Objective To investigate the relationship between Post stroke depression (PSD) and Post stroke cognitive impairment (PSCI) using proton magnetic resonance spectroscopy.Methods 82 patients of acute stroke,which were met with the third edition of the Chinese Classification of Mental Disorders (CCMD-Ⅲ) and expert consensus of cognitive impairment since January 2012 to December 2012,Select continuously 82 patients who are hospitalized in our hospital due to acute stroke from January 2012 to December 2012 from Zhongnan Hospital of Wuhan University,were examined by 1H-MRS in one month.They were divided into PSD and PSCI simultaneously (n =19),PSD (n =21),PSCI (n =22) and control group (n =20).Results The differences between PSD and PSCI was not significant.On hippocampus japonicas,the Cho/Cr ratio in patients of A group (left (1.05 ± 0.10),right(1.18 ± 0.15)),showed higher than those in B group (left (0.84 ± 0.10),right (0.88 ± 0.08)),C group (left(0.88 ±0.08),right (0.87 ±0.07)),D group(left(0.87 ±0.06),right(0.89 ±0.06)).The difference was statistically significant.PSD and PSCI promoted each other in influencing Cho/Cr ratio.Conclusion There is no significant relationship between PSD and PSCI in the produce of disease,and they can promote each other in hippocampus japonicas Cho/Cr ratio.

Objective:To investigate the effect of partial p osterior teeth with reverse cross-bite at one side of mandible on the chewing m ovement. Methods: 16 university students with partial posterior teeth reverse cross-bite and 12 with normal occlusion were included, 5 cycles o f gum chewing movement with left and right side separately were recorded with K6 -Ⅰmandibular kinesiograph (MKG) for the trace and velocity. Results: ①The chewing movement recorded in frontal plane was with a typical cycl e in controls while that in reverse cross-bite individuals was vertically in an d/or out type (59.38%), as well as in and out in same direction type (21.88%). ②Chewing movement in reverse cross-bite patients was in posterior direction, together with a larger angle of closing trace to horizontal plane and higher che wing terminal velocity. Conclusion: Partial posterior teeth with reverse cross-bite at one side have significant effect on both direction and v elocity of chewing movement.

Objective:To evaluate the effect of problem-based learning (PBL) combined with scene simulation in the cardiopulmonary resuscitation (CPR) teaching of standardized training of general practitioner, and explore a high-quality teaching method that will help students develop their clinical thinking and practical skills.Methods:Forty students of the Grade 2018 general practitioner training program in Yixing Hospital Affiliated to Jiangsu University were randomly divided into experimental group ( n=20) given PBL combined with scene simulation teaching method and control group ( n=20) given traditional teaching method. The pre-class preparation, classroom discussions, actual combat simulations, and analysis and summary were conducted in the experimental group (4-hour CPR training), while classroom teaching, teaching rounds, analysis and discussion, skills training were conducted in the control group (4-hour CPR training). Furthermore, both groups received the same theoretical test, skill assessment, and questionnaires. t-test or chis-quare test was performed for comparison between the two groups using SPSS 18.0. Results:The average score of theoretical test in the experimental group was significantly higher than that in the control group [(87.5±4.3) vs. (81.2±4.7), P<0.05]; the average score of the skill assessment in the experimental group was significantly higher than that in the control group [(91.0±1.5) vs. (83.1±1.8), P<0.05]. The questionnaire survey showed more students of the experimental group who reported greater improvement in their abilities than those of the control group ( P<0.05). Conclusion:PBL combined with scene simulation teaching method can effectively improve the quality of CPR teaching for standardized training of general practitioners, help students improve clinical thinking and comprehensive processing capabilities.

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.

Objective:To explore the independent influencing factors of patients with spontaneous rupture hemorrhage of primary liver cancer (PLC).Methods:A retrospective cohort study was conducted. The clinical data of 128 patients with PLC spontaneous rupture hemorrhage in Ningxia Medical University General Hospital from January 2017 to March 2022 were analyzed, including 108 males and 20 females, aged (53.4±10.6) years. According to different treatment, 128 patients were divided into liver resection group (LR, n=28), interventional group [ n=39, transcatheter arterial chemoembolization (TACE) and transcatheter arterial embolization (TAE)], and conservative group ( n=61). Univariate and multivariate Cox regression was performed to analyze prognostic factors. The LR and TACE groups were subdivided into LR (aLR, n=15), TACE/TAE (aTACE, n=33) and LR+ TACE ( n=19) groups. Kaplan-Meier analysis was performed, and the survival rate was compared by log-rank test. Results:The median survival time of LR group and TACE group was 23 months and 21 months, respectively, with no statistical significance ( P>0.05). The median survival time (38 months) in LR+ TACE group was significantly longer than that in aLR group (10 months) and aTACE group (9 months), and the difference was statistically significant ( P<0.05). Univariate analysis showed that Barcelona Clinical Liver Cancer (BCLC)staging, tumor length ≥10.0 cm, vascular invasion, α-fetoprotein ≥400 μg/L, total bilirubin, prothrombin time and treatment affected overall survival of PLC spontaneous rupture hemorrhage patients (all P<0.05). Multivariate analysis showed that BCLC staging, tumor length ≥10.0 cm, Child-Pugh grade and treatment were independent influencing factors for overall survival of PLC spontaneous rupture hemorrhage patients (all P<0.05). Conclusion:BCLC stage, tumor length ≥10.0 cm, Child-Pugh grade and treatment method are independent predictors of overall survival in patients with spontaneous rupture of PLC. LR combined with TACE therapy can improve the survival and prognosis of patients with spontaneous rupture of primary liver cancer.

Objective:To investigate the safety and efficacy of transcatheter genicular artery embolization (GAE) for moderate to severe knee osteoarthritis (KOA).Methods:This prospective study included 13 patients (17 knees) with KOA who were treated with GAE from October 2020 to March 2021. The Kellgren-Lawrence (K-L) grade was 2-3 for 11 knees, and 4 for 6 knees. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Whole-Organ Magnetic Resonance Imaging Score (WORMS) assessments were performed for all the subjects before operation. The success rate, clinical efficacy and complications were recorded after operation. Clinical outcomes were evaluated at 1 day, 1week and 1, 3, 6 months after the operation.Results:The success rate of GAE in 17 cases was 100%, and the success rate of target artery superselection was 98.4%(63/64). The baseline WOMAC pain score was 11(10, 13) and total score was 44(38, 58) for 17 knees. Post-operation follow-up WOMAC pain score were 4(3, 7), 2(1, 5), 2(1, 6) and 4(2, 6) at 1 day, 1 week, 1 month, and 3 months. Post-operation follow-up WOMAC total score were 22 (15, 34),20 (12, 24),17 (12, 26) and 20 (12, 31) at 1 day, 1 week, 1 month, and 3 months. There were 16 knees with 6 month follow-up assessment, with the WOMAC pain score of 2.5(2, 5), and the total score of 15(12, 26). Significant difference was found in the WOMAC pain score between baseline and the 1 day, 1 week, 1, 3 and 6 months follow up ( Z=-3.631, -3.623, -3.622, -3.622, -3.532, all P<0.001); also, the total score was statistically significant different between the baseline and the 1 day, 1 week, 1, 3 and 6 months follow up ( Z=-3.639, -3.634, -3.646, -3.527, -3.532, all P<0.001). At 3 months follow-up, there was 1 knee recognized clinical failure. Post-operative adverse reaction in this group included skin ecchymosis in femoral artery puncture area ( n=3), knee joint stiffness and pain within 1 week ( n=4),and clanging joints during postoperative activities ( n=6). Conclusion:GAE is a feasible and safe procedure with obvious short-term curative effect, which can alleviate pain symptoms and improve restricted movement in patients with KOA.

Objective:To analyze the hepatic hemodynamics changes after partial splenic embolization in patients with cirrhosis and hypersplenism.Methods:A total of 26 patients with cirrhosis and hypersplenism who underwent partial splenic embolization in the General Hospital of Ningxia Medical University from April 2018 to June 2019 were included in this study. The clinical data was retrospectively studied. The study objects consisted of 19 males and 7 females with an average of 55 years. Whole-liver perfusion enhanced CT imaging scan was performed for all patients. Changes in laboratory indexes and the blood perfusion of the liver sections including hepatic arterial perfusion, portal venous perfusion, total liver perfusion and hepatic arterial perfusion indexes before PSE and postoperative 1 month were compared.Results:The postoperative leukocyte and platelet counts increased, and the prothrombin time decreased in the 26 patient, and the differences were significant ( P<0.05). The hepatic arterial perfusion of the left lateral section, left medial section, right anterior section and right posterior section increased in postoperative 1 month, from 10.0 (7.0, 13.5) ml·min -1·(100 ml) -1, 9.3 (5.4, 12.8) ml·min -1·(100 ml) -1, 8.0 (6.0, 11.2) ml·min -1·(100 ml) -1, 10.7 (7.1, 13.8) ml·min -1·(100 ml) -1 to 7.7 (4.2, 11.0) ml·min -1·(100 ml) -1, 6.9 (2.6, 10.2) ml·min -1·(100 ml) -1, 7.1 (4.1, 8.7) ml·min -1·(100 ml) -1, 5.9 (4.4, 8.5) ml·min -1·(100 ml) -1, respectively. The differences were all significantly different ( P<0.05). There were no significant difference in portal venous perfusion and total liver perfusion before and after operation ( P>0.05). The hepatic arterial perfusion index of left lateral section, right anterior section and right posterior section increased after operation ( P<0.05). Conclusion:For patients with cirrhosis and hypersplenism who underwent partial splenic embolization, the state of hypersplenism was relieved, the hepatic arterial blood flow increased, and the liver function improved.

Objective To discuss the clinical value of tumor components of renal angiomyolipoma(AML)in predicting the efficacy of selective arterial embolization(SAE).Methods The clinical data of 20 patients with AML,who received SAE treatment at the General Hospital of Ningxia Medical University of China between August 2019 and April 2023,were retrospectively analyzed.The pre-SAE and post-SAE total tumor volume,fat volume(FV),non-fat volume(NFV),proportion of FV,proportion of NFV were calculated.Pearson correlation analysis was used to analyze the relationship between the initial volume of each tumor component and the tumor volume reduction rate.Multiple linear regression analysis was used to analyze the factors affecting the tumor volume reduction rate.Results The postoperative tumor volume,FV,and NFV were all significantly reduced when compared with their preoperative values(all P＜0.01).The postoperative proportion of FV was increased,and the postoperative proportion of NFV was decreased(P＜0.05).The postoperative tumor volume reduction value was closely correlated with the volume of tumor components and the presence of rupture(P＜0.05).Multivariate regression analysis revealed that the proportion of NFV was the independent risk factor for reduced tumor size.Conclusion After SAE,the proportion of NFV in AML is decreased.The preoperative measurement of this index can help clinicians to predict the postoperative tumor volume reduction ratio and to evaluate the postoperative efficacy of patients.

Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.