Objective To investigate the correlation between hemorrhagic transformation (HT) and each parameter of blood pressure variability (BPV) in patients with massive cerebral infarction caused by cardioembolic middle cerebral artery occlusion. Methods The patients with massive cerebral infarction caused by unilateral cardioembolic middle cerebral artery occlusion admitted to hospital within 24 h after onset were selected. For patients without revealing HT with head MRI on admission were analyzed retrospectively. According to the results of MRI rescan within 7 days after onset, they were divided into either a HT group or a non-HT group. Al specific parameters of blood pressure were compared and analyzed between the 2 groups, specificaly including initial value (initial), mean value ( mean), maximum value (max), minimum value (min), maximum-minimum difference (max-min), standard deviation (sd), successive variation (sv), and maximum value of sv (svmax) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results A total of 146 patients were enroled in the analysis, and 77 (52. 7% ) had HT within 7 d after onset. Al the blood pressure parameters were grouped by quartiles. Multivariate logistic regression analysis showed that after adjusting for age, admission time, baseline National Institutes of Health Stroke Scale score, congestive heart failure, antiplatelet therapy, initial blood glucose, prothrombin time, and international normalized ratio of the patients, SBPmin , SBPmax-min , SBPsv , SBPsvmax , DBPinitial, DBPsd , DBPmax , DBPmax-min , DBPsv , and DBPsvmax had significant independent association with and HT (likelihood ratio test of trend, al P < 0. 05). Conclusions Higher BP level and variability may increase the risk of HT in patients with massive cerebral infarction after cardioembolic middle cerebral artery occlusion. A smooth and slow antihypertensive treatment may need for these patients.

The dental clinical internship is the critical stage of combining theory and practice and changing the knowledge into ability for medical smdents through clinical practice.It should be based on the characteristics of oral medicine such as integrating the teaching content firstly,promoting the discussion teaching;then carrying the seminar teaching,including three steps,question-making,question-suspecting and question-solving Meanwhile,the training of scientific research and cultivate the innovative ability should be strengthened to cultivate students'creative ability by guiding studetents to refer to data.fill in the proposal of medical students and process an opening report,make medical records discussion and write professional summary and thesis.

BACKGROUND: Guided tissues regeneration (GTR) has been successfully used in the treatment of periodontal diseases by using biocompatible membrane to prevent tooth epithelial cell growing towards root and to facilitate the formation of a certain gap which is favorable for periodontal membrane cells to occupy the surface of the root, thereby to rebuild the peridental structure. OBJECTIVE: To verify whether GTR can promote the repair of periodontal bone defect and the formation of new bones and whether combined use of GTR membrane, artificial bone, and growth factors can acquire much more new periodontal tissue. DESIGN, TIME AND SETTING: An animal observation experiment was performed at the laboratory of Medical College of Dalian University between February and July 2006. MATERIALS: Basic fibroblast growth factor (bFGF) freeze-dry powder (50 mg/ampoule) was thoroughly dissolved with ddH2O to prepare 5 g/L bFGF solution, bFGF solution was dropped onto collagen membranes with a size of 10 mm ×10 mm (5 mg bFGFs per piece of collagen membrane). METHODS: Cementum and the alvelor bone 6 mm below the cement-enamel junction were removed to induce periodontal defect in 16 rabbits with big ears. Artificial bone with bFGF and GTR membrane were used to fold around the defect on the right side, followed by reduction and suture, serving as experimental side. The left side underwent identical experimental procedure, with the exception of application of artificial bone with bFGF and GTR membrane, serving as control side. MAIN OUTCOME MEASURES: Carrier material absorption, inflammation of inner connective tissues, and status of junctional epithelium were examined through the use of microscope. RESULTS: The control side exhibited no concrescence, while the expedmental side displayed concrescence of the cementum to various extents. CONCLUSION: Application of GTR membrane, artificial bone, and bFGF can promote the concrescence of damaging bone.

Objective:To investigate the correlation between fluid attenuated inversion recovery vascular hyperintensities (FVH) -diffusion weighted imaging (DWI) mismatch and the outcomes after endovascular mechanical thrombectomy (EMT) in patients with acute middle cerebral artery M1 segment occlusive stroke.Methods:Patients with middle cerebral artery M1 segment occlusive stroke who received EMT treatment and whose FLAIR images showed FVH in the Affiliated Hospital of Yangzhou University from January 2016 to June 2020 were enrolled retrospectively. The demographics and basic clinical information of the patients were collected. The modified Rankin Scale was used to evaluate the outcomes at 3 months after the onset of symptoms. 0-2 was defined as a good outcome, and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 77 patients were enrolled in the study. Their age was 67.16±9.63 years, 51 were males (66.23%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 14.16±7.49. Forty patients (51.95%) had a good outcome, and 37 (48.05%) had a poor outcome. Univariate analysis showed that the proportion of patients with FVH-DWI mismatch in the good outcome group was significantly higher than that in the poor outcome group (60.00% vs. 29.73%; χ2=7.103, P=0.008), and baseline NIHSS score (11.60±4.44 vs. 16.92±9.05; t=-3.312, P=0.001) and the proportion of patients with hypertension (65.00% vs. 86.49%; χ2=4.774, P=0.029) were significantly lower than those in the poor outcome group. Multivariate logistic regression analysis showed that FVH-DWI mismatch was independently associated with the good outcomes (odds ratio [ OR] 0.345, 95% confidence interval [ CI] 0.121-0.984; P=0.047), baseline NIHSS score was independently associated with the poor outcomes ( OR 1.133, 95% CI 1.036-1.239; P=0.006). Conclusion:FVH-DWI mismatch was independently associated with the good outcomes after EMT treatment in patients with acute middle cerebral artery M1 segment occlusive stroke.

Objective:To investigate the predictive role of relative diffusion-weighted imaging (DWI) signal intensity (DWI-rSI) in outcome in patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after endovascular therapy (EVT).Methods:Patients with anterior circulation large vessel occlusion stroke due to cardioembolic embolism underwent EVT and successful recanalization at the Affiliated Hospital of Yangzhou University from March 2017 to March 2023 were retrospectively included. According to the modified Rankin Scale score 3 months after procedure, the patients were divided into a good outcome group (0-2 points) and a poor outcome group (3-6 points). Multivariate logistic regression analysis was used to identify independent predictive factors for poor outcome. Results:A total of 59 patients were enrolled, including 29 males (49.2%), median age of 74 years (interquartile range, 68-80 years). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (12-21), and the median DWI Alberta Stroke Program Early CT Score (ASPECTS) was 8 (5-9). Thirty-two patients (54.2%) had good outcome, and 27 (45.8%) had poor outcome. Among them, 9 patients (15.3%) died (6 died from cerebral herniation after malignant brain edema, 2 died from complications, and 1 died from severe intracranial hemorrhage after procedure). Twenty-one patients (35.6%) experienced hemorrhagic transformation, including 12 (20.3%) with symptomatic intracranial hemorrhage. There were significant differences in baseline systolic blood pressure, NIHSS score, DWI-ASPECTS, DWI-rSI, and incidence of symptomatic intracranial hemorrhage between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that baseline systolic blood pressure (odds ratio 0.977, 95% confidence interval 0.919-0.991; P=0.015) and DWI-rSI (odds ratio 11.809, 95% confidence interval 1.932-72.170; P=0.008) were the independent predictors for poor outcome. Conclusion:DWI-rSI can predict the outcome of patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after EVT.

Objective To investigate the correlation between early blood pressure variability and early neurological deterioration (END) in patients with acute ischemic stroke.Methods Inpatients with acute ischemic stroke were collected prospectively.The blood pressure values of the enrolled patients were recorded continuously for 72 h after admission.The mean value (mean),maximum value (max),differences betw een the maximum and minimum (max-min),standard deviation (SD),and coefficient of variation (CV) for the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.END was as an increase of at least 2 in the highest score of the National Institute of Health Stroke Scale (NIHSS) compared to the baseline.Multivariate logistic regression analysis was used to identify the independent correlation between the different blood pressure variability parameters and END following acute ischemic stroke after adjusting the confounding factors.Results A total of 128 patients with acute ischemic stroke were enrolled,including 53 females and 75 males,and their mean age was 63.30 ± 11.82 years.After standard treatment,35 patients (27.34％) developed END within 72 h after admission.There were significant differences in age,sex,diabetes mellitus,baseline NIHSS,C-reactive protein and SBPmax,SBP in,SBPSD,SBPCv,DBPmax,DBP max-min,DBPsD,and DBPCv between END group and non-END group (all P ＜0.05).Multivariate logisticregression analysis showed that SBPmax-min(odds ratio [OR] 1.040,95％ confidence interval [CI] 1.014-1.067,SBPsD(OR 1.191,95％ CI 1.052-1.347),SBPCv(OR 1.317,95％ CI 1.100-1.578),DBP max-min(OR 1.076,95％ CI 1.018-1.138),DBPsD(OR 1.508,95％ CI 1.128-2.016),and DBPCv(OR 1.338,95％ CI 1.093-1.638) in blood pressure variability indices were the independent risk factors for END in patients with acute ischemic stroke.Conclusion Blood pressure variability is significantly associated with END within 72 h after admission in patients with acute ischemic stroke.

Objective To investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. Methods From January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. Results A total of 38 patients were enrolled, 19 (50. 00％) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50. 00％, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71. 05％) and 11 had poor outcomes (28. 95％). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89. 47％ vs. 2. 63％; P = 0. 029), and there was no significant difference between the incidence of sICH within 7 days (15. 79％ vs. 5. 26％; P = 0. 604) and 90-day mortality (0％ vs. 10. 53％; P = 0. 486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62. 96％ vs. 18. 18％; P = 0. 029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0. 103, 95％ confidence interval 0. 015-0. 714; P = 0. 021). Conclusion Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion.

Objective:To investigate the effect of regional leptomeningeal collateral circulation (rLMC) score based on CT angiography (CTA) and onset-to-reperfusion time (OTR) on the outcome after endovascular treatment (EVT) in patients with anterior circulation acute large vessel occlusive stroke (ACA-LVOS).Methods:Patients with ACA-LVOS underwent EVT in the Department of Neurology, the Affiliated Hospital of Yangzhou University from July 2017 to July 2023 were included retrospectively. The rLMC score 0-10 was defined as poor collateral circulation, and 11-20 were defined as good collateral circulation. At 90 days after EVT, the modified Rankin Scale (mRS) was used to evaluate the outcome. A score of 0-2 was defined as a good outcome and 3-6 were defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome after EVT. Results:A total of 144 patients with ACA-LVOS underwent EVT were enrolled, including 78 males (54.2%), median aged 73 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, the median baseline Alberta Stroke Program Early CT Score (ASPECTS) was 9, and the median OTR was 330.5 minutes. Eighty patients (55.6%) had good collateral circulation, 63 (43.8%) had poor outcome, including 13 deaths. Univariate analysis showed that there were significant differences in hypertension, previous stroke history, smoking, triglycerides, baseline NIHSS score, baseline ASPECTS, OTR, and collateral circulation status between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that good collateral circulation (odds ratio [ OR] 0.223, 95% confidence interval [ CI] 0.077-0.643; P=0.005) was an independent predictor of good outcome. In the poor collateral circulation group, longer OTR was an independent predictor of poor outcome ( OR 1.020, 95% CI 1.008-1.032; P=0.001). In the good collateral circulation group, longer OTR was not an independent risk factor for poor outcome ( OR 1.005, 95% CI 1.000-1.010; P=0.062). Conclusion:rLMC score based on CTA and OTR are the independent predictors of the outcome after EVT in patients with ACA-LVOS.

Objective: To explore the relationship between cerebral hemorrhagic transformation (HT) and angiographic early venous filling (EVF) following mechanical thrombectomy for acute ischemic stroke. Methods: A retrospective imaging analysis was performed in the consecutive patients treated from January 2015 to November 2018 for acute anterior circulation large vessel occlusion using mechanical thrombectomy on the Affiliated Hospital of Yangzhou University. The demography, vascular risk factors and other clinical data of the patients were also collected. According to the experimental study of European Cooperative Acute Stroke Study Ⅱ (ECASS Ⅱ), the modified classification of HT after mechanical thrombectomy was divided into HT negative, HT-Ⅰ type and HT-Ⅱ type. The differences in EVF, clinical and demographic characteristics were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for HT and clinical outcome. Diagnostic test characteristics of EVF for HT-Ⅱ type were determined using a receiver operating characteristic curve (ROC) analysis. Results: A total of 98 patients with acute ischemic stroke who received mechanical thrombectomy were enrolled, including HT negative in 48 cases (49.0%, 48/98), HT-Ⅰ in 40 cases (40.8%, 40/98) and HT-Ⅱ in 10 cases (10.2%, 10/98). Significant differences were noted in age, and incidence of atrial fibrillation, EVF and poor outcomes among three groups (P<0.05). Multivariate logistic regression analysis showed that EVF [odds ratio (OR) 5.960, 95%CI 1.750-8.960, P=0.001] and atrial fibrillation (OR 3.485, 95%CI 1.962-18.986, P=0.028) were risk factors for the occurrence of HT-Ⅱ after mechanical thrombectomy. No risk factor for HT-Ⅰ was noted. Baseline National Institute of Health Stroke Scale (NIHSS) score (OR 1.162, 95%CI 1.021-1.345, P=0.038), EVF (OR 5.358, 95%CI 1.665-13.653, P=0.006) and HT-Ⅱ (OR 1.326, 95%CI 1.226-2.038, P=0.032) were independent risk factors for poor outcomes. And the sensitivity and specificity of EVF in prediction for HT-Ⅱ were 80.0% and 86.4% respectively, with the area under the ROC curve of 0.832. Conclusion Presence of EVF after mechanical thrombectomy may be the predictor for HT-Ⅱ, which indicates the poor clinical outcomes for acute ischemic stroke patients.