At present,intravenous thrombolysis within 4.5 h is still the most effective method in treatment of acute ischemic stroke.For those who do not meet the criteria of intravenous thrombolytic therapy,do not have significant improvement after intravenous thrombolysis and even worse,endovascular interventional therapy is a safe alternative treatment method.Arterial mechanical thrombectomy devices can achieve rapid and complete recanalization and provide more treatment options for patients with acute ischemic stroke.This article reviews the related technical evolution and clinical trials of mechanical thrombectomy devices.

Objective To investigate the effects of different BIS values on postoperative cogni-tive dysfunction (POCD)and S100βprotein(S100β)in the early stage of postoperation.Methods Fifty patients who were scheduled for selective abdominal surgery under general anesthesia (male 34 cases, female 1 6 cases,aged 65 to 75 years,ASA Ⅰ or Ⅱ)were randomly divided into two groups:light anesthesia group (group L,n =25,BIS value was maintained at 50 to 59)and deep anesthesia group (group D,n =25,BIS value was maintained at 30 to 39).BP,HR,SpO 2 ,ECG,PET CO 2 ,inhaled anes-thetic concentration and BIS values were recorded on time points of 5 minutes after the patients ente-ring the operating room (T0 ),before endotracheal (T1 ),intubation (T2 ),incision (T3 ),two hours after incision (T4 ),three hours after incision (T5 )and at the end of surgery (T6 ).The procedure du-ration,anesthesia time,dosages of propofol,fentanyl,midazolam and VAS scores on 1 d after sur-gery were also recorded.Blood samples were collected on time points of 10 min before anesthesia,im-mediately after surgery and 24,48 h after operation.S100β concentration were detected.Mini-mental State Examination (MMSE)score and Trail Making Test (TMT)completion time were recorded on 1 d before surgery and 1,3,7 d after surgery.Results BIS value of group D were lower than group L on T2 ,T3 and T4 .The propofol dosage of group D was significantly greater than that in group L (P <0.05 ).The concentration of serum S100βincreased significantly immediate and 48 h after operation in both groups compared with 10 min before anesthesia(P < 0.05).It was still higher 24 hours after op-eration than before anesthesia.But there was no statistic difference.Compared with the end of surger-y,the concentration of serum S100βin two groups on 24 h after surgery were significantly decreased (P < 0.05 ).The concentration of serum S100β in group L on the end of surgery and 24 h after surgery were higher than that in group D significantly (P <0.05).Compared with 1 d before surgery, postoperative 1 d MMSE scores in two groups and postoperative 3 d MMSE score in group L de-creased significantly (P <0.01).Compared with postoperative 3 d,postoperative 7 d MMSE score in group L increased significantly (P <0.01).Postoperative 1,3 d MMSE score in group D were signifi-cantly higher than group L (P <0.05).Compared with 1 d before surgery,TMT completion time in two groups on 1 d after surgery were significantly prolonged (P <0.01 ).Compared with 1 d after surgery,TMT completion time in two groups on 3 d after surgery were significantly shortened (P <0.01).Compared with 3 d after surgery,TMT completion time in group L on 7 d after surgery was significantly shortened (P <0.01 ).TMT completion time in group D on 1,3 d postoperative were significantly shorter than group L (P <0.05).POCD incidence of group D on 1 d after surgery was lower than that in group L (P < 0.05).Conclusion Different depth of anesthesia can ensure hemo-dynamic balance in old patients during surgery and after surgery.When BIS value was maintained at 30 to 39,it had lower S100βprotein levels,lower incidence of early POCD and a lesser degree of post-operative cognitive dysfunction.

Objective To investigate the efficacies of different times and frequencies of acupoint application in preventing and treating child asthma of spleen-lung qi deficiency type. Method Sixty children with asthma of spleen-lung qi deficiency type were randomly allocated to dog days, dog days reinforcement, coldest days and coldest days reinforcement groups for treatment by acupoint application. The therapeutic effects were evaluated using the TCM symptom score as the observation indicator in the four groups after three months of treatment. Result The TCM symptom score decreased significantly in the four groups at the follow-up after three months of treatment (P<0.05). The main effect of treatment time was marked (F=17.04, P<0.05). The main effect of treatment frequency was marked (F=8.17, P<0.05). Conclusion Different times and frequencies of acupoint application both decrease the TCM symptom score in children with asthma. The therapeutic effect is better in dog days than in three nine-day period after the winter solstice. An increase in treatment frequency influences the therapeutic effect obviously. The therapeutic effect is best in the dog days reinforcement group.

Objective To research the antiviral activity of artesunate (ART) in vitro fighting against both standard laboratory strains and ganciclovir(GCV)-resistance strains of human cytomegalovims(HCMV) and to explore whether fractionation dosage method can obviously enhance the antiviral effect of ART.Methods 1.Cytotoxicity assay to ART was performed by the use of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetry.The 0％ toxic concentration (TC0) were determined,and median cytotoxic concentration (TC50) was calculated with Probit regression method.2.Antiviral activity assays of ART against HCMV:human embryonic lung fibroblast cells (HELs) were infected with standard laboratory strains and GCV-resistance strains of HCMV,respectively,after which virus was removed and overlays of dulbecco's modified eagle medium(MEM) containing different antiviral drugs were added to the wells.All cells were cultured continuously at 37 ℃ in a 50 mL/L CO2 humidified atmosphere for 7-10 days and the cytopathic effect (CPE) was observed under a microscope.When the degree of CPE was clear (+ + +-+ + + +),the values of absorbency at 490 nm of all cell wells were measured by MTT colorimetry.The cell survival rate (CSR)and drug inhibitory rate (IR) for HCMV were calculated.By Probit regression method,the median inhibitory concentration (IC50) of 2 drugs was calculated respectively.3.To explore whether fractionation dosage method could obviously enhance the antiviral effect of ART against HCMV,the experiment was divided into 3 groups and compared with GCV group,respectively:Group 1:ART antiviral compounds were added to cell layers by one dosage.Group 2:Total drug dosage was divided into 3 parts,and each part was added to cell layers once a day for 3 days.Group 3:Total antiviral compounds were divided into 6 and delivery 2 times a day.The values of absorbency at 490 nm of all cell wells were measured by MTT colorimetry.The CSR and viral inhibitory rates were calculated.All data were statistically analyzed by One-Way ANOVA analyzing using SPSS 18.0 statistical software.P value of ＜0.05 was considered to indicate statistical significance.Results 1.Cytotoxicity assay showed that cytotoxicity was not found in the relevant range of ART concentrations under 62.5 μmol/L.TC0 and TC50 value of ART were 62.5 μmol/L and 171.7 μmol/L.2.In concentration of 5 μmol/L,15 μmol/L and 30 μmol/L,ART and GCV could obviously inhibit growth of HCMV AD169 strains.There was no significant difference between them.The value of GCV IC50 was 3.49μmol/L,and the value of ART IC50 was 2.17 μmol/L.Treatment index (TI) of ART was 28.8,and GCV was 716.3.ART could still obviously inhibit growth of HCMV resistant strains,but GCV couldn't.Differences between them were statistically significant.The value of GCV IC50 to HCMV resistant strains was 44.4 μmol/L,and the value of ART IC50 was 2.5 μmol/L.3.Fractionation dosage method (2 times a day) of ART could improve the inhibition rate of virus significantly compared to that used once a day and single dose method.Difference was statistically significant(P ＜ 0.01).GCV delivered as the same method had little different changes in virus suppression ratio(P ＞ 0.05).Conclusions 1.Cytotoxicity was not found in the relevant range of ART concentrations under 62.5 μmol/L.2.ART could obviously inhibit growth of HCMV resistant strains and standard laboratory strains.3.Fractionation dosage method (2 times a day) of ART could improve the inhibition rate of virus significantly compared to that used once a day and single dose method.4.Because the action mode of ART is different from other anti-HCMV drugs,and ART has a high biological activity and fewer side effects,it is expected to become a kind of new antiviral drugs for HCMV infections.

Objective To compare gross tumor volume (GTV) of nasopharyngeal carcinoma (NPC) according to MRI and FDG PET/CT and to investigated four fixed threshold methods to delineate the GTV using FDG PET/CT.Methods Fifty patients with primary biopsy-proven NPC were prospectively were enrolled into the study.FDG PET/CT scans and MRI were carried out within one week prior to pretreatment,respectively.The GTV was named GTV-MRI (GTV were delineated according to MRI),GTV-PETvis,GTV-PET30,GTV-PET40,GTV-PET50 (GTV was delineated according to the PET-based GTVs obtained by visual interpretationor,by percentage of the SUVmax (30％,40％,50％) thresholds,respectively).The differences were compared among the GTV-MRI,GTV-PETvis,GTV-PET30,GTV-PET40 and GTV-PET50 in different by Wilcoxon test.Results Of 50 patients,the median of volume descending order were: GTV-MRI 27.8 cm3,GTV-PETvis 22.2 cm3,GTV-PET30 22.7 cm3,GTV-PET40 14.4 cm3 and GTV-PET50 9.0 cm3.However,there was no significant difference between GTV-PETvis and GTV-PET30 (Z=-0.05,P=0.958),as well as GTV-MRI and GTV-PETvis or GTV-PET30 in 25 patients who were T1-2 stage (Z =-0.93,-0.93,P=0.353,O.353),the other GTVs were all different in 50 patients' (Z=-5.74-2.09,P =0.000-0.037).Conclusions All the GTVs delineated by the different methods of using FDG PET/CT were less than the GTV delineated by MRI.The potential advantages with the GTV-PETvis or GTV-PET30 delineated by FDG PET/CT are reduction of biological metabolic tumor volume in GTV delineation and reduction of the size of the GTV in NPC patients.

Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8％ (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P＞0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P＜0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1％ (22/129),P＜0.05].In the TOLAC group,99.3％ (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P＜0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.

Objective To explore the effect of mobile phone-based health education on independent living ability of postoperative patients with hypertensive intracerebral hemorrhage. Methods Sixty patients with postoperative hypertensive intracerebral hemorrhage who underwent craniotomy in our hospital during March 2016 and December 2017 were divided into experimental and control groups, 30 cases in each group, according to the random number table method. Functional training conducted during hospitalization in both groups. After discharge, the control group used a telephone for follow-ups every 2 weeks and took part in a face-to-face training in the first month to implement continuous nursing intervention for a total of 3 months. After discharge, in the experimental group, various information forms of rehabilitation training for hypertensive intracerebral hemorrhage were comprehensively integrated, and mobile phone education was used for a total of 3 months in addition to the training as in the control group. The two groups were compared in terms of independent living ability between the two groups. Result The scores of independent living ability and self-care ability, action ability, metastatic ability, social cognitive ability and communication ability of the experimental group were significantly higher than those of the control group (P＜0.05). Conclusion The mobile phone-based education can promote the effect of rehabilitation exercise in patients with hypertensive intracerebral hemorrhage, so as to promote the independent living ability of patients.

Objective:To investigate the clinical value of high-frequency ultrasound combined with virtual touch tissue imaging and quantification in the assessment of limb muscle tension after stroke in patients.Methods:A total of 31 patients with stroke who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to May 2022 and 41 healthy controls who concurrently underwent physical examination in the same hospital were included in this study. Before rehabilitation treatment, the shear wave velocity of the main muscle groups of the limbs was measured using virtual touch tissue imaging and quantification in all participants. The shear wave velocity of the main muscle groups was compared between the affected and healthy sides of patients between two sides of patients. The patient's muscle tension was evaluated using the modified Ashworth Scale. The shear wave velocity of the affected muscle groups in patients was correlated with the modified Ashworth Scale score.Results:There were no significant differences in the shear wave velocities of the main muscle groups of upper (biceps, flexor digitorum sublimis, flexor digitorum profundus) and lower [medial head of the gastrocnemius muscle, lateral head of the gastrocnemius muscle] limbs between the left [(2.46 ± 0.26) m/s, (2.81 ± 0.50) m/s, (2.96 ± 0.31) m/s, (2.49 ± 0.44) m/s, (2.21 ± 0.20) m/s] and right [(2.42 ± 0.29) m/s, (2.80 ± 0.47) m/s, (3.02 ± 0.36) m/s, (2.54 ± 0.37) m/s, (2.18 ± 0.17) m/s] sides in healthy controls ( t = 0.78, 0.04, 0.83, 0.58, 1.15, P = 0.435, 0.967, 0.405, 0.558, 0.216). The shear wave velocities of the main muscle groups of upper [flexor digitorum sublimis (3.74 ± 0.67) m/s, flexor digitorum profundus (3.64 ± 0.60) m/s), biceps (3.63 ± 0.64) m/s] and lower [medial head of the gastrocnemius muscle (3.28 ± 0.61) m/s, lateral head of the gastrocnemius muscle (2.90 ± 0.37) m/s] limbs on the affected side in patients with stroke were significantly higher than (2.56 ± 0.40) m/s, (2.67 ± 0.38) m/s, (2.78 ± 0.41) m/s, (2.30 ± 0.21) m/s, (2.25 ± 0.23) m/s on the healthy side ( t = 11.81, 8.21, 8.75, 8.91, 10.43, all P < 0.001). The shear wave velocities of the main muscle groups of the upper (flexor digitorum sublimis, flexor digitorum profundus, and biceps) and lower (medial head of the gastrocnemius muscle and lateral head of the gastrocnemius muscle) limbs were positively correlated with the modified Ashworth Scale score ( r = 0.77, 0.70, 0.72, 0.74, 0.78, P = 0.007, 0.029, 0.021, 0.016, 0.001). Conclusion:Monitoring the shear wave velocities of the main muscle groups of the upper and lower limbs using high-frequency ultrasound combined with virtual touch tissue imaging and quantification can effectively reflect the change in limb muscle tension of patients with stroke, which is highly valuable for evaluating rehabilitation efficacy and prognosis in patients with stroke.

Objective To emphasize characteristics in professional education and focus on practical use and serve the regional economy.Methods We studied the patients from six hospitals in 2013,and compared the first ten diseases and their specialized nursing skills with our current teaching curriculum,teaching contents and the guidance of the national nursing qualification test.Results The current surgical nursing teaching curriculum could not match the common clinical tasks.Some common diseases did not include in our teaching plan;on the other hand,some rare diseases were still included.The current teaching content was not complete,with a lack of new nursing methods.It could not fulfill the need of practical clinical tasks.Conclusions In order to serve the practical use,the teaching contents must be modified based on the regional spectrum of disease and the changes in the treatment and the nursing methods.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.