methods and evaluation, the consensus does not mention the etiology, but the examination methods are completely consistent. The reference standard of mental and psychological assessment is added in the consensus. (3) For the diagnosis of constipation, the diagnostic criteria and classification of constipation are specified in the guideline, and only the classification of constipation is mentioned briefly, while the consensus further develops the three different degrees of constipation. (4) For the treatment of constipation, the basic principles are the same. In the description of the specific treatment plan, the guideline divides the treatment methods of constipation into two categories: non-surgical treatment and surgical treatment, and then focuses on the suitability and specific operation of surgical treatment, while the consensus focuses more on coping strategies and treatment options for different degrees of constipation, including how to deal with the unavoidable mental and psychological disorders in the diagnosis and treatment of constipation questions. It can be seen that the consensus is a supplement and improvement of the guideline for surgical diagnosis and treatment of constipation. The consensus provides more targeted and applicable clinical reference ideas for clinical practice from different perspectives, especially the better auxiliary clinical decision-making after the quantification of the classification standard of constipation.

The 2017 edition of expert consensus onclassification and clinical strategy of constipation was released in March 2018. This artide makes a joint interpretation of it with the Guideline for surgical diagnosis and treatment of constipation ( 2017 edition). The similarities and differences between the two mainly include: (1) The concept of constipation is basically the same, the main difference is that the consensus puts forward the association between constipation and mental disorders. (2) For constipation in terms of etiology, examination methods and evaluation, the consensus does not mention the etiology, but the examination methods are completely consistent. The reference standard of mental and psychological assessment is added in the consensus. (3) For the diagnosis of constipation, the diagnostic criteria and classification of constipation are specified in the guideline, and only the classification of constipation is mentioned briefly, while the consensus further develops the three different degrees of constipation. (4) For the treatment of constipation, the basic principles are the same. In the description of the specific treatment plan, the guideline divides the treatment methods of constipation into two categories: non-surgical treatment and surgical treatment, and then focuses on the suitability and specific operation of surgical treatment, while the consensus focuses more on coping strategies and treatment options for different degrees of constipation, including how to deal with the unavoidable mental and psychological disorders in the diagnosis and treatment of constipation questions. It can be seen that the consensus is a supplement and improvement of the guideline for surgical diagnosis and treatment of constipation. The consensus provides more targeted and applicable clinical reference ideas for clinical practice from different perspectives, especially the better auxiliary clinical decision-making after the quantification of the classification standard of constipation.