Objective:To investigate the risk of new-onset stroke caused by cerebral microbleed (CMB) and asymptomatic lacunar infarction (ALI) and their risk factors.Methods:A prospective observational study over a 18 month period was conducted on 397 non stroke patients who visited the Affiliated Hospital of Xuzhou Medical University from March 2020 to June 2022. By the presence of CMB and ALI about magnetic resonance imaging, they were divided into th control group (without CMB and ALI, 117 cases, 29.5%), ALI group (101 cases, 25.4%), CMB group (89 cases, 22.4%) and CMB-ALI group (90 cases, 22.7%).They were followed up for 18 months, the risk factors for CMB, ALI, and the risk of new stroke were analyzed.Results:The systolic blood pressure and uric acid in the CMB group were higher than those in the control group: (155.2 ± 24.2) mmHg(1 mmHg = 0.133 kPa) vs. (138.2 ± 19.0) mmHg, (387.0 ± 28.3) μmol/L vs. (354.0 ± 21.5) μmol/L, there were statistical differences ( P<0.05). After followed up for 18 months, the incidence rate of cerebral infarction, cerebral hemorrhage and TIA in the CMB group and CMB-ALI group were higher than those in the control group: 13.5%(12/89), 13.3%(12/90) vs.5.1%(6/117); 9.0%(8/89), 10.0%(9/90) vs. 2.6%(3/117); 5.6%(5/89), 6.7%(6/90) vs. 0.8%(1/117), there were statistical differences ( P<0.05). Conclusions:CMB is prone to abnormal systolic blood pressure and uric acid. CMB, CMB-ALI are prone to new onset ischemic stroke, cerebral hemorrhage and TIA.

High mobility group protein B1 (HMGB1) is a kind of nuclear protein widely existing in cells, which is released or secreted from cells by stress in the body and plays a key role in the survival or death pathways of cells. HMGB1 has a huge biological function and is the main regulator of major diseases such as inflammatory diseases and tumors. HMGB1 is closely related to the proliferation, differentiation, migration, apoptosis and drug resistance of tumor cells. With the continuous deepening of research on HMGB1, it is found that HMGB1 plays an important role in the occurrence, development, metastasis and drug resistance of breast cancer. Combined with the research status of HMGB1, the expression of HMGB1 in breast cancer is discussed to provide a new therapeutic scheme for clinical treatment.

Objective? To understand the heaLth seeking behavior among ruraL residents of Yanchuan County in Yan'an City and to anaLyze its infLuencing factors. Methods? From JuLy 2017 to August 2017, we seLected 552 ruraL permanent residents of Yanchuan County in Yan'an City by convenience sampLing. ALL of them were investigated with the seLf-designed heaLth seeking behavior questionnaire for ruraL residents. The binary Logistic regression was used to anaLyze the infLuencing factors of heaLth seeking behavior among ruraL residents. ResuLts? When ruraL residents were iLL, 224 (40.58%) ruraL residents bought medicines for treatment, 216 (39.13%) knew disease reLated knowLedge and 352 (53.01%) ruraL residents attended ruraL cooperative medicaL care. Binary Logistic regression showed that the infLuencing factors of heaLth seeking behavior of ruraL residents incLuded ages, monthLy income, attending insurance or new ruraL cooperative medicaL care, knowing disease reLated knowLedge, diet ruLes and the proportion of vegetabLes and meats each meaL. ConcLusions? HeaLth conscious of ruraL residents is weak; the heaLth seeking behavior is traditionaL, backward and negative;they Lack knowLedge on heaLth, medicaL treatment, heaLth care and emergency treatment and their medicaL insurance participation is inactive. Government sector shouLd pay attention to heaLth seeking behavior of ruraL residents, strengthen the deveLopment of ruraL doctor team and cLinics in viLLages and towns,improve medicaL care system and ruraL cooperative medicaL care so as to soLve the probLems high cost and difficuLty of getting medicaL service among ruraL residents.

Objective To analyze the overseas imported malaria situation of Shijiazhuang City from 2012 to 2015,so as to provide the evidence for exploring the prevention and control strategy. Methods The data of overseas imported malaria were collected and analyzed with the descriptive method including Plasmodium species,population characteristics,epidemic focus distribution,onset time,diagnosis and treatment in Shijiazhuang City from 2012 to 2015,and the time from the onset to first medical visit,time from first medical visit to being diagnosed,and time from onset to being diagnosed of different Plasmodium species were analyzed respectively with the statistical analysis method. Results A total of 92 overseas imported malaria cases were reported in Shijiazhuang City from 2012 to 2015,including 88 cases from African countries(falciparum malaria taking 53.41％),and 4 cases from Southeast Asian and other countries(vivax malaria taking 50％). Eighty-nine cases were distributed in 28 counties(districts)of 6 cities in Hebei Province,except 2 persons with foreign nationalities and 1 with Anhui Province cen-sus register. The male and young adults were dominant. The median time from the onset to seeing a doctor was one day and the median time from seeing a doctor to being diagnosed was five days. Most cases were reported by the Fifth Hospital of Shijia-zhuang which was the sentinel hospital. Totally 42.39％of the cases were misdiagnosed when the first visit to a doctor. All of the cases were laboratory confirmed and 100％of them received the standard treatment after diagnosis. Conclusions The overseas imported malaria cases are increasing rapidly with years and the malignant malaria cases were more than other malaria cases in Shijiazhuang City. It is necessary to further strengthen the long-term cooperation mechanism between the medical institutions and the entry-exit inspection and quarantine department. The technician training should be strengthened to avoid the severe cas-es and death cases.

Objective To compare the clinical outcome of internal fixation(IF)and total hip arthroplasty (THA)for the elderly patients with displaced femoral neck fracture. Methods A total of 128 patients with dis-placed femoral neck fracture admitted from January 2010 to December 2012 were selected and divided into IF group(61 cases)and THA group(67 cases). The operation and hospitalization index were compared between the 2 groups. All patients underwent follow-ups after operation. The functional recovery scale for hip fracture (FRS) and EQ-5D index were applied to evaluate the clinical outcomes periodically. Results Compared to THA group, the intraoperative trauma ,operation time and bed days were less in IF group(P<0.05),however the incidence of complication in IF group was higher than that in THA group. All the patients were followed up more than 3 years and mortality rate between the 2 groups showed no significant difference(P>0.05). Follow-ups at all time points revealed hip function in THE group is better than that in IF group(P<0.05),while no significant difference was found in terms of life quality(P > 0.05). Within 3 years,the costs related to fracture were 41772 yuan for IF group and 61174 yuan for THA group respectively. Conclusion Both internal fixation and total hip arthroplasty can provide satisfactory outcome for elderly patients with displaced femoral neck fracture. Compared with IF ,THA causes bigger trauma and costs more ,but ends up with lower complication incidences ,and improve hip function in a shorter period.

Objective To investigate the clinical effect ofYishen-Lishi formula combined with conventional treatment for gouty nephropathy.MethodsA total of 118 patients with gout nephropathy were included and divided randomly into a conventional treatment group (n=60) and a combined treatment group (n=58) according to the random number table method. The patients in the conventional treatment group were treated with allopurinol and those in the combined treatment group were treated with allopurinol and Yishen-Lishi formula, both for 3 months. Serum uric acid, blood urea nitrogen (BUN), serum creatinine (SCr), 24 h endogenous creatinine clearance (CCr), 24 h urine protein, urineb2 microglobulin, serum triacylglycerol (TG), serum total cholesterol (TC), serum apolipoprotein A1, 24 h urine volume and urine pH were determined. The therapeutic effect was evaluated.ResultsThe urine pH (6.43 ± 0.6vs.6.21 ± 0.4;t=2.351,P=0.020), 24 h urine volume (3.3 ± 0.4vs.2.8 ± 0.6 L;t=5.308,P<0.001), 24 h CCr (1.61 ± 0.11 ml/svs. 1.33 ± 0.10 ml/s;t=14.477,P<0.001) and serum apolipoprotein A1 (1.90 ± 0.40 g/Lvs. 1.01 ± 0.33 g/L;t=13.203,P<0.01) in the combined treatment groupwere significantly higher than those in the standard treatment group. The serum uric acid (312.01 ± 33.56mmol/Lvs.350.12 ± 35.21 mol/L;t=6.015,P<0.001), BUN (6.22 ± 0.91 mmol/Lvs.11.50 ± 4.01 mmol/L;t=9.586,P<0.001), SCr (87.32 ± 13.90mmol/Lvs.122.54 ± 18.37mmol/L;t=11.743,P<0.001), 24 h urine protein (0.7 ± 0.2 gvs.1.2 ± 0.5 g;t=7.087,P<0.001), urineb2 microglobulin (220.3 ± 90.3mg/Lvs.330.1 ± 90.1mg/L;t=6.611,P<0.01), serum TG (5.11 ± 0.50 mmol/Lvs.6.30 ± 0.50 mmol/L;t=12.923,P<0.001), serum TC (1.50 ± 0.50 mmol/Lvs.2.30 ± 0.52 mmol/L;t=8.689,P<0.001) in the combined treatment group were significantly higher than those in the standard treatment group. The total effective rate inthe standard treatment group was significantly higher than those in the standard treatment group (89.7%vs.70.0%;χ2=5.871,P=0.015). ConclusionYishen-Lishi formula combined with conventional treatmentmay protect renal function, and reduce the blood lipids, its therapeutic effect is superior to conventional treatment alone in patients with gouty nephropathy.

Strokes due to atrial fibrillation (AF) are common and frequently devastating.While oral anticoagulant agents are the mainstay in the prevention of embolic events,they have several limitations and not all patients can tolerate them long term.The left atrial appendage (LAA) has been identified as the source of thrombus formation in nonvalvular AF.Several LAA closure devices have been developed,they have been successful in stroke prevention in patients with nonvalvular AF and fewer periprocedural complications.This article reviews the application of percutaneous left atrial appendage closure for stroke prevention in patients with nonvalvular AF.

Objective To observe and explore clinical efficacy ofTianma-Gouteng decoction combined valsartan in the treatment of patients with renal hypertension and its effects on renal function. Methods A total of 130 patients with renal hypertension were enrolled and randomly divided into a study group (68 patients) and a control group (62 patients). Both groups were given prescription of lower sodium diet, exercising and enalaprilscheme. On this basis, the control group plus valsartan, and the study group was further added withTianma-Gouteng decoction. After 2 courses treatment, renal function, and blood pressure of both groups were compared, and clinical efficacy on blood pressure were evaluated.Results After treatment, the SBP (126.8 ± 9.1 mmHg vs. 134.1 ± 8.8 mmHg,t=4.648), DBP (82.4± 5.0 mmHgvs. 85.3 ± 5.4 mmHg, t=3.167), Scr (148.5 ± 46.3μmol/Lvs. 172.1 ± 52.0μmol/L, t=2.723), BUN (8.3 ± 2.7 mmol/Lvs. 9.7 ± 3.1 mmol/L,t=2.734) and 24hAlb (1.7 ± 0.6 gvs. 1.9 ± 0.7 g,t=2.209) in the study group were significantly lower than control group (P<0.05 orP<0.01). The total effective rate in the study group was significantly increased than that in the control group (91.2%vs. 79.0%;χ2=0.383,P=0.050).Conclusion Valsartan combined with Tianma-Gouteng decocntion can reduce blood pressure, and alleviate the kidney damage effectively.

Mortality of patients with malignant middle cerebral artery infarction (mMCAI) is as high as 41％ to 78％ with the conservative treatment in the intensive care unit.Malignant edema caused tentorial herniation is the most common cause of resulting in the death of patients.Some evidence supports the hemicraniectomy for the treatment of patients with mMCAI.The patients must receive supportive and adjuvant therapies before surgical decision making.Therefore,the prediction and intensive care of mMCAI have a very important significance.This article reviews the predictive factors and intensive care of mMCAI.

Objective To explore the 5,10-methylenetetrahydrofolate reductase( MTHFR) and 5-methyltet-rahydrofolate-homocysteine methyltransferase reductase( MTRR) gene polymorphisms among the Han women in Laiwu City.Methods A total of 559 Han women were recruited.And their oral epithelial cells were collected to extract genome DNA in order to detect gene polymorphisms of MTHFR and MTRR using fluorescence quantitative PCR.Then the results were compared with those in other cities in China.Results The frequency of MTHFR 677CC,677CT and 677TT of Han women in Laiwu city was 14.3%,46.7%and 38.1%,respectively.The frequency of MTHFR 677TT among Laiwu women was significantly different to those of Zhenjiang, Wuhan, Kunming, Deyang, Huizhou, Qionghai (P<0.05).The frequency of AA,AC,CC gene type on MTHFR A1298C was 78.2%,19.7% and 2.1%,respec-tively, the frequency was significantly different to those of Zhenjiang, Wuhan, Kunming, Deyang, Huizhou, Qionghai (P<0.05).The frequency of AA,AG,GG gene type on MTRR A66G was 53.3%,38.8%and 7.9%,respectively. The frequency of MTRR 66GG was significantly different to that of Qionghai(P<0.05).Conclusion The MTHFR, MTRR polymorphism distribution of Han women in Laiwu City has the characteristic of region specificity,respectively.