Objective To investigate the correlation between 24-h ambulatory blood pressure variability and the overall burden of cerebral small vessel disease (CSVD) in patients with acute ischemic stroke. Methods From March 2016 to December 2017, consecutive patients with acute ischemic stroke admitted to the Department of Neurology, the Affiliated Changshu Hospital of Soochow University were enrolled. The 3. 0 T-MRI was used to assess asymptomatic lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces within 24 h after admission, and the total CSVD score (0-4) was calculated. 24-h ambulatory blood pressure monitoring was performed 24 to 72 h after admission. Ordinal logistic regression analysis was used to determine the independent correlation between the 24-h ambulatory blood pressure-related index and the total CSVD score. Results A total of 220 patients with acute ischemic stroke were enrolled. The patients were divided into five groups according to the total CSVD score. Univariate analysis showed that there were significant differences in age, homocysteine, the proportion of hypertension, as well as 24 h, daytime and nighttime mean systolic blood pressure (SBP), and coefficient of variation of daytime SBP among the 5 groups (all P < 0. 05). Ordinal logistic regression analysis showed that age (odds ratio [OR] 1. 078, 95％ confidence interval [CI] 1. 051-1. 106; P < 0. 001), 24-h mean SBP (OR 1. 043, 95％ CI 1. 026-1. 060; P < 0. 001), daytime mean SBP (OR 1. 042, 95％ CI 1. 025-1. 059; P < 0. 001), nighttime mean SBP (OR 1. 034, 95％ CI 1. 019-1. 049; P < 0. 001), and coefficient of variation of daytime SBP (OR 1. 129, 95％ CI 1. 052-1. 210; P = 0. 003) were independently correlated with the total CSVD score. Conclusions The elevated 24 h, daytime and nighttime mean SBP levels and coefficient of variation of daytime SBP are independently correlated with the severity of overall CSVD burden in patients with acute ischemic stroke.

ObjectiveTo explore and find the risk factors affecting the spontaneous closure of secundum atrial septal defect in newborn.MethodsCollected301 cases diagnosed in our hospital for typeⅡ atrial septal defect in newborn, follow-up plan was strict formulation, the risk factors included gender, location, size, quantity, and complications were the possible risk factors. Through single factor analysis and multiple factor stepwise Logistic regression analysis, the independent risk factors of spontaneous closure of typeⅡ atrial septal defect were analyzed.Results 301 cases of typeⅡatrial septal defect newborn with 24 cases of atrial septal defect were not spontaneous closure at the end of follow-up, univariate analysis showed that the risk factors of the defect location, size, and pulmonary hypertension were statistically significant, further regression analysis showed that the independent risk factors of natural healing of neonatal typeⅡatrial septal defect were obtained by the stepwise Logistic regression analysis of the location of the defect (Vena cava sinus), the size of the defect (>4 mm), and pulmonary hypertension. ConclusionAtrial septal defect, defect size>4 mm, and pulmonary hypertension were the independent risk factors of atrial septal defect spontaneous closure in newborn. In order to improve the quality of life of children in the future, we need to develop a more positive follow-up and treatment plan for the patients with the defect location of the vena cava sinus, defect size >4 mm and atrial septal defect with pulmonary hypertension.

Aim To investigate the protection of oxymatrine on focal crerebral ischemic injury in rats and its mechanism of inhibition of opoptosis.Methods The method of permanent middle cerebral artery occlusion in rats(permanent middle cerebral artery occlusion,pMCAO) was adopted to establish cerebral ischemia model,Through the abdominal cavity pMCAO postoperative rats were given OMT(30,60,120 mg·kg-1).Evaluation index like cerebral infarction volume,water content and behavioral symptoms of brain were taken account in terms of OMT in cerebral ischemia neural protection.Through HE dyeing method the influence of OMT on form change and number of ischemic cortex of nerve cells was observed.Western blot was applied to detect OMT of ischemic cerebral cortex Caspase-3,Bcl-2,Bax protein level of expression.Results In rat focal cerebral ischemia body model,OMT(30,60,120 mg·kg-1) could significantly reduce the cerebellum infarction volume,water content and improve brain behavior signs(P0.01).HE dyeing results indicated: OMT could significantly increase the survival rate of nerve cells and improve the form of nerve cells.Western blot results showed: compared with false surgery group,PMCAO rats after 3,6,12,24 h,ischemic cortex Caspase-3,Bax protein expression level in 3 h began to rise and peaked at 24 h;Bcl-2 in the expression level 3h began to drop,24 h to a minimum.After given the OMT,the levels of Caspase-3,Bax protein in PMCAO rat cortex ischemia could down-regulated and the levels of Bcl-2 protein up-regulated.Conclusions The current finding provide the first evidence that OMT has a direct neuroprotective activity in cerebral ischemic neuronal injury,which is probably related to the inhibition of opoptosis by up-regulation of the levels of Bcl-2 and down-regulation of the levels of Bax and Caspase-3 singnal way.

目的观察不同负荷剂量氯吡格雷治疗急性冠状动脉综合征的临床效果。方法将88例急性冠状动脉综合征患者随机分为高剂量组45例和常规剂量组43例。高剂量组给予氯吡格雷600mg,然后以150mg维持7d,继以75mg维持;常规剂量组给予常规剂量氯吡格雷300mg,继以75mg维持。比较2组治疗1年之后主要不良心血管事件(死亡、心肌梗死、紧急血运重建、再发缺血入院及支架内血栓形成)的发生率和30d内出血事件发生率。结果高剂量组各不良事件发生率均低于常规剂量组,差异均有统计学意义(P<0.05)。30d内,高剂量组发生轻微出血8例,常规剂量组发生轻微血5例,2组30d内轻微出血情况比较差异无统计学意义(P>0.05)。2组均无致死性出血事件发生。结论高负荷剂量氯吡格雷治疗ACS可显著改善其预后,且安全耐受性好。

目的 观察脑必通胶囊对局灶性脑缺血大鼠脑血流量及内皮细胞诱导型一氧化氮合酶(iNOS)表达的影响.方法 采用大鼠永久性大脑中动脉阻塞(pMCAO)模型观察脑必通胶囊350、175、87.5 mg/kg对大鼠局部脑血流量的影响.建立人脐静脉内皮细胞(HUVEC)缺氧缺糖模型,采用Real time PCR技术检测HUVEC iNOS mRNA的表达；应用免疫组织化学法及Western-blotting法检测HUVEC缺氧后iNOS蛋白水平的变化及脑必通胶囊含药血清对HUVEC iNOS蛋白水平的影响.结果 缺血模型组动物脑血流量较假手术组动物及pMCAO前明显减少.脑必通胶囊可显著增加大鼠的基础脑血流量及pMCAO后大鼠缺血部位的脑血流量.Real time PCR结果表明,HUVEC细胞缺氧3h后,iNOS mRNA出现表达高峰.免疫荧光法证明:对照组HUVEC细胞缺氧后12 h,iNOS阳性细胞显著增多.Western-blotting亦显示,HUVEC细胞缺氧后,iNOS蛋白水平明显增加,12h达高峰.结论 脑必通胶囊对大鼠局灶性脑缺血脑血流量有明显增加作用,其作用机制可能与上调血管内皮细胞iNOS表达有关.

Gene therapy for glioma is becoming more and more popular in the field of biology,and the double gene therapy has attracted much attention.In recent years,the gene-radiation therapy provides a novel possibility for better treatment of glioma,which combine the speciality of both radiation treatment and gene therapy.This review is aimed to summarize the gene therapy of glioma,especially the latest progress of combination of double gene delivery and radiation therapy.

目的 探讨成人重复肾输尿管畸形的诊断与治疗方法.方法 回顾性分析33例重复肾输尿管畸形患者的临床资料.其中,B超检查33例,排泄性尿路造影(IVU)25例,CT扫描14例,磁共振尿路成像(MRU)11例.29例行手术治疗.结果 33例中,29例重复肾输尿管畸形患者经手术治疗临床症状消失,病理检查均报告为重复肾;另4例因无症状、肾功能良好且无并发症,未做任何处理,仅随访观察.结论 B超简单、无创,确诊率较高,可作为首选检查方法;MRU简便、无创,可获得尿路全貌资料,对尿路积水、梗阻定位准确率达100%.手术方式主要为重复肾输尿管切除术.