Objective:To investigate the risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.Methods:From November 2013 to December 2019, patients with spontaneous extracranial vertebral artery dissection admitted to the Department of Neurology, Baotou Central Hospital were enrolled retrospectively. According to whether they had ischemic stroke or not, they were divided into ischemic stroke group and non-ischemic stroke group. The independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection were identified by binary logistic regression analysis. Results:A total of 39 patients were enrolled, 25 were female (64.1%), 14 were males (35.9%), their age was 51.51±14.98 years old, 16 of them (41.0%) had ischemic stroke. The proportion of patients with double-lumen sign, intimal flap sign of occluded lumen (37% vs. 4%; P=0.013) and specific initial symptoms (56% vs. 9%; P=0.003) of the ischemic stroke group were significantly higher than those of the non-ischemic stroke group. Multivariate logistic regression analysis showed that double-lumen sign and intimal flap sign of occluded lumen (odds ratio 47.951, 95% confidence interval 26.284-87.478; P<0.001), and specific initial symptoms (odds ratio 19.232, 95% confidence interval 10.695-34.587; P<0.001) were independently associated with ischemic stroke in patients with spontaneous extracranial vertebral artery dissection. Conclusions:Double-lumen sign, intimal flap sign of occluded lumen and specific clinical symptoms are the independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.

Objective:To discuss the efficacy and safety of ultrasound-guided rectus sheath block (RSB) combined with subcostal transversus abdominis plane block(TAPB) in peritoneal dialysis catheter implantation in patients with end-stage renal disease.Methods:A total of sixty patients (scheduled for elective peritoneal dialysis catheter placement from June 2018 to March 2019 in Wuhan First Hospital were randomly divided into two groups: local anesthesia group(group LA, 30 patients) and ultrasound-guided RSB combined with subcostal TAPB (group NB, 30 patients). Group LA: local infiltration anesthesia was performed with 1% lidocaine and 0.5% ropivacaine 20ml; group NB: RSB, 1% lidocaine and 0.5% ropivacaine 15 ml were injected into the lateral rectus sheath, and TAPB, 1% lidocaine and 0.5% ropivacaine 20 ml were injected into the transversus abdominis plane. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at the point of entering the operating room (T 0), after anaesthesia (T 1), at the beginning of operation (T 2), twenty minutes after the beginning of operation (T 3), and at the end of the operation (T 4). The duration of operation, the times of additional local anesthetia during the surgery, the score of visual analogue scale (VAS) during and 24 h after the surgery, the rate of alteration to general anesthesia and the occurrence of adverse reactions were recorded. Results:In group LA, compared with T 0, MAP and HR at T 2 and T 3 increased significantly: (93.1 ± 9.7), (99.8 ± 11.6) times/min vs. (78.4 ± 10.5) times/min and (105.1 ± 13.7), (110.5 ± 14.4) mmHg (1 mmHg = 0.133 kPa) vs. (92.1 ± 12.8) mmHg, P<0.05. In group NB, there were no differences among T 0-T 4. At T 2 and T 3, MAP and HR in group LA were higher than those in group NB ( P<0.05). Compared with that in group LA, the duration of operation time decreased significantly in group NB ( P<0.05). The times of additional local anesthetia during the surgery in group LA were more than those in group NB ( P<0.05). Compared with those in group LA, the VAS scores during and 24 h after the surgery in group NB were significantly lower: (3.25 ± 0.65) scores vs. (5.85 ± 0.76) scores, (1.46 ± 0.57) scores vs. (2.37 ± 0.45) scores, P<0.05. There were no significant differences in the rate of alteration to general anesthesia between the two groups: 3.33% (1/30) vs. 0, P>0.05. There was no adverse reaction in these two groups. Conclusions:Ultrasound-guided rectus sheath block combined with subcostal transversus abdominis plane block is safe and effective in peritoneal dialysis catheter implantation. The effect of intraoperative anesthesia is definite, with little influence on hemodynamics. The postoperative analgesia effect is good, without obvious anaesthesia-related adverse events.

Based on the requirement of the ongoing healthcare reform on the performance appraisal for public hospitals, Shanghai Tenth People′s Hospital explored the performance appraisal system oriented by clinical ability and cost control from the perspective of medical administration and finance. Performance appraisal programs were made from five aspects: clinical development ability, key efficacy indicators, clinical path, disease-entity structure, cost control, aiming to highlight the functional positioning of tertiary hospitals, change doctors′ behaviors of diagnosis and treatment, lead clinical improvement and maintain healthy economy development.

Objective: To compare the safety and efficacy of pulsed dye laser (PDL) with different sessios for the East Asian infants with port-wine stains(PWS). Methods: From September 2016 to September 2017, 24 East Asian infants with untreated PWS, who met the standards of enrollment, received seven treatments by PDL at 2-week intervals and three treatments at 6-week intervals at adjacent locations in each patient 2 months after final treatment. The efficacy outcome was compared with Wilcoxon signed-rank test, while the safety was compared using Fisher′s exact test. Results: Of the 24 patients, 20 completed study. Seven patients had multiple sites, given a total of 62 treated PWS sites. Among the patients, 18 had lesions on the face and 2 on the extremities. The average blanching rate was (43.71 ± 27.16) % and (43.29 ± 31.58) % for PDL treatments with 7- and 3- sessions, respectively (P>0.05). The result was consistent with independent observer assessment judging that the result of 7 laser treatments was equally with that of 3 treatments (r=0.416, P=0.0008). The average grade was 3.58 ± 1.21 and 3.53 ± 1.16 for 7- and 3-sessions. The patients treated with 7-sessions developed a little more side effects than 3-sessions, including residue purpura, pigmentation changes, eczema and dermatitis. Conclusions After three treatments of PDL, the efficacy may not necessarily increased by more frequent treatments for East Asian infantile PWS.

Type Ⅶ secretion system(T7SS) is a novel and specialized secretion system discovered in recent years. It was first found in Mycobacterium tuberculosis. Type Ⅶ secretion system is involved in the secretion of virulence-associated proteins, the interaction between pathogens and hosts and the balance of zinc/iron ions. Moreover,it plays a critical role in the growth and pathogenesis of Mycobacteria. This review summarizes the components,substrates and translocation mechanisms of the type Ⅶ secretion system and its relation to the virulence of Mycobacteria aiming to provide references for developing novel strategies for disea-ses diagnosis,treatment and prevention.

Objective To assess the efficacy and safety of nalbuphine in preventing the side effect of pruritus induced by intrathecal morphine after cesarean section. Methods Sixty patients aged 18- 35 years with ASAⅠ~Ⅱand undergoing cesarean section with combined spinal-epidural anesthesia were randomly and double blindly divided into two groups. Patients in Group N (30 patients) received nalbuphine 4 mg (2 ml) by intravenous route after clamping of the umbilical cord; Patients in Group P (30 patients) received 0.9% NaCl (2 ml) by intravenous route after clamping of the umbilical cord. The protocol of postoperative analgesia was intrathecal morphine 0.2 mg. The patients were followed up for 4 h , and the vital signs were detected at the time of returning to patient s room (T0), 1 h (T1), 2 h(T2), 3 h(T3) and 4 h(T4) after operation. The VAS scores, pruritus severity scores, time of pruritus onset, Ramsay sedation scores and and other adverse effects were recorded. Results The levels of MAP, SpO2, HR in two groups at T0, T1, T2, T3, T4 had no significant differences (P>0.05). The rate of pruritus severity score 0-1 score in group N was significantly higher than that in group P (χ2=17.4, P=0.00). The VAS scores and the rate of drowsiness, nausea, vomiting, shivering and dizziness in two groups had no significant difference (P>0.05). Conclusions Nalbuphine provides a significant reduction of morphine induced pruritus for patients who received intrathecal morphine analgesia after cesarean section.

Objective To assess the efficacy and safety of multimodal analgesia with different doses of nalbuphine combined with flurbiprofen on patients who received intravenous patient -controlled analgesia(PCIA) after thoracotomy.Methods Sixty patients underwent thoracotomy,ASA Ⅰ -Ⅱ,18 -65 years old,who underwent postoperative PCIA,were randomly divideded into three groups according to the digital table,nalbuphine 60 mg group (N60 group),nalbuphine 80 mg group(N80 group)and nalbuphine 100 mg group (N100 group),20 cases in each group.All patients were given 150mg flurbiprofen,a total of 100mL.PCIA solution:the background dose was 2mL/h, PCIA dose of 0.5mL,locking time of 15min.10min before surgery,each patient was intravenously given flurbiprofen 50mg,given a loading dose of 0.1mL/kg when closed chest.All patients were followed up for 48h.The incidence of adverse reactions such as vital signs,number of times,visual analog scale(VAS)score,sedation score,nausea and vomiting were recorded.Results There were no significant differences in the age,gender,body mass index and surgery duration among the three groups(all P >0.05).The vital signs were stable within 48h after operation.The VAS scores of N60 group were higher than the other two groups(N80 group:t =7.94,6.35,6.49,5.21,5.63,all P =0.00;N100 group:t =8.41,9.10,5.80,8.07,8.18,all P =0.00)at 4,6,8,24 and 48h after operation(all P <0.05).The VAS score of N80 group 48 h after operation was lower than that of N100 group(t =2.30,P =0.03),and the difference was not statistically significant in remaining(all P >0.05).The effective /actual compression ratio of PCIA of N80 group and N100 group were significantly higher than that of N60 group (t =7.30,8.35,all P <0.05). There were no differences in the incidence of adverse reaction among the three groups(group N80:χ2 =0.17,0.23, 1.03,all P >0.05;group N100:χ2 =3.14,0.23,1.03,all P >0.05).Conclusion Postoperative PCIA with nalbu-phine (80 mg)combined with flurbiprofen(150 mg)has significant analgesic effect and lower costs.

Theacrine is one kind of natural purine alkaloids, which mainly exists in an unusual Chinese tea known as Kucha. It shows various biological activities, such as anti-depression, sedative and hypnotic effects and anti-inflammatory and analgesic activi-ties. The study on theacrine dates back to a few decades ago. According to the references published in recent years, the resource, preparation, characterization and pharmacological effects of theacrine were reviewed, and its application prospect was also explored.

BACKGROUND:MicroRNAs (miRNA) through regulating specific target gene mRNA expression play important roles in different processes of diseases. OBJECTIVE:To study the interaction of miRNA-21 with its target gene TLR4 in Hela cels. METHODS:The candidate target gene of miRNA-21 was determined according to miRNA analysis databases. The constructed recombinant adenovirus vector carrying pri-miRNA-21 gene was used, which could package and amplify viruses to transfect Hela cels. Then, the expression of fluorescent proteins was detected. Forty-eight hours after transfection of miRNA-21 or control, extracted proteins were used for detection of TLR4 protein using western blot assay. RESULTS AND CONCLUSION:Recombinant adenoviruses pAd/pri-miRNA-21 and pAd/neg at 100 MOI could successfuly infect Hela cels. Bioinformatic analysis suggested several possible binding sites between miRNA-21 and TLR4. The experimental results showed that miRNA-21 down-regulated TLR4 at protein levels, indicating that miRNA-21 can interfere with the expression of TLR4 target gene.

In resent years,brain parenchyma and cerebrovascular sonography have received considerable attention.Monitoring of cerebral vessels and their blood flow velocities and pulsation indexes may reflect the intracranial vascular lesions.However,there are a few studies about transcranial color-code duplex sonography (TCCD) in the monitoring of space-occupying stroke.This technology has the non-invasive,convenient,and economical advantages,and can timely provide clinical information.Using TCCD to monitor pace-occupying stroke may play a positive role in prevention of the diseases and prognosis.