Objective:To explore the feasibility of mismatch of amide proton transfer weighted (APTw) imaging with diffusion weighted imaging (DWI) in evaluating ischemic penumbra (IP) in patients with wake-up stroke.Methods:A prospective study was performed; 96 patients with wake-up stroke and unilateral middle cerebral artery territory infarction admitted to Emergency Stroke Department, Affiliated Hospital of Jining Medical University from September 2020 to January 2023 were chosen. All patients underwent routine MRI, DWI, APTw imaging and 3D arterial spin labeling (3D-ASL) before treatment and 90 d after treatment. IP presence was defined as changes of abnormal signal on T2-fluid-attenuated inversion recovery (FLAIR) 90 d after treatment greater than 20% of high signal range on DWI before treatment, and it was used as the gold standard to compare the efficacy in evaluating whether the patients had IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw imaging with DWI before treatment. The infarct core (IC) region, mismatch region of APTw imaging with DWI, mismatch region of 3D-ASL with APTw imaging were delineated on the fusion images in patients with IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw with DWI, and the differences of APTw values in different regions were compared.Results:According to the 90-d follow-up results, 50 patients had IP and 46 patients did not have IP. Specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of 3D-ASL with DWI were 86.9%, 93.7% and 100.0%, respectively; specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of APTw imaging with DWI were 100.0%, 95.8% and 92.0%, respectively. The APTw max, APTw min and APTw ave values of the IC region were significantly lower than those of mismatch region of APTw with DWI, and the APTw max-min values of mismatch region of APTw imaging with DWI were significantly higher than those of mismatch region of 3D-ASL with APTw imaging ( P<0.05). Conclusion:APTw imaging can reflect the acidosis status of different brain regions in patients with wake-up stroke; specificity and accuracy evaluating whether the patients have IP based on mismatch of APTw imaging with DWI are higher than those based on mismatch of 3D-ASL with DWI.

Objective To investigate the effect of ultrasound-guided bilateral superior laryngeal nerve internal branch block combined with endotracheal surface anesthesia in patients with hypertensive cerebral hemorrhage for the duration of postoperative tube insertion.Methods A total of 100 emergency hypertensive intracerebral hemor-rhage surgical patients who visited our hospital from October 2021 to April 2023 were included as the research subjects.They were randomly divided into four groups,25 patients in each group.After surgery,group U received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound combined with endotracheal surface anesthesia,group C1 received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound,group C2 received endotracheal surface anesthesia,and group C3 did not undergo any procedure after surgery.Hemodynamic changes(HR,MAP,and SpO2)at different time points during the postoperative tube insertion in four groups of patients were recorded.The frequency of restlessness within 10 hours after surgery,the dosage of dexmedetomidine and urapidil,the volume of wound drainage,and the satisfaction of bed nurses were also recorded.Results There was no statistically significant difference in general conditions among the four groups(P>0.05).There was no statistically significant difference in HR and MAP at different time points in Group U(P>0.05),while the differences among the other three groups were statistically significant(P<0.05).At the same time point,the MAP and HR of group U and C1 were significantly lower than those of group C3(P<0.05),and the MAP of group U was significantly lower than that of group C2(P<0.05).There was no statistical difference in SPO2 among the four groups of patients at the same time point(P>0.05);The frequency of restlessness,dosage of dexmedetomidine and urapidil,and volume of wound drainage in the U and C1 groups were significantly lower than those in the C2 and C3 groups(P<0.05).Except for the difference in restlessness frequency(P<0.05),there was no statistical difference in other indicators between group U and C1;There was a statistical difference in satisfaction among the four groups of nurses(P<0.05,C3>C2>C1>U group).No nerve block related complications were observed in the U and C1 group.Conclusion Ultrasound-guided bilateral superior laryngeal nerve branch block combined with endotracheal surface anesthesia can maintain hemodynamics steadily of the postoperative patients in the NICU to varying degrees and reduce the frequency of postoperative restlessness,the dosage of sedative and anti-hypertensive drugs,while reducing the flow of wound drainage,and improve the satisfaction of bed nurses.

Objective To explore the effect of etomidate-propofol mixture anaesthesia in painless gastrointestinal endoscopy.Methods Eighty-two patients who underwent painless gastrointestinal endoscopy from September 2023 to November 2023 were divided into etomidate-propofol mixture group(observation group,n=41)and propofol group(control group,n=41)by using the random number table method.Morphine-benzedrine group(MBG)scores were recorded 30 min before the examination and before leaving the recovery room in both groups.Percutaneous arterial oxygen saturation(SpO2),heart rate(HR)and mean arterial pressure(MAP)were noted at anesthesia induction(T0),before entering the endoscope(T1),5 min after anesthesia induction(T2),and awakening(T3).Gastrointestinal endoscopy time,awakening time,recovery room stay time,total propofol consumption,and adverse reactions were also documented.Results MBG scores in both groups significantly increased before leaving the recovery room compared to 30 min before the examination,the observation group had lower MBG scores before leaving the recovery room in comparison with the control group,there were statistically significant(P＜0.05).From T1 to T3,MAP,SpO2,HR were higher in the observation group than those in the control group,there were statistically significant(P＜0.05).The observation group had shorter awakening time and recovery room stay time,there were statistically significant(P＜0.05).The observation group had lower total propofol consumption,there was statistically significant(P＜0.05).The observation group also exhibited a lower incidence of hypotension,hypoxemia,and injection pain,there were statistically significant(P＜0.05),with no statistically significant difference in the incidence of other adverse reactions(P＞0.05).Conclusion Etomidate-propofol combination anesthesia can reduce postoperative MBG scores in painless gastrointestinal endoscopy,contributing to a decreased risk of potential propofol addiction and abuse.Additionally,it stabilizes circulatory and respiratory functions,reduces adverse reactions rate,and shortens awakening time and recovery room stay time.Its application is worthy of further promotion.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

Biodegradable stents (BDSs) are the milestone in percutaneous coronary intervention(PCI). Biodegradable polymeric stents have received widespread attention due to their good biocompatibility, moderate degradation rate and degradation products without toxicity or side effects. However, due to the defects in mechanical properties of polymer materials, the clinical application of polymeric BDS has been affected. In this paper, the BDS geometric configuration design was analyzed to improve the radial strength, flexibility and reduce the shrinkage rate of biodegradable polymeric stents. And from the aspects of numerical simulation, in vitro experiment and animal experiment, the configuration design and mechanical properties of biodegradable polymeric stents were introduced in detail in order to provide further references for the development of biodegradable polymeric stents.
Absorbable Implants ; Animals ; Percutaneous Coronary Intervention ; Polymers ; Prosthesis Design ; Stents