Arterial steal syndrome(ASS),a scarce complication after liver transplantation,is charac-terized by hepatic arterial hypoperfusion of the graft caused by a shifting of blood flow into the splenic,left gastric,or gastroduodenal arteries. It can lead to stricture formation of biliary system and transplanted liver function exhaustion. The early diagnosis and treatment are important for protecting the transplanted liver function. Dynamic CDFI after liver transplantation as a routine is necessary to find out the suspected lesions,and transcatheter angiography as the gold standardization can give clear dignosis. Embolization of splenic artery is minimally invasive,successful and less complication treatment for ASS and especially the coil embolization of middle segment of splenic artery is the best choice.

The insufficient blood supply to the portal vein after liver transplantation, mainly caused by portal vein stenosis (PVS)or portal vein thrombosis(PVT), occurs low in incidence but would be serious enough to lead to graft failure. Prompt diagnosis and treatment is critical to allow graft salvage. The color Doppler flow image (CDFI) could be the first choice for testing portal venous flow, and angiography is reliable for further accurate diagnosis on meaningful functional change of the stenosis. The interventional therapy , including percutaneous balloon angioplasty and stent placement, is safe and effective in lowering the portal venous pressure after hepatic transplantation with portal vein stenosis. Thrombolysis, percutaneous mechanical fragmentation and stent placement ,as the treatments of early portal vein thrombosis, are effective therapeutic methods, and TIPS is also a proper management if necessary.

The occurrence rate of the obstruction of the hepatic vein or the inferior vena cava is very low. Obstruction can develop acutely as a result of technical problems or can present itself much later after the transplantation due to intimal hyperplasia or perianastomotic fibrosis. Clinically, the common presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, etc. Percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment, which can keep the vessels open for a long period of time. Angioplasty can achieve technical success in restoring anastomotic patency almost to 100% of cases, but, unfortunately, restenosis occurs frequently. For adult patients or pediatric patients with adult-sized hepatic veins, stenting seems to be the optimal choice.

Objective To investigate the prevalence of hyperuricemia in health check-up population of Beijing suburb.Methods Total 1 336 rural residents in Nankou Township of Beijing received health check-up from July to Aug 2014,including 686 subjects aged 20-59 years (young/middle-aged group) and 650 subjects aged 60-96 years (elderly group).The blood pressure and body mass index (BMI) were measured;serum uric acid (SUA),fasting blood glucose (FBG) and blood lipids (TG,TC,HDL-C,LDL-C) were determined.The SUA levels ＞ 420 μmol/L for male and ＞ 360 μmol/L for female were defined as hyperuricemia.Results The four quartiles of SUA levels were 27.00-254.59 μmol/L (Q1),254.60-302.35 μmol/L (Q2),302.36-359.78 μmol/L(Q3) and 359.79-702.0 μmol/L (Q4).The prevalence of hyperuricemia was significantly higher in young/middle-aged group than that in elderly group [20.41％ (140/686) vs.13.85％ (90/650),x2 =10.08,P =0.001 5],the systolic blood pressure [SBP,(126.8±15.7) vs.(116.7±12.0)mmHg(1 mmHg=0.133 kPa),t=2.76,P=0.008],FBG [(7.40±4.10) vs.(6.11 ±2.03)mmol/L,t=2.12,P=0.036],TC [(5.52±1.10) vs.(5.23±1.00)mmol/L,t =2.04,P =0.045],LDL-C [(3.5 ±0.7) vs.(2.4 ±0.9)mmol/L,t =2.21,P =0.029]in young/middle-aged group were significantly higher than those in elderly group.BMI,FBG were significantly higher in Q4 than those in other quartiles [BMI:(26.44 ± 3.88) vs.(24.19 ± 3.37),(25.49±3.42) and (25.61 ±3.49)kg/m2,t =2.78,P=0.008;FBG:(8.19 ±1.52) vs.(6.34±1.34),(6.09 ± 1.51) and (6.40 ± 1.98) mmol/L,t =2.80,P =0.007].The triglyceride (TG) levels in group Q3 and Q4 [(1.85 ± 0.90) and (1.92 ± 0.44) mmol/L] were higher than those in Q1 and Q2 [(1.37 ±0.76) and (1.70 ±0.84) mmol/L,t =2.1,P =0.035].Only 9.57％ subjects (22/230)with hyperuricemia was not combined with metabolic disorder;subjects combined with one and two metabolic disorders accounted for 20.87％ (48/230) and 69.57％ (160/230),respectively.Conclusion Screening for hyperuricemia is important for comprehensiye treatment and management of hyperuricemia in rural residents,especially in the young and middle-aged population.

Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1,2014 and February 1,2016.Patients were divided into good collaterals group (n =31) and poor collaterals group (n =18) according to their distribution of leptomeningeal arteries with CTA.Thirty day mortality rate,the incidence of symptomatic intracranial hemorrhage,24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups.Corrected chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0％ vs.16.7％,P ＜ 0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups (P ＞ 0.05),however,30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2 ± 3.1 vs.9.6 ± 2.7,P ＜ O.05).Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis,good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis.However,good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.

Objective To establish an easily reproducible rabbit model of acute pulmonary embolism (APE) with right ventricular dysfunction (RVD).Methods Two gelfoam strips (5 rnm×5 mm× 10 mm) were squeezed and were introduced into the pulmonary arteries of each healthy rabbit (n=12).Pulmonary and systemic hemodynamic function were recorded.All rabbits underwent CT pulmonary angiography (CTPA) and pathological examination after the introduction of APE.Results All gelfoam strips located in the bilateral lower lobe arteries.Compared with baseline mean pulmonary artery pressure (mPAP) ([9.75±1.75] mmHg),mPAP increased to (20.58 ± 5.86) mmHg immediately after embolism (P ＜ 0.001),and then decreased to (18.78 ±4.80) mmHg 1 h after embolism (P＜0.001).Right ventricle/left ventricle diameter ratio (RV/LV) increased from baseline (0.67±0.09) to (1.90±0.28) 45 min after embolism (P＜0.001).Conclusion An easily reproducible rabbit model of APE with RVD are established and may be suitable for study of APE pathophysiology.

Objective:To investigate the effect of ultrapulse fractional carbon dioxide laser (UFCL) microporous transdermal triamcinolone acetonide acetate (TAA) in the treatment of early hypertrophic scar.Methods:Ninety patients with early hypertrophic scar in Luoyang Central Hospital Affiliated to Zhengzhou University from March 2016 to March 2019 were included and randomly divided into study group ( n=30), control group A ( n=30) and control group B ( n=30). The control group A was treated with UFCL, the control group B was treated with TAA, and the study group was treated with UFCL combined with TAA. All three groups were treated for 6 months. The effectiveness of the three groups before and 6 months after treatment was compared, the status of hypertrophic scar was evaluated by Vancouver Scar Scale (VSS), the pain degree before and after treatment was evaluated by Visual Analogue Scale (VAS), and the patients’ satisfaction with the treatment was also evaluated. Results:(1) The study group and the control group were effective in the treatment of early hypertrophic scar, and the effective rate of the study group was higher than that of the control group A and the control group B [93.3%(28/30) vs. 70.0%(21/30) and 66.7%(20/30); all P<0.05]. (2) There was no significant difference in the scores of color, thickness, softness and vascular distribution among the three groups before treatment ( P>0.05). After 6 months of treatment, the scores of the three groups were lower than those before treatment ( P<0.05). The scores of study group were lower than those of control group A and control group B respectively( P<0.05). (3) There was no significant difference in VAS scores among the three groups before treatment ( P>0.05). The VAS scores of the three groups after treatment were lower than those before treatment, and the VAS scores in study group were lower than those in control group A and control group B( P<0.05). (4) After 6 months of treatment, the satisfaction rate of study group was higher than that of control group A and control group B ( P<0.05). Conclusions:UFCL microporous transdermal TAA can effectively treat early hypertrophic scar, reduce the VSS score and VAS score of hypertrophic scar, significantly improve the state of scar hyperplasia, and improve the satisfaction rate of patients, which can be widely used in clinic.

Objective:To investigate the effect of ultrapulse fractional carbon dioxide laser (UFCL) microporous transdermal triamcinolone acetonide acetate (TAA) in the treatment of early hypertrophic scar.Methods:Ninety patients with early hypertrophic scar in Luoyang Central Hospital Affiliated to Zhengzhou University from March 2016 to March 2019 were included and randomly divided into study group ( n=30), control group A ( n=30) and control group B ( n=30). The control group A was treated with UFCL, the control group B was treated with TAA, and the study group was treated with UFCL combined with TAA. All three groups were treated for 6 months. The effectiveness of the three groups before and 6 months after treatment was compared, the status of hypertrophic scar was evaluated by Vancouver Scar Scale (VSS), the pain degree before and after treatment was evaluated by Visual Analogue Scale (VAS), and the patients’ satisfaction with the treatment was also evaluated. Results:(1) The study group and the control group were effective in the treatment of early hypertrophic scar, and the effective rate of the study group was higher than that of the control group A and the control group B [93.3%(28/30) vs. 70.0%(21/30) and 66.7%(20/30); all P<0.05]. (2) There was no significant difference in the scores of color, thickness, softness and vascular distribution among the three groups before treatment ( P>0.05). After 6 months of treatment, the scores of the three groups were lower than those before treatment ( P<0.05). The scores of study group were lower than those of control group A and control group B respectively( P<0.05). (3) There was no significant difference in VAS scores among the three groups before treatment ( P>0.05). The VAS scores of the three groups after treatment were lower than those before treatment, and the VAS scores in study group were lower than those in control group A and control group B( P<0.05). (4) After 6 months of treatment, the satisfaction rate of study group was higher than that of control group A and control group B ( P<0.05). Conclusions:UFCL microporous transdermal TAA can effectively treat early hypertrophic scar, reduce the VSS score and VAS score of hypertrophic scar, significantly improve the state of scar hyperplasia, and improve the satisfaction rate of patients, which can be widely used in clinic.

Objective To explore the impact of case teaching in small group and case assessment pattern on nursing undergraduates′ autonomous learning competency in intensive training of nursing skill. Methods Nursing skill intensive training implemented in grade 2011 students with fixed group case teaching and case exam as groups was conducted before undergraduate clinical practice. Nursing undergraduates were evaluated by Lin Yi′s Measure Scale of Autonomous Learning Competencies of Nursing Undergraduates before and after the training and the students′autonomous learning competency compared before and after the training. Results With the implementation of group case teaching and exam pattern, nursing undergraduates′total score of self-learning was (88. 31 ± 9. 29) while the scores of self-learning ability dimensions and cooperative learning skill dimensions were (32. 40 ± 3. 71) and (21. 90 ± 3. 16), which all were higher than the scores before implementation (t= -13. 970, -12. 023, -9. 981;P<0. 01). Conclusions Case teaching method and case examination as a group can enhance nursing undergraduates′interests in learning and their self-learning ability, which are worthy of further promotion.

To evaluate the safety and efficacy of mechanical thrombectomy with stent-retriver for anterior circulation small vessel occlusion in patients with acute ischemic stroke (AIS).Methods:From a prospectively collected thrombectomy database of consecutive patients with AIS between January 2017 and November 2018, 311 angiographic images were analyzed to assess small vessel occlusions (A 2 and M 2 segments). Patients were categorized into alteplase with thrombectomy group and thrombectomy alone group. The primary outcome was a favorable outcome (modified Rankin Scale scores 0-2) at 90 days. Secondary outcomes were successful recanalization (modified thrombolysis in cerebral infarction 2b or 3), symptomatic intracranial hemorrhage, and 90-day mortality. Results:Small vessel occlusions were identified in 19 patients, including 14 M 2occlusions, two A 2occlusions, and three M 2+A 2 occlusions. Six patients were in the alteplase with thrombectomy group and 13 patients in the thrombectomy alone group. Favorable outcome was achieved in eight of 19 patients at 90 days. Successful recanalization was achieved in 18 patients (18/19), symptomatic intracranial hemorrhage was observed in one patient (1/19), and death was recorded in five patients (5/19). No statistically significant difference was detected between the two groups with regard to successful recanalization (6/6 in the alteplase with thrombectomy group vs 12/13 in the thrombectomy alone group), symptomatic intracranial hemorrhage (0/6 vs 1/13), favorable outcome (2/6 vs 6/13) and death (1/6 vs 4/13; all P>0.05). Conclusion:As to anterior circulation small vessel occlusions, the combination-therapy within 4.5 hours or mechanical thrombectomy alone in extended time window with perfusion evaluation may be both safe and effective.