颈动脉斑块性质和管腔狭窄与年龄的相关性研究

目的探讨年龄与颈动脉管腔狭窄及斑块性质的关系。方法随机对照研究,选择2012年1月~2014年1月在青岛市市立医院行颈动脉超声检查的患者165例,根据临床及影像学表现分为缺血性脑卒中组100例和非脑卒中组65例,分析缺血性脑卒中发病的危险因素。其次,根据年龄分为中青年组(年龄≤59岁)36例,老年组(60~79岁)98例,高龄组(年龄≥80岁)31例,对3组患者的颈动脉狭窄程度、斑块性质进行统计分析。结果缺血性脑卒中组年龄、高血压、易损斑块及管腔重度狭窄比例明显高于非脑卒中组[(70.6±11.2)岁vs(65.1±12.8)岁,P=0.004;79.0%vs 60.0%,P=0.008;40.0%vs 24.6%,P=0.041;20.0%vs 6.2%,P=0.014]。高龄组管腔重度狭窄比例明显高于中青年组及老年组(54.8%vs 2.8%和6.1%,P0.01)。与中青年组比较,老年组和高龄组稳定斑块及易损斑块检出率明显升高,差异有统计学意义(P0.01)。多因素logistic回归分析显示,年龄是缺血性脑卒中的危险因素(OR=1.039,95%CI:1.011~1.068,P=0.005)。年龄是颈动脉重度狭窄及易损斑块的危险因素(OR=1.225,95%CI:1.125~1.335,P=0.000;OR=1.035,95%CI:1.005~1.065,P=0.023)。结论年龄增长是缺血性脑卒中的危险因素,缺血性脑卒中患者比非脑卒中患者易损斑块多且管腔重度狭窄比例大。年龄≥60岁患者颈动脉易损斑块多于年龄≤59岁患者,年龄≥80岁患者管腔重度狭窄比例最高,发生缺血性脑卒中危险性可能更大。     

老年高血压缺血性脑卒中合并2型糖尿病患者颈动脉粥样硬化程度的分析

目的应用CT血管成像联合颈动脉超声检查对颈动脉粥样硬化斑块进行评价,并探讨其与2型糖尿病的关系。方法选择缺血性脑卒中患者152例,根据诊断分为糖尿病组56例,非糖尿病组96例,并进行CT血管成像联合颈动脉超声检查,分析斑块性质、形态,观察发生缺血性脑卒中事件相关因素,logistic回归分析老年缺血性脑卒中颈动脉粥样硬化程度与糖尿病的相关性。结果与非糖尿病组比较,糖尿病组颈动脉内膜中层增厚及斑块发生率高,易损斑块多,颈总动脉分叉部及动脉狭窄比例高,差异有统计学意义(P<0.05)。logistic回归分析表明,空腹血糖(OR=5.924,95%CI:1.176～2.468,P=0.003)与颈动脉粥样硬化程度密切相关;LDL-C(OR=2.283,95%CI:1.108～4.276,P=0.009)、纤维蛋白原(OR=1.856,95%CI:1.287～3.095;P=0.011)与颈动脉粥样硬化程度相关。结论老年缺血性脑卒中合并2型糖尿病患者颈动脉粥样硬化程度重,危险因素多于非糖尿病患者;常规对于颈动脉粥样硬化患者进行定期的血糖检测有重要参考价值。     

前循环急性进展性缺血性卒中相关危险因素的分析

目的探讨前循环急性进展性缺血性卒中住院患者的危险因素。方法选择前循环急性缺血性进展性卒中100例患者为研究对象,均进行抗血小板聚集治疗。分为进展组32例,非进展组68例。由1名经过相关培训的神经科主治医师询问病史并进行体检,记录与前循环急性进展性缺血性卒中发生可能相关的24个危险因素,进行χ2或t检验,对所有入组的患者以病情是否进展为因变量(Y),以单因素分析后差异有统计学意义的因素作为自变量,采用Logistic多因素逐步回归后退法分析,筛选出独立的危险因素。结果两组患者危险因素的多因素分析显示:有颈动脉狭窄(OR=22.069,95%CI:5.169~94.223)、入院体温增高(OR=13.404,95%CI:1.958~91.736)、有糖尿病史(OR=12.598,95%CI:2.867~55.359)3个因素进入模型(P<0.05)。结论颈动脉狭窄、入院体温增高、有糖尿病史是前循环急性进展性缺血性卒中的主要危险因素。前循环急性进展性缺血性卒中是多种因素、多种机制共同作用的结果。     

支架置入治疗颈动脉狭窄发生重度低血流动力学状态的危险因素分析

目的分析颈动脉支架置入术(CAS)治疗颈动脉狭窄后发生重度低血流动力学(HD)状态的危险因素。方法回顾性分析85例接受CAS手术的患者,其中男70例,女15例。按照是否发生重度HD(血压≤90/60 mm Hg或心率≤50次/min)状态分为重度HD组18例和非重度HD组67例,观察相关因素对重度HD的影响,并应用多因素Logistic回归分析确定重度HD的独立危险因素。结果多因素Logistic回归分析显示,颈动脉彩色多普勒血流显像(CDFI)高回声斑块(OR=6.219,95%CI:1.163~33.266;P=0.033)、最狭窄处距颈动脉分叉处距离1 cm(OR=8.360,95%CI:1.372~50.930;P=0.021)、基础收缩压120 mm Hg(OR=6.384,95%CI:1.217~33.486;P=0.028)、扩张球囊直径≥5 mm(OR=8.028,95%CI:1.462~44.091;P=0.017)为CAS术后发生重度HD状态的独立危险因素。结论 CDFI高回声斑块、最狭窄处距颈动脉分叉处距离1 cm、基础收缩压120 mm Hg、扩张球囊直径≥5 mm为CAS术后发生重度HD状态的独立危险因素。     

症状性颈动脉狭窄对急性脑梗死患者短期预后的影响

目的评估症状性颈动脉狭窄对急性缺血性脑梗死短期预后的影响。方法选取前循环急性缺血性脑梗死患者421例,通过血管影像学检查评估颈动脉,根据颈动脉狭窄程度分为颈动脉重度狭窄组44例,中度狭窄组43例和轻度或无狭窄组334例。采用多元logistic回归分析评估颈动脉狭窄程度与急性脑梗死短期预后的关系。结果与中度狭窄组和轻度或无狭窄组比较,重度狭窄组病死率、神经功能恶化和不良转归比例更大,住院时间更长(P<0.05,P<0.01)。多元logistic分析显示,与中度狭窄组比较,重度狭窄组患者死亡风险更高(OR=2.564,95%CI:0.469¹4.009),神经功能恶化(OR=2.037,95%CI:0.74214.009),神经功能恶化(OR=2.037,95%CI:0.742⁵.922)、不良转归更严重(OR=2.347,95%CI:0.9885.922)、不良转归更严重(OR=2.347,95%CI:0.988⁵.577)和住院时间延长(OR=7.000,95%CI:2.6625.577)和住院时间延长(OR=7.000,95%CI:2.662¹8.409)。结论症状性颈动脉重度狭窄是急性脑梗死短期不良预后的独立预测因素,因此,针对症状性颈动脉重度狭窄的患者应尽早采取积极的干预措施。     

血清脂蛋白(a)水平与中青年缺血性卒中患者颈动脉粥样硬化的相关性:回顾性病例系列研究

目的 探讨中青年缺血性卒中患者颈动脉粥样硬化的危险因素以及血清脂蛋白(a)[lipoprotein (a),Lp(a)]水平对中青年缺血性卒中患者颈动脉粥样硬化的影响.方法 收集18 ～55岁的缺血性卒中患者.采用颈动脉超声评价颈动脉粥样硬化程度,并检测血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、载脂蛋白A1、载旨蛋白B和Lp(a)浓度.根据颈动脉超声结果分为无动脉粥样硬化组、有斑块无狭窄组和颈动脉狭窄组,比较三组的人口统计学和临床特征,并采用多变量logistic回归分析确定中青年缺血性卒中患者颈动脉粥样硬化的独立危险因素.结果 共纳入106例缺血性卒中患者,无动脉粥样硬化组50例,有斑块无狭窄组44例,颈动脉狭窄组12例,三组间年龄[分别为(45.98±7.12)、(50.07±4.79)和(50.92± 1.83)岁;F =7.169,P=0.001]、高血压(分别为26.0％、47.7％和58.3％;x2=6.862,P=0.032)、糖尿病(分别为22.0％、45.5％和66.7％;x2=10.729,P=0.005)、高脂血症(分别为24.0％、40.1％和75.0％;x2=11.372,P=0.003)和吸烟(分别为34.0％、61.4％和75.0％;x2=10.393,P=0.006)患者的构成比以及血清高密度脂蛋白胆固醇[分别为(1.03±0.26)、(0.95 ±0.26)和(0.76±0.08) mmol/L;F=5.882,P=0.004]和Lp(a)[分别为(0.108±0.044)、(0.155±0.028)和(0.200±0.011)g/L;F=41.556,P=0.000]水平存在显著性差异.多变量logistic回归分析显示,年龄＞48岁[有斑块无狭窄:优势比(odds ratio,OR)2.89,95％可信区间(confidence interval,CI)1.20 ～ 6.96,P=0.018;颈动脉狭窄:OR4.43,95％ CI 1.19 ～ 16.57,P=0.027]、高血压(有斑块无狭窄:OR 2.60,95％ CI 1.09～6.18,P=0.031;颈动脉狭窄:OR3.99,95％ CI l.08～14.77,P=0.039)、糖尿病(有斑块无狭窄:OR2.96,95％ CI 1.21～7.23,P=0.018;颈动脉狭窄:OR 7.09,95％ CI 1.79 ～ 28.02,P=0.005)、高脂血症(有斑块无狭窄:OR2.19,95％ CI 0.91 ～5.31,P=0.082;颈动脉狭窄:OR9.50,95％ CI 2.21 ～40.86,P=0.002)、吸烟(有斑块无狭窄:OR 3.08,95％ CI 1.33～7.16,P=0.009;颈动脉狭窄:OR 5.82,95％ CI1.39 ～24.38,P=0.016)和Lp(a)(有斑块无狭窄:OR 4.38,95％ CI l.76 ～ 10.90,P=0.001;颈动脉狭窄:OR 12.80,95％ CI2.73 ～ 52.67,P=0.001)为中青年缺血性卒中患者颈动脉粥样硬化的独立危险因素.结论 年龄、吸烟、高血压、糖尿病和Lp(a)为中青年缺血性卒中患者颈动脉粥样硬化的独立危险因素.     

缺血性脑血管病患者阻塞性睡眠呼吸暂停低通气综合征与有症状颈动脉狭窄的关系

目的 探讨缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与颈动脉狭窄的关系,为制定颈动脉狭窄的干预策略提供参考.方法 从南京卒中注册系统中筛选出87例ICVD患者,根据呼吸暂停低通气指数(apnea-hypopnea index,AHI)将患者分为无OSAHS组(n=21)以及轻度(n=24)、中度(n=27)和重度(n=11)OSAHS组;另外,根据数字减影血管造影(digital subtraction angiography,DSA)结果,将患者分为无颈动脉狭窄组(n=34)和颈动脉狭窄组(n=49).分析脑血管病危险因素和OSAHS对ICVD患者颈动脉狭窄的影响.结果 无OSAHS以及轻度、中度和重度OSAHS组之间饮酒(χ2=8.56,P=0.036)、高血压(χ2=13.2,P=0.004)和颈动脉狭窄(χ2=22.97,P=0.006)患者比例均存在显著差异.单因素分析显示,年龄(OR=1.066,95% CI 1.023～1.112;P=0.003)、高血压(OR=3.587,95%CI 1.294～9.949;P=0.014)、饮酒(OR=5.275,95%CI 1.855～15.001,P=0.002)和OSAHS(OR=1.073,95%CI 1.033～1.115,P=0.000)是颈动脉狭窄的危险因素;多变量logistic回归分析显示,年龄(OR=1.113,95%CI 1.047～1.182;P=0.001)、OSAHS(OR=1.096,95%CI 1.034～1.160;P=0.000)、饮酒(OR=4.292,95% CI 1.217～15.139;P=0.024)是颈动脉狭窄的独立危险因素.Spearman等级相关分析提示,AHI水平与颈动脉狭窄程度呈正相关(r=0.435,P=0.000).无颈动脉病变组(n=34)、单侧病变组(n=22)和双侧病变组(n=27)AHI存在显著差异[(12.97±10.04)次/h对(21.40±16.38)次/h对(29.33±13.81)次/h,F=11.64,P<0.01].结论 OSAHS是颈动脉狭窄的独立危险因素,且与颈动脉狭窄严重程度呈正相关.AHI在一定程度上能反映颈动脉狭窄程度和颈部血管受累范围.     

多中心超声筛查中国卒中高危人群颈动脉粥样硬化性病变结果的初步分析

目的采用彩色多普勒血流显像(CDFI)对我国卒中高危人群进行筛查,建立中国人群卒中发病危险的预测模型,以早期防治卒中。方法采用横断面研究,于2011年7月—2012年4月,41家基地医院首次联合对我国6个省市40个项目区715 286人进行常规体格检查及心脑血管疾病相关危险因素调查。对其中61 860例患者进行颈动脉CDFI筛查,高危人群(暴露于≥3项危险因素)有49 386例。筛查记录双侧颈动脉内-中膜厚度(IMT)情况、斑块数量及颈动脉狭窄程度。并对颈动脉IMT是否增厚、有无颈动脉斑块和颈动脉狭窄程度(分为狭窄率0~49%与≥50%)分别与卒中危险因素进行多因素Logistic回归分析。结果 (1)Logistic回归分析显示,高血压、心房颤动、吸烟、缺乏体育锻炼是颈动脉IMT增厚的独立危险因素(高血压,OR=1.17,95%CI:1.12~1.22;心房颤动,OR=1.15,95%CI:1.09~1.21;吸烟,OR=1.13,95%CI:1.08~1.17;缺乏体育锻炼,OR=1.12,95%CI:1.08~1.16)。(2)高血压、心房颤动、吸烟、糖尿病是颈动脉斑块及颈动脉狭窄率≥50%发生的独立危险因素(颈动脉斑块,高血压:OR=1.55,95%CI:1.47~1.62;心房颤动:OR=1.13,95%CI:1.06~1.21;吸烟:OR=1.16,95%CI:1.11~1.22;糖尿病:OR=1.30,95%CI:1.24~1.37。颈动脉狭窄率≥50%,高血压:OR=1.78,95%CI:1.55~2.03;心房颤动:OR=1.59,95%CI:1.39~1.81;吸烟:OR=1.33,95%CI:1.20~1.48;糖尿病:OR=1.30,95%CI:1.17~1.45)。单纯肥胖不增加颈动脉粥样硬化性斑块及颈动脉狭窄率≥50%的发生率(OR分别为0.78、0.83,95%CI分别为0.75~0.82、0.75~0.92)。结论颈部血管超声检查可作为卒中高危人群筛查及危险因素检测有价值的手段,对早期诊断及治疗颈动脉粥样硬化性疾病具有重要的指导意义。     

颈动脉狭窄与进展性脑卒中的相关性

目的研究颈动脉狭窄与进展性脑卒中的相关性,进一步探讨进展性脑卒中的危险因素。方法选取2012年2月～2012年12月在北京军区总医院神经内科住院经头颅核磁证实的急性缺血性脑卒中患者239例,按照病情是否加重(NIHSS评分)分成进展性脑卒中组(进展组)141例和非进展性脑卒中组(非进展组)98例,两组患者均行颈动脉超声检查,比较两组患者颈动脉狭窄程度与进展性脑卒中的相关性。结果在进展组内颈动脉狭窄的发生率明显高于非进展组。颈动脉狭窄与进展性脑卒中呈相关性,多因素Logistic回归分析显示,高脂血症、高同型半胱氨酸水平、颈动脉狭窄是进展性脑卒中发生的独立危险因素(OR=0.264,95%CI:0.064～1.260;OR=0.163,95%CI:0.036～0.743;OR=0.006,95%CI:0.036～0.568)。结论颈动脉狭窄程度与进展性脑卒中的发生密切相关,通过观察颈动脉狭窄的发生率可预测脑卒中的发生发展。     

责任动脉狭窄程度与轻型卒中病情进展的关系

目的研究急性缺血性轻型卒中患者责任动脉狭窄程度与卒中病情进展的关系。方法回顾性收集2013年6月至2014年9月苏州大学附属第一医院住院的104例急性缺血性轻型卒中患者的病历资料,按病情是否加重分为卒中进展组46例和卒中无进展组58例。患者急性期即行ABCD2评分,并通过DSA完成责任动脉狭窄程度检测。对ABCD2评分和责任动脉狭窄程度等相关临床数据行Logistic回归分析、Spearman相关分析及ROC曲线分析。结果单因素Logistic回归分析显示卒中进展组责任动脉狭窄程度、ABCD2评分、多支病变程度、年龄和低密度脂蛋白等均高于卒中无进展组(P0.05);Spearman相关分析显示责任动脉狭窄程度和ABCD2评分与轻型卒中进展具有相关性(r_(ABCD2)=0.6890,P=0.000;r_(责任动脉狭窄程度)=0.4296,P=0.000);多因素Logistic回归分析显示责任动脉狭窄程度(OR=5.258,95%CI为1.124~24.608,P=0.035)、ABCD2评分(OR=8.010,95%CI为3.093~20.748,P=0.000)是轻型卒中病情进展的独立危险因素;ROC曲线分析表明两者曲线下面积(AUC)分别为:AUC责任动脉狭窄程度=0.7324,95%CI为0.64324~0.82153;AUCABCD2=0.8859,95%CI为0.83128~0.94046。结论责任血管狭窄程度和ABCD2评分一样,是轻型卒中病情进展的独立危险因素,需要密切观察,及早进行临床干预。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.