Background: The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity to the lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. We compared efficiency of these two approaches on the UN blockade. Methods: Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 ml of local anesthetic agents (1 : 1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunks (IT approach). Additional 15 ml was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention. Results: Complete sensory blockade (75.9% [22/29] vs. 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs. 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of the UN was significantly shorter in the IT compared to the CP group (15.0 [10.0; 15.0] min vs. 20.0 [15.0; 20.0] min; P = 0.012). Conclusions The IT approach provided a more rapid onset of UN blockade than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.

Objective:To investigate the independent predictors of the long-term clinical outcomes in patients with branch atheromatous disease (BAD) in lenticulostriate artery (LSA) territory.Methods:Patients with LSA-BAD admitted to the Department of Neurology, Zhongnan Hospital of Wuhan University from January 1, 2016 to June 1, 2019 were enrolled retrospectively. Their demography, vascular risk factor, and baseline clinical data were collected. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. The clinical outcomes were evaluated by the modified Rankin Scale at 6 months. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcomes in patients with LSA-BAD. Results:A total of 81 patients with LSA-BAD were enrolled. Their age 59.20±11.75 years (range, 39-81 years), 53 were male (65.4%), and median baseline NIHSS score was 1.0 (interquartile range, 0-4.0). Forty-one patients (50.6%) received intravenous thrombolysis. At 6-month follow-up after the onset, 63 patients (77.8%) had a good outcome, and 18 (22.2%) had a poor outcome. The baseline NIHSS score of the poor outcome group was significantly higher than that of the good outcome group (6.5 [0-9.0] vs. 1.0 [0-3.0]; Z=2.395, P=0.017), while the proportion of mild stroke (61.6% vs. 98.4%; χ2=17.595, P<0.001) and patients receiving intravenous thrombolysis (38.9% vs. 54.0%; χ2=4.450, P=0.035) were significantly lower than those of the good outcome group. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, venous thrombolysis was independently correlated with the good outcome (odds ratio 0.099, 95% confidence interval 0.011-0.924; P=0.042), while the high baseline NIHSS score was independently associated with the poor outcome (odds ratio 1.736, 95% confidence interval 1.262-2.388; P=0.001). Conclusion:Intravenous thrombolysis is helpful to improve the outcomes of patients with LSA-BAD, and a higher baseline NIHSS score is an independent predictor of the poor outcome.

Objective:To investigate the clinical characteristics of carotid webs and prevention measurements of cerebral ischemic stroke caused by carotid webs.Methods:The clinical data of three patients with carotid webs admitted to our hospital from October 2017 to January 2019 were retrospectively studied, and publications (208 patients with carotid webs) reported from January 1, 2014 to June 30, 2019 in PubMed, Embase, Wanfang and CNKI databases were collected. The demographic and clinical characteristics of carotid webs and secondary prevention measurements of ischemic stroke caused by carotid webs were analyzed.Results:A total of 211 patients with carotid webs were enrolled, including 68 male (32.2%) and 143 female (67.8%), with an median age of 48 years. Prevalence of risk factors for cerebrovascular disease reported in 148 patients was as follows: hypertension ( n=43, 29.1%), dyslipidemia ( n=19, 12.8%), diabetes mellitus ( n=14, 9.5%), and smoking ( n=12, 8.1%); 89.8% of carotid webs(44/49) caused mild stenosis of carotid artery (stenosis degree<50%). In secondary stroke prevention, the recurrence rate of stroke patients treated with anticoagulation plus antiplatelet was obviously lower than that of patients treated with antiplatelet alone (11.1% vs. 49.3%). No ischemic stroke or surgical complications were noted in 23 patients underwent carotid endarterectomy and 54 patients underwent carotid stent implantation during the mean follow-up period of 12 months (one-60 months) and 11 months (3-144 months), respectively. Conclusions:Carotid web may be a vital risk factor for cryptogenic stroke. Anticoagulation plus antiplatelet is superior to antiplatelet alone in preventing stroke recurrence. Carotid endarterectomy and carotid stent implantation may be the perfect choices for carotid web patients with high risk of stroke recurrence.

Objective: The aim was to investigate the genotype distribution of two major epitopes of large surface protein (PreS1) of hepatitis B in Chinese patients and to explore the association between the genotypes of these two epitopes, and to determine whether PreS1 full-length genotype could be revealed according to the polypeptide sequence of key epitopes. Methods: HBV DNA was extracted from the serum of patients for PCR amplification. 278 samples amplified successfully were sequenced and compared with the known HBV sequences in Genbank to determine the two key epitopes of HBV PreS1 genotype (amino acid epitope 21-47 and 94-117, abbreviated as P21 and P94) and PreS1 full-length genotypes. The correlation among three genotyping approaches was analyzed by Cohen’s kappa coefficient to verify the consistency between the key-epitope genotyping and the full-length preS1 genotyping. Results: 232 samples were successfully sequenced. The genotyping based on the kind of P21 epitope protein sequence, 201 cases for genotype C, 23 cases for genotype B and 8 cases for uncertain genotypes and genotyping based on the form of P94 epitope protein sequence, 199 cases for genotype C, 25 cases for genotype B and 8 cases for indeterminate genotypes. Lastly, the genotyping based on sequence of the full-length PreS1 sequence, 207 and 25 cases for genotype C and B. P21 or P94 epitope genotyping and PreS1 full length genotyping were highly consistent, respectively, 96.55% and 96.12%, and the two epitopes (P21and P94) genotyping have parallel consistency (93.10%). Conclusion In this study, an innovatively genotyping method based on the amino acid sequence of key epitopes was proposed. The genotypes of HBV in china were mainly B and C genotypes, and the genotypes of key conserved epitopes of HBV PreS1 were highly consistent with the full-length genotyping ( > 96%). Moreover, genotyping with one or two key epitopes can be used in place of the full-length genotyping.

Objective To investigate the expression of regulators of G protein signaling(RGS), including RGS2, RGS3 and RGS4 in OLETF rats, as well as the effects of metformin on these expressions. Methods LETO rats were used as control group. Eight-week-old male OLETF rats were assigned to two guoups randomly:model and trial(metfomin dose during 8~(th) to 22~(nd) weeks:300mg kg~(-1)·d~(-1);during 23rd to 28th weeks:400 mg·kg~(-1) ·d~(-1))groups. Expressions of RGS mRNA in aorta and heart werequantified by real-time PCR. Results RGS2, RGS3 and RGS4 mRNA of the thoracic aorta and left ventricle were significantly higher in model group than in control group (P<0.01). Compared with model group, metformin significantly reduced their mRNA in trial group (P<0.01). Conclusions Upregulation of RGS2, RGS3 and RGS4 mRNA expression in the thoracic aorta and left ventricle of OLETF rats is in correlation with cardiovascular lesions; while downregulation of their expression is in correlation with the action of metformin.

Objective To investigate the current status of prevalence, prevention and management of chronic obstructive pulmonary disease(COPD) in rural area in China. Methods A cross-sectional survey of COPD was conducted in Beijing city, Shanghai city, Guangdong province, Liaoning province,Tianjin city, Chongqing province and Shanxi province. A population-based cluster sample was randomly selected from each rural area. In the selected community,all residents at least 40 years old were recruited,and interviewed with a modified standardized questionnaire from the international burden of obstructive lung diseases (BOLD) study. All participants were tested with spirometry. Those with airflow limitation were performed on post-bronchedilator spirometry. The post-bronchedilator a ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) less than 70% was defined as the diagnostic criteria of COPD. Results (1) Data of 9434 participants was valid for analysis, with a valid response rate of 83. 6% ;the prevalence of COPD in rural was 8. 8% (830/9434), 12. 8% in male and 5.4% in female. (2)The percentage of smoking and the exposure to biomass smoke in rural was 43. 0% (4059/9434) and 83. 1% (7835/9434) respectively; cigarettes cessation rate was 17.5% ; only 12. 4% ( 502/4059 ) of smokers had received advice to quit smoking. (3) Among COPD patients, only 30. 0% (249/830) had ever been diagnosed as COPD, bronchitis, emphysema, or asthma, 2. 4% (20/830) had ever received spirometric tests, and 74. 5% were current smokers; only 7.9% (50/634)COPD patients in stage two or over had received regular drug treatment. Conclusion There was high prevalence and poor prevention and management for COPD in rural areas. Therefore, an enforced prevention and management for COPD are urgent.

Plasmodium vivax malaria is an endemic disease in Korea, which rarely causes severe complications including those occurring in the cerebrum. There are limited numbers of complicated cases that have been reported around the world. We experienced a case of vivax malaria with cerebral complication: cognitive impairment and ataxia. A 55-year-old female with diabetes mellitus presented to the emergency department with acute fever of two days' duration. She did not have any history of travelling abroad or receiving blood transfusions. Peripheral blood smear revealed vivax malaria with parasitemia density of 0.53 percent. She demonstrated loss of orientation, especially regarding time and place, and ataxia. Although the initial hydroxychloroquine treatment for malaria was successful, cognitive impairment and ataxia persisted and were not recovered. Brain MRI showed no structural abnormality. Brain PET showed diffuse hypometabolism in right parieto-temporal lobe of the brain.
Ataxia ; Blood Transfusion ; Brain ; Cerebrum ; Diabetes Mellitus ; Emergencies ; Endemic Diseases ; Female ; Fever ; Humans ; Hydroxychloroquine ; Hypogonadism ; Korea ; Malaria ; Malaria, Cerebral ; Malaria, Vivax ; Middle Aged ; Mitochondrial Diseases ; Ophthalmoplegia ; Orientation ; Parasitemia ; Plasmodium ; Plasmodium vivax

Plasmodium vivax malaria is an endemic disease in Korea, which rarely causes severe complications including those occurring in the cerebrum. There are limited numbers of complicated cases that have been reported around the world. We experienced a case of vivax malaria with cerebral complication: cognitive impairment and ataxia. A 55-year-old female with diabetes mellitus presented to the emergency department with acute fever of two days' duration. She did not have any history of travelling abroad or receiving blood transfusions. Peripheral blood smear revealed vivax malaria with parasitemia density of 0.53 percent. She demonstrated loss of orientation, especially regarding time and place, and ataxia. Although the initial hydroxychloroquine treatment for malaria was successful, cognitive impairment and ataxia persisted and were not recovered. Brain MRI showed no structural abnormality. Brain PET showed diffuse hypometabolism in right parieto-temporal lobe of the brain.
Ataxia ; Blood Transfusion ; Brain ; Cerebrum ; Diabetes Mellitus ; Emergencies ; Endemic Diseases ; Female ; Fever ; Humans ; Hydroxychloroquine ; Hypogonadism ; Korea ; Malaria ; Malaria, Cerebral ; Malaria, Vivax ; Middle Aged ; Mitochondrial Diseases ; Ophthalmoplegia ; Orientation ; Parasitemia ; Plasmodium ; Plasmodium vivax

BACKGROUND: To discuss the feasibility of allogeneic freeze-drying radiation sterilization bone sheet applying in the prevention of post-laminectomy adhesion as an ideal biological material for filling and repairing bone defect. OBJECTIVE: To observe the preventive effect of allogeneic freeze-drying radiation sterilization bone sheet on the postlaminectomy adhesion and restenosis.DESIGN: Follow-up survey on cases.SETTINGS: Department of Orthopedics, Union Hospital, Tongji Medical School of Huazhong University of Science and Technology; Shanxi Medical Tissues of China Institute for Radiation Protection PARTICIPANTS: From March 2003 to June 2005, 58 patients with segmental lumbar spinal stenosis (LSS) were selected from Department of Orthopedics, Union Hospital, Tongji Medical School of Huazhong University of Science and Technology, including 34 males and 24 females, aged 30-78 years, including 25 cases of simple LSS and 33 combined LSS; and including 36 cases in L4-5 and 33 cases in L5, S1 segments. All the patients were similar in age, gender and healthy conditions.METHODS: The segmental whole laminectomies were performed in 58 patients with prolapse of lumbar intervertebral or LSS, and allogeneic freeze-drying radiation sterilization bone sheet in "H" shape was used to cover the vertebral laminae. According to the follow-up standard of lumbar spine operation recommended by the Orthopaedics Branch of Chinese Medical Association, all patients were followed up to evaluate their clinical symptoms, absorption of implanted bone as well as CT and MRI presentations.MAIN OUTCOME MEASURES: Improvements of clinical symptoms;Absorption of bone sheet in lumbar spinal canal.RESULTS: Totally 58 LSS patients were involved in the result analysis.In postoperative 0.5-year follow-up period, 17 of 21 patients showed excellent curative effects while other 4 patients showed fine effects. In postoperative 1-year follow-up period for 23 patients, CT and MRI results demonstrated that the spinal canal had been extended obviously. There was no tilt or displacement of the femoral sheet or compression of the spinal cord. As for 14 patients who were followed up for 1.5 years, CT results displayed that there was no rejective reaction observed in this study. The edgeof the allograft was inosculated with connective lamina of vertebra, and the shape of lumber spinal was good.CONCLUSION: Allogeneic freeze-drying radiation sterilization bone sheet is an ideal dressing material for epidural laminoplasty. The imaging results of patients in postoperative 1.5-year follow-up indicate that it can effectively reduce the post-laminectomy adhesion formation and prevent recurrence of post-laminectomy spinal restenosis, so as to apply on the segmental vertebral plate dressing.

OBJECTIVETo investigate the role of cell adhesion molecule in the development and extramedullary infiltration (EI) of acute leukemia.

METHODSThe expressions of neural cell adhesion molecule (NCAM) gene, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1) genes in 25 acute leukemia patients bone marrow cells were detected by microarray and reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTSThe expressions of NCAM, ICAM-1 and VCAM-1 gene were significantly higher in acute leukemia cells and leukemia cells with EI than in normal tissues and leukemia cells without EI, respectively, both by cDNA microarray and by RT-PCR.

CONCLUSIONThe cDNA microarray is a powerful technique in analysis of acute leukemia cells associated genes. High expressions of cell adhesion molecule genes might be correlated with leukemia pathogenesis and infiltration of acute leukemia cell.

Acute Disease ; Adolescent ; Adult ; Aged ; Bone Marrow Cells ; metabolism ; pathology ; Cell Adhesion Molecules ; genetics ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Intercellular Adhesion Molecule-1 ; genetics ; Leukemia, Myeloid ; genetics ; pathology ; Male ; Middle Aged ; Neural Cell Adhesion Molecules ; genetics ; Oligonucleotide Array Sequence Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; pathology ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Vascular Cell Adhesion Molecule-1 ; genetics