Objective To investigate the efficacy and security of tirofiban with low-dose heparin for treating progressing stroke with intracranial vessel stenosis,to analyze the clinical value of tirofiban in the treatment of ischemic stroke.Methods Clinical data of 26 patients treated with tirofiban and low-dose heparin for progressing stroke were retrospectively collected with NIHSS increment ≥3 within 6 days of stroke as the diagnosis standard.The degree of intracranial vessel stenosis was checked by CT angiography (CTA).The efficacy of tirofiban for treating progressing stroke,and the correlation between the degree of intracranial vessel stenosis and the prognosis of progressing stroke were observed.Results The percentage of progressing stroke patients with intracranial vessel stenosis/lesion was higher than without intracranial vessel stenosis/lesion (88.5 ％vs.11.5％,x2=14.786,P 0.000).There was a significant difference in NIHSS scores between progressing stroke patients with and without intracranial vessel stenosis/lesion before treatment (t 2.17,P=0.046).NIHSS scores were significantly decreased (t=3.59,P=0.021) in both two groups after treatment.MRS was lower in progressing stroke patients without intracranial vessel stenosis/lesion than in progressing stroke patients with intracranial vessel stenosis/lesion after treatment (t=6.79,P=0.001).The efficacy of tirofiban was higher in progressing stroke patients without intracranial vessel stenosis/lesion than in progressing stroke patients with intracranial vessel stenosis/lesion (60.2％ vs.30.8％,x2=4.35,P＜0.05).Conclusions Combination of tirofiban with low-dose heparin is safe and effective in the treatment of progressing stroke.The degree of intracranial vessel stenosis is correalted with progressing stroke prognosis.

Objective To study the influence of oral health education and the family nursing intervention on the incidence rate of gingivitis and the enamel decalcifyication for adolescent patients with fixed diorthosis.Methods Divided 146 adolescent patients who had accepted fixed diothosis into the experiment group and the control group randomly, there were 73 cases in the each group. In the experimental group, oral health education and the family nursing intervention were both used for patients and their parents, while in the control group, only traditional nursing methods were used. Compared the incidence rate of complication between the two groups at the 6th and the 12th month after the fixed diorthosis.Results The incidence rate of gingivitis and the enamel decalcifyication in the control group was significant higher than those of in the experiment group.Conclusion Oral health education and the family nursing intervention can effective decline the incidence rate of gingivitis and the enamel decalcifyication for adolescent patients who have accepted the fixed diorthosis.

Objective In this study we discussed the training method for skills of evidence-based nursing(EBN)for nurses in surgical department.Methods We selected 43 nurses in two surgical department as training objects.The trainging procedure was established according to the four steps of evidencebased nursing,putting forward questions,searching for evidences,making observations and applying evidence-based nursing.The nurses were trained according to the procedure.The skills of EBN,ability of obtaining information and satisfaction degree of nurses was evaluated after training.Results The skills of EBN and the ability of obtaining information after training Was statistically different from those before training(P ＜0.01).95% nurses considered that their EBN ability was improved after training. Conclusions The skills of EBN and the ability of obtaining information increased after EBN training in nurses of surgical department.This had instructive significance for the application of evidence-based nureing.

Objective: To establish the fingerprint chromatogram of Tongguanteng Injection (caulis Marsdeniae Tenacissimae). Methods: HPLC with ZORBAX SB C 18 column was used, the (a) 0.05% H 3PO 4 H 2O and (b) ACN 0.05% H 3PO 4 H 2O (13∶87) (gradient elution) as a mobile phase and detection wavelength at 254nm. Results: 22 peaks were indicated on the HPLC fingerprint of Tongguanteng Injection. The relative retention time and relative peak area were obtained with itself peak at retention time 48.5 min. Conclusion: The method is simple and accurate with a good reproducibility and can be used as a quality control method for Tongguantent Injection.

Objective:To analyze one case of delayed diarrhea caused by irinotecan. Methods:The pathogeny, mechanism, ge-netics and treatment of the case were analyzed. Results:Delayed diarrhea was the dose-limited toxicity of irinotecan, which was related with the cytotoxicity of the active metabolite 7-ethyl-10-hydroxycamptothecin (SN-38). Genetic polymorphism was one of important risk factors, especially UGT1A1 polymorphisms could be used as a predictor for the diarrhea. The pharmacotherapy of the diarrhea was ef-fective and rational, and the clinical pharmacist provided rational pharmaceutical care for the patient. Conclusion:It is very important to enhance pharmaceutical care for the patients treated with irinotecan.

Objective To improve patient postoperative comfort of vitrectomy with tamponnade in the prone position, design a new prone position headrest to reduce complications caused by improper body position and observe its clinical effect. Methods According to the postoperative position of the patients, 360 cases were collected. The patients were divided into the control group and the observation group with 180 cases of each group. Observation group was treated with the new prone position headrest nursing, control group were treated with routine prone position. The comfort of patients, postoperative adverse reactions, success rate of retina reattachment were observed. Results According to simplified comfortable situation scale, physiological, psychological, social culture and environment of each individual score respectively was (2.74±0.21), (3.54±0.29) , (3.25±0.23), (3.36±0.27) points in observation group and (2.30± 0.19), (2.92±0.31), (2.93±0.26), (2.79±0.30) points in control group, and there were significant differences (t=12.368-20.845, all P<0.05). The daily posture duration in postoperative first time and 5 days was respectively (220.00±25.08), (1008.00 ± 20.32) min in observation group and (85.00±28.07), (650.00± 30.12) min in control group, and there were significant differences(t=48.117, 133.194, all P<0.01). The incidence of corneal edema, conjunctival congestion, water turbidity in observation group were lower than those in control group at 4 weeks after surgery, and there were statistically significant difference (U=6.308,8.130, 6.875, P < 0.01). The incidence of high intraocular pressure, recurrent retinal detachment rate and reduction rate in observation group were lower than those in control group at 4 weeks after surgery, and there were statistically significant difference (χ2=9.000, 10.540, 11.770, P < 0.01). Conclusions The new prone headrest can effectively improve the resection of vitreous body with tamponade patients in comfort, ensure the operation effect.

Objective To explore the pulse diagram parameter changes of chronic renal insufficiency patients with five symptoms types(spleen kidney qi deficiency ,spleen kidney Yang deficiency ,kidney liver Yin deficiency and the deficiency of Yin and Yang ) , and to establish the differentiation mode of each symptoms type for assisting the clinical diagnosis .Methods The DS01-C pulse manifestation instrument made by the Shanghai Daosh company was adopted to detect and analyze the pulse manifestations in the healthy control group and the chronic renal insufficiency group .Results The healthy control group was dominated by the normal pulse manifestation .The chronic renal insufficiency group was dominated by the taut pulse and its concurrent pulse .Along with the progress of the disease ,the pulse manifestations also appeared the corresponding changes .The patients with spleen kidney qi defi-ciency and spleen kidney Yang deficiency were dominated by the taut pulse .Comparing the patients with liver kidney Yin deficiency and Qi Yin deficiency ,the taut pulse and concurrent rapid pulse were common ,in addition ,the former also had the deep pulse .The patients with Yin and Yang deficiency showed the slow pulse and the taut pulse or the taut pulse and rapid pulse .Conclusion The pulse manifestation change in the patients with chronic renal insufficiency is dominated by the taut pulse and the concurrent pulse , the pulse manifestation change of various symptoms types are complex .

Objectives:This study aims to investigate optimal surgical management strategies for pediatric patients diagnosed with volume-overloaded mitral regurgitation. Methods:A comprehensive retrospective analysis was conducted on a cohort of 110 pediatric patients who underwent primary mitral valve repair for volume-overloaded mitral regurgitation at Fuwai Hospital between April 2020 and March 2022.The cohort,with an average age of(14.5±15.1)months and 38.2%males,was divided into standardized group for patients receiving 3-step standardized mitral valvuloplasty(n=69)and annuloplasty group for patients undergoing annuloplasty only(n=41).After propensity score matching,a total of 38 pairs of patients were included,comparing the primary endpoint(functional mitral failure and postoperative heart failure)between the two groups. Results:Over a median follow-up of 26.3(19.8,32.9)months,and with a median echocardiographic follow-up of 11.9(7.5,14.8)months,no death was recorded.Among the cases,one patient(0.8%)necessitated unplanned reoperation;and seven patients(6.4%)experienced a recurrence of moderate-severe mitral regurgitation as observed through echocardiography beyond 6 months post-surgery.Additionally,nine patients developed heart failure at one month post-discharge.Above events were similar between the two groups.Following propensity score matching,patients in the standardized group demonstrated significantly longer cardiopulmonary bypass and aortic cross-clamp times compared to the annuloplasty group(both P＜0.05),other outcomes were similar between the two groups.Subgroup analysis based on age indicated that infants(＜1 year old)in the standardized group exhibited a significantly lower incidence of major endpoint events compared to the annuloplasty group.Additionally,postoperative echocardiography in annuloplasty group indicated that Z score of left ventricular end diastolic diameter was still greater than 2 during the latest follow-up. Conclusions:Patients with volume-overloaded mitral regurgitation in the standardized group exhibited comparable perioperative recovery and postoperative outcomes as in the annuloplasty group.For pediatric patients suffering from volume-overloaded mitral regurgitation,particularly those under one year of age,the standardized surgical approach exhibited reduced rates of heart failure and major endpoint events,and this strategy is more suitable for this patient group.

Objective    To summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect (CAVSD) above the optimal age for surgery. Methods    We retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013. The patients were divided into a normal group (n=84, including 37 males and 16 females with an average age of 7.6±2.7 months) and an over-age group (n=79, including 30 males and 49 females with an average age of 34.6±19.6 months) according to whether the age was more than 1 year. Results    The average aortic cross clamp time (88.3±24.4 min vs. 106.1±35.4 min, P<0.001) and cardiopulmonary bypass time (123.6±31.1 min vs. 142.6±47.1 min, P=0.003) were statistically different between the two groups. During the follow-up period (the normal group 53.3±43.9 months, the over-age group 57.2±48.2 months), there was no statistical difference in all-cause mortality (10.7% vs. 8.9%, P=0.691), the incidence of moderate or severe left atrioventricular valve regurgitation (16.7% vs. 21.5%, P=0.430) and reintervention rate (3.6% vs. 0.0%, P=0.266) between the two groups. No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups. Conclusion    For CAVSD children above the optimal age, rational surgical treatments can also achieve satisfying results.

Objective    To summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy. Methods    From 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed. Results    The interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients. Conclusion    Standardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.