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Objective To analyze and evaluate the clinical characteristics of imported falciparum malaria cases and the antimalarial effect of artemisinin-based drugs, to promote rational and standardized drug use, and to improve the clinical cure rate of falciparum malaria. Methods A total of 116 imported cases of falciparum malaria admitted to the provincial malaria designated hospital in Wuhan were collected, and the clinical characteristics of the patients and use of artemisinin, and the therapeutic effects of the artemisinin-based drugs were retrospectively analyzed. Results The clinical manifestations of imported falciparum malaria were complicated and varied and had many complications, including mainly fever, anorexia, anemia, and jaundice, etc. The symptoms were alleviated or disappeared after treatment with artemisinin, without obvious adverse drug reactions. The median time of fever reduction was 2 days, the median time of Plasmodium becoming negative was 3 days, and the median time of clinical symptom relief was 3 days. 109 cases of common falciparum malaria were treated by oral artemisinin compound or artesunate injection combined with oral artemisinin compound, including 30 cases of oral artemisinin compound treatment for 1 to 4 days (1 case relapsed) and 79 cases of artesunate injection combined with oral artemisinin compound for 4 to 6 days (4 cases relapsed). Seven severe cases were cured after long-term and high-dose treatment with artesunate injection combined with oral multiple artemisinin compounds, and the total cure rate was 95.69% (111/116). Conclusion The present study demonstrates that the treatment of falciparum malaria by oral injection of artemisinin is safe and effective, and the cure rate is high. However, some patients have recurrence of the malaria parasite after stopping artemisinin drugs. It is necessary to ensure the use of artemisinin-based drugs in a “standardized, full-process, and adequate” way to contain the risk of severe illness and drug resistance.
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Objective:To explore the value and significance of sensorimotor cortex (SMC) in the recovery of upper limb motor function after cerebral infarction in the striatum with blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods:A total of 17 patients with primary onset of striatal intracapsular infarction (SCI) with unilateral severe upper limb paralysis, who were strictly screened from the Department of Neurology, Affiliated Hospital of Yangzhou University from June 2015 to December 2017, were selected as research subjects, and 15 healthy volunteers were selected as controls. BOLD-fMRI under the passive finger extension (FE) task on the hemiplegic side was performed within one week, one month and three months after the onset of the disease. The activation of SMC was observed by SPM8 software. The activation of corresponding brain activation areas in BOLD-fMRI was observed by Xjview software and compared with the standard brain activation areas dynamically. The upper limb section of the Fugl-Meyer Scale (FM-UL) was used to track the motor function of the upper limb. The upper limb motor function of the selected patients was evaluated before functional magnetic resonance imaging (fMRI) scanning, at one month and three months after onset of the disease.Results:In the controls, fMRI showed that the main brain activation areas were located in the contralateral SMC and bilateral supplementary motor area. According to the activation time course of the affected side SMC and the comparison results with the standard brain activation area, the study patients were divided into three groups: group 1 (six patients), in which the activation intensity of SMC was stronger than that of standard brain activation area in the early stage of onset; group 2 (five patients), in which the activation intensity of SMC in the affected side was stronger than that in the standard brain activation area at one month after onset; group 3 (six patients), in which the activation intensity of SMC in the affected side increased gradually in three months, but still did not exceed the standard brain activation area. The activated voxel values of the affected side SMC in group 1 patients at the first time, one month and three months were 3 570.2±1 125.9, 1 205.8±328.2 and 1 121.5±407.5, respectively, the difference within the group being statistically significant ( F=12.8, P=0.001); the activated voxel values of the affected SMC in group 2 patients were 556.2±171.7, 648.6±177.3 and 993.2±182.9, respectively, and the differences within the group were statistically significant ( F=6.5, P=0.018); the activated SMC values of the affected SMC in group 3 patients were 520.0±375.9, 573.5±375.0 and 680.9±359.8, respectively, and there was no statistically significant difference within the group ( P>0.05). The three times FM-UL scores corresponding to group 1 patients were (10.0±3.3) points, (52.3±4.6) points and (63.7±2.9) points; the three times FM-UL scores corresponding to group 2 patients were (10.6±5.7) points, (36.6±2.4) points and (59.2±3.1) points; and the three times FM-UL scores corresponding to group 3 patients were (9.2±4.0) points, (12.5±3.0) points and (13.3±5.0) points; FM-UL scores in group 1 and group 2 patients showed statistically significant differences within the groups ( F=348.4, 183.6; P<0.001), whereas that in group 3 patients showed no statistically significant difference within the group ( P>0.05). There was no statistically significant difference in the initial FM-UL score among the groups ( P>0.05), while the differences among the groups at one month and three months were statistically significant ( F=191.7,304.5; P<0.001). Conclusions:The survival of SMC on the affected side after cerebral infarction is a prerequisite for the rehabilitation of limb motor function. Its early activation cannot predict the clinical prognosis, but the dynamic enhancement of SMC activation on the affected side is related to the rehabilitation speed of the affected limb.
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Objective:To study the dynamic changes of cortical functional reorganization in striatocapsular infarction (SCI) by blood oxygenation level dependent-functional MR imaging (BOLD-fMRI) and its relation with recovery of motor function in the upper extremity of the hemiplegia.Methods:A total of 17 patients with SCI at first onset and combined with upper extremity of the hemiplegia, admitted to our hospital from June 2015 to December 2017, were included; 15 healthy volunteers recruited at the same time were selected as control group. Within 1 week of onset, and 1 and 3 months after onset, BOLD-fMRI was performed under passive finger flexion and extension task on hemiplegia side, and the activation of brain functional areas at different stages was observed by SPM8 software. The Xjview software was used to observe the activation of the corresponding brain activation areas in BOLD-fMRI and make dynamic comparison with the standard brain activation areas. The upper limb part of Fugl-Meyer (FM-UL) scale was used to track the motor function of the upper limb.Results:The activation in the control group was mainly located in the contralateral sensorimotor cortex (SMC) and bilateral supplementary motor area (SMA). The regions of interest in early BOLD-fMRI for stroke patients at early stage can be divided into 3 types. The activation in patients with type I was mainly at the affected side, enjoying bilateral SMC and SMA activation; 1 and 3 months after onset, activation at the contralateral SMC decreased gradually, and activation at the ipsilateral SMC region gradually increased. The activation in patients with type Ⅱ was merely at the ipsilateral SMC and SMA regions; 1 month after onset, bilateral SMC area and SMA area were significantly activated, mainly at the contralateral side; 3 months after onset, the SMC area was further activated at the ipsilateral side and weakened at the ipsilateral side. The activation in patients with type Ⅲ was only at SMC or M1 at the ipsilateral side; 1 month after onset, activation at the ipsilateral SMC area increased slightly; 3 months after onset, activation at the ipsilateral SMC area further enhanced, and SMA area was without activation performance. The FM-UL scores of the affected limbs of patients with type I, type II and type III at the early onst were 10.0±3.3, 10.6±5.7 and 9.2±4.0, respectively, without statistical differences ( P>0.05); 1 month after onset, the FM-UL scores of patients with type I, type II and type III were 52.3±4.6, 36.6±2.4 and 12.5±3.0, respectively, with significant differences ( P<0.05); 3 months after onset, FM-UL scores of patients with type I, type II and type III were 63.7±2.9, 59.2±3.1 and 13.3±5.0, respectively, with statistical differences ( P<0.05). Conclusions:Intracranial functional reorganization is a dynamic process. The early and dynamic activation of the affected SMC region and the early activation of the contralateral SMC region and bilateral SMA regions are of great significance in the process of stroke rehabilitation.
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Objective To investigate the expression and clinical significance of serum miR-125b-5p in patients with hepatitis B related liver diseases.Methods 159 cases of hepatitis B related liver disease (case group) and 64 cases of health examinees (control group) in our hospital were selected.The case group was further divided into three subgroups according to the disease type,namely,chronic hepatitis B (CHB) group (n =40),hepatitis B virus associated liver cirrhosis (HBV-LC) group (n =65) and HBV associated hepatocellular carcinoma (HBV-HCC) group (n =54).Then the levels of miR-125b-5p,albumin (ALB),alanine aminotransferase (ALT),aspartate aminotransferase (AST),HBV-DNA,total bilirubin (TBIL),total cholesterol (TC),alpha fetoprotein (AFP),triglyceride (TG) and prothrombin time (PT) were measured in each group.Results The levels of ALT,AST,HBV-DNA,TBIL,PT,AFP,TC and TG in the case group were higher than those in the control group (P ＜ 0.05),and ALB was lower than that in the control group (P ＜ 0.05).The expression level of miR-125b-5p among all groups ranked in a descending order was HBV-HCC group,HBV-LC group,CHB group and control group (P ＜ 0.05).The expression level of miR-125b-5p was positively correlated with the disease severity (P ＜ 0.05).The miR-125b-5p expression level was positively correlated with AST,ALT,TBIL,HBV-DNA,PT,AFP,TC,TG levels (P ＜0.01),and was negatively correlated with ALB (P ＜0.01).Serum miR-125b-5p levels had no difference among patients with different age,tumor maximum diameter,and tumor number characteristics (P ＞ 0.05);The expression level of serum miR-125b-5p was positively correlated with the pathological grade,tumor node metastasis (TNM) stage,lymphatic vascular infiltration,lymph node metastasis and recurrence (P ＜0.05).The results showed that high levels of miR-125b-5p,HBV-DNA and AFP were risk factors for adverse prognosis outcomes in patients with hepatitis B-related liver disease (P ＜ 0.05).The AUC of miR-125b-5p and AFP were similar (P ＞ 0.01),which were all smaller than miR-125b-5p combined with AFP (x2 =12.657,13.052,P ＜ 0.01).Conclusions Serum miR-125b-5p is elevated in hepatitis B related liver diseases,such as CHB,HBV-LC,HBV-HCC,and is associated with disease progression;High levels of miR-125b-5p,HBV-DNA,and AFP are risk factors for adverse prognosis outcomes in patients with hepatitis B-related liver disease;The sensitivity and specificity of combined detection of miR-125b-5p and AFP in the diagnosis of HBV-HCC are relatively high,so the combined detection of the two indicators can be widely applied in clinical practice.
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Objective To observe the cortical functioning of healthy volunteers during acupuncture as a way of exploring acupuncture's neural mechanisms.Methods Twenty healthy volunteers received acupuncture applied to the left hegu and waiguan acupoints while their cortical activity was examined using blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI).Brain activation,especially of the regions related to motor function,were observed and analyzed.Results Acupuncture applied to the left hegu and waiguan acupoints was observed to significantly activate the left middle frontal gyrus and the inferior frontal gyrus,with many activated regions in the left insula and a few in the left cerebellum,the left precentral gyrus,the left postcentral gyrus,the left inferior parietal lobule,the left medial frontal gyrus,the left precuneus,the left anterior cingulate gyrus and the left claustrum.The right side of the brain was excited mainly in the right middle frontal gyrus and the right medial frontal gyrus.The right inferior parietal lobule and the right precentral gyrus were also activated to some extent.There was slight activation of the right middle temporal gyrus,the right superior temporal gyrus,the right insula,the right inferior frontal gyrus and the right postcentral gyrus.The negatively activated regions were mainly located on both sides of the limbic lobe,including the hippocampus,the parahippocampal gyrus and the cingulate gyrus.The left superior temporal gyrus,the left middle temporal gyrus and the right middle frontal gyrus also had small negative activation zones.Conclusions In brain regions associated with motor function,in addition to partial activation of the contralateral primary sensorimotor area,acupuncture at these two points clearly generates bilateral activation of secondary motor areas with some activation in the ipsilateral cerebellum.This may serve as a neuropathological basis for acupuncture treatment of motor dysfunction.BOLD-fMRI imaging displays the neural effects of acupuncture in an intuitive way.It can be a useful technique for further study of the neural effects of acupuncture on pathological conditions.
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Objective Total aortic arch replacement and stented elephant trunk surgery is an important surgical method for acute type A aortic dissection, and the short, middle, long term curative effect has been recognized by more and more experts at home and abroad.Circulatory arrest was an independent risk factor for postoperative complications and mortality in patients with type A aortic dissection.The aim of this article is to observed the effection of a new technology to block aortic arch, whicn can shorten the circulatory arrest time to 2 minutes and avoid harm of circulatory arrest on patients.Methods From May 2016 to February 2017, 68 patients with acute type A aortic dissection were divided into the conventional group and the modified group.All the patients underwent total arch replacement and stented elephant trunk surgery.The rectal temperature of the conventional group was 25℃ and circulatory arrest time was 20 min.While the rectal temperature of the modified group was 28℃ and and circulatory arrest time was 2 min.Results In the conventional operation group, 3 patients died after operation while all the patients in the modified group were cured and discharged.There are no differences between the two groups in the time of cardiopulmonary bypass(CPB) and heart arrest time(P>0.05).There are Significant differences in CPB time, circulatory arrest time, postoperative awake time, intubation time, amount of blood used, the amount of drainage during the first two days after operation, the time staying in ICU and the postoperative time in hospital.And the modified group was much better.(P<0.05)Conclusion The results of new technology blocking aortic arch in the patients with acute type A aortic dissection are better than the conventional surgical approach during the perioperative period.This technology is simple and effective.It is worth promoting.
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Objective To investigate the mechanism of motor recovery in hemiplegic patients after ischemic stroke using acupuncture-induced blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging (DTI).Methods A total of 20 patients with left hemiplegia after ischemic stroke were enrolled in the study. DTI raw data was used to reconstruct three dimensional image of pyramidal tract through post-processing of workstation,and the damage and recovery of the pyramidal tract were observed. SPM8 and other software were used to compare and analyze the acupuncture-induced BOLD-fMRI data, and the distribution differences in the brain activation areas were compared. Results The muscle strength grade and the Fugl-Meyer scale score at 6 months were significantly higher than those during 3-6 weeks after stroke onset. DTI showed that the right pyramidal tract had different degrees of damage, interrupt, compression, and displacement during 3-6 weeks after onset, and there were different degrees of repair, remodeling at 6 months after onset. Acupuncture-induced BOLD-fMRI showed that compared with 3-6 weeks after onset, the positive activated brain regions were mainly located in the motor related brain regions in bilateral frontal cortex and the left cerebellum, and the negative activated brain regions were mainly located in the limbic system, such as bilateral anterior cingulate cortex and parahippocampal gyrus. Conclusions The mechanism of motor recovery in hemiplegic patients after ischemic stroke may be mainly related to the regulation and compensation of motor related brain regions,as well as the regulation of muscular tension through the extrapyramidal system. The repair and reorganization of the damaged motor pathway may also be the mechanism of motor recovery in hemiplegic patients after ischemic stroke.
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Objective To explore the pattern of functional reorganization in the cortex after corticospinal tract ( CST) injury and its relationship with the recovery of upper limb motor function. Methods Fifteen patients with complete paralysis on one side after acute cerebral infarction were studied. Within 1 week after the onset, func-tional magnetic resonance imaging ( fMRI ) and diffusion tensor tractography ( DTT) were performed in parallel with timed finger flexion and extension movements in all subjects. The number of nerve fibers in corticospinal tract ( CST) in the affected and healthy sides was measured by using Dtv.Ⅱ. R2 software. One and three months later, fMRI was performed while the affected fingers were flexed and extended passively and any cortical activation was observed. In addition, Fugl-Meyer arm motor function scores were assessed one week, one month and three months after the stroke. Results According to the reconstructed nerve fiber number in CST on the affected side, the patients were classified into three types. Type I:the number of newly-built CST nerve fibers is more than 2/3 of that on the healthy side;type II:the ratio is between 1/3 and 2/3;and type III:the ratio is less than 1/3. For typeⅠpatients, blood oxygenation level-dependent fMRI ( bold-fMRI) showed initial activation of the bilateral sensorimotor cortex ( SMC) and the sup-plementary motor area ( SMA) on the affected side. That was followed by a gradual decrease in the activity in the healthy SMC and an increase in the affected SMC at 1 and 3 months. Among the type II patients bold-fMRI indicated activation of the SMC and SMA on the affected side initially, significant activation of the bilateral SMC and SMA one month later and then stronger activation in the SMC on the healthy side and a weakening of activation in the SMC on the affected side. For typeⅢpatients, initially the SMA and the posterior parietal cortex were found to be slightly ac-tivated. One month later SM1 on the unaffected side was slightly activated, and 3 months later neither the SMC nor the SMA on either side was activated. One week after the onset, the average upper extremity FM scores of the three types of subjects were not significantly different. After one month the three groups′averages were all significantly dif-ferent from one another. But after three months the averages for types I and II were again not significantly different, but significantly better than the average of the type III patients. Conclusion Different CST injuries induce different modes of cortical reorganization. The reorganization is a dynamic process, and different activation patterns are closely correlated with clinical prognosis.
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Objective To study the incidence and duration of residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo (BPPV) as well as the clinical factors associated with the residual dizziness.Methods Two hundred and eighty-four cases of confirmed BPPV patients were followed up for 3 months after particle repositioning,and the incidence and duration of residual dizziness were analyzed; The risk factors for residual dizziness were analyzed by logistic regression.Results (1) Two hundred and eighty-four cases of confirmed BPPV were included in this study,and 158 cases (55.63％,158/284) complained of residual dizziness.Two hundred and forty-five cases completed the 3-month's follow-up,the rate of residual dizziness in the 30th was 13.67％ (38/278),the 60th was 9.29％ (25/269),and 7.75％ (19/245) in the 90th day.The average age of the residual dizziness group was significantly older than non-dizzy group (61.46 ± 9.38 vs 56.93 ± 7.62,t =2.121,P =0.015).In addition,the incidence of residual dizziness in female was higher than that seen in male(62.41％ (88/141)vs 37.59％ (53/141),x2 =7.984,P =0.005).(2) Logistic regression analysis showed that the duration of vertigo before treatment was an independent risk factor for residual dizziness (OR =2.988,95％ CI 1.688-5.292,P =0.000).Conclusions (1) More than half of the patients included in this study complain of residual dizziness after particle repositioning,and symptoms disappear naturally within one month.(2)The duration of vertigo pre-treatment is an independent risk factor for residual dizziness.
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Objective To explore the effect of transcatheter hepatic artery chemoembolization(TACE)between different types of liver cancer patients with portal vein tumor thrombus(PVTT).Methods 413 liver cancer patients with PVTT were divided into two groups,TACE(332 cases)group and control group(81 cases);To compare the survival rate and the curative effect of two group.Results Survival rate in the TACE group of 3 months,6 months,12 months,24 months were 93.4%,71.7%,44.9%,24.4%,in the control group 3 months,6 months,12 months,24 months survival rate were 24.7%,2.5%,0,0.The difference has statistical significance(P＜0.01).In the TACE group,type Ⅰ,Ⅱ,Ⅲ,Ⅳ of PVTT patients treatmented with TACE also has different survival rate and different curative effect(P＜0.01).Conclusion TACE treatment is particularly effective for type Ⅰ,type Ⅱ and type Ⅲ patients of PVTT.
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Objective:To study the clinical significance of serum glypican-3 in patients with hepatocellar carcinoma who underwent interventional therapy.Methods:Serum levls of glypican-3 were detected with ELISA in patients with hepatocellar carcinoma,cirrhosis and normal people.Results:Serum levels of glypican-3 in patients with hepatocellar carcinoma(52 cases)were significantly higher than those with cirrhosis(16 cases)or healthy group(30 cases)(P
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Objective:To explore the effect of Weishenjiang Liquor on immune function in mice.Methods: Feeding mice with 8.5, 17, 50ml/kg Weishenjiang Liquor which contains 10mg/dl polysaccharide continuously for 28d, were determined the spleen index, chest gland index, phagocytosis of monocytes phagocytes, activity of NK cell, hemolysin formation, lymphocyte transformation and DTH test.Results: Phagocytosis of monocytes phagocytes, NK cell activity, hemolysin formation, lymphocyte transformation rate were increased in mice with a dose of 50ml/kg group. Conclusions: Weishenjiang Liquor has the function of strengthening cellular and humoral immunization in high dose.