Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

Objective To explore the efficacy and safety of low-dose tirofiban in stent-assisted coil embolization(SAC)for ruptured intracranial aneurysms.Methods From April 2011 to September 2020,335 patients of ruptured intracranial aneurysms with subarachnoid hemorrhage(SAH)admitted in the First People's Hospital of Changzhou were retrospectively analyzed.All cases underwent stent-assisted coil embolization within 24-48 h and antiplatelet medications.The patients were divided into dual antibody group(89 cases)and tirofiban group(246 cases).Baseline and clinical data of all patients were collected for comparison between groups,including age,sex,hypertension,diabetes mellitus,Hunt-Hess grade at admission,modified Fisher scale score at admission,aneurysm diameter(＞5 mm,≤5 mm),aneurysm location(anterior circulation,posterior circulation),postoperative acute hydrocephalus or intraventricular hemorrhage,postoperative complete embolization rate of ruptured aneurysm.All patients with ruptured intracranial aneurysm with SAH were confirmed by emergency cerebral CT scan after admission.The Raymond grading criteria were used to evaluate the embolization effect after operation:grade Ⅰ refers to no development(complete embolization),grade Ⅱ refers to only aneurysm neck development(incomplete embolization),and grade Ⅲ refers to aneurysm body development,in which Raymond grading Ⅰ orⅡ indicates effective embolization.Tirofiban group:4.2 μg/kg tirofiban was intravenously injected after the coil was placed in the aneurysm lumen and the stent was released,followed by maintenance dose 0.07 μg/(kg·min)for 6-8 h,and aspirin 100 mg and clopidogrel 75 mg were given as sequential dual antiplatelet therapy 2 hours before the tirofiban infusion was stopped.Dual antiplatelet group:a loading dose of aspirin 300 mg and clopidogrel 300 mg was given at least 2 hours before stent implantation,and then transferred to aspirin 100 mg and clopidogrel 75 mg given on the second day after operation.All patients received aspirin(100mg/d)for 6 months and clopidogrel(75 mg/d)for 3 months after operation.The efficacy indicators,safety indicators,adverse events and other complications of the two groups were collected and compared.The efficacy indicators were the incidence of thrombotic events during operation and within 72 hours after operation.The safety indicators were the incidence of intraoperative and early postoperative intracranial hemorrhage(within 48 hours after operation),the incidence of late postoperative intracranial hemorrhage(over 48 hours after operation),and the incidence of intracranial hemorrhage related to external ventricular drainage(symptomatic and asymptomatic).The adverse event was the occurrence of drug-related thrombocytopenia.Other complications were delayed ischemic events.The modified Rankin scale(mRS)score was used to evaluate the clinical prognosis of patients at 180 days after operation.mRS score ≤2 was defined as good prognosis,mRS score＞2 was defined as poor prognosis,of which 6 was defined as death.Results(1)There were no significant differences in baseline and clinical data between the tirofiban group and the dual antibody group(all P＞0.05).(2)There was no significant difference in the proportion of patients with good outcome(75.2％[185/246]vs.74.2％[66/89],P=0.845)and death(10.2％[25/246]vs.12.4％[11/89],P=0.566)at 180 days after operation between the tirofiban group and the dual antiplatelet group.(3)There was no significant difference in the incidence of intraoperative(0.8％[2/246]vs.4.5％[4/89],P=0.075)and postoperative thrombotic events(11.0％[27/246]vs.13.5％[12/89],P=0.527)between the tirofiban group and the dual antiplatelet group.(4)Results about safety comparison between this two antiplatelet regimens showed that the incidence of early postoperative intracranial hemorrhage were lower in the tirofiban group than that in the dual antiplatelet group(2.8％[7/246]vs.10.1％[9/89],P=0.014).There were no significant differences in the symptomatic external ventricular drainage related intracranial hemorrhage(0 vs.2/15,P=0.050),incidences of intraoperative intracranial hemorrhage(1.6％vs.3.4％,P=0.580),late postoperative intracranial hemorrhage(3.3％vs.4.5％,P=0.836),and drug-related thrombocytopenia(0.4％vs.1.1％,P=0.461)between the two groups.Conclusion Low-dose tirofiban infusion in SAC for ruptured aneurysms may prevent perioperative thromboembolic events without high risk of intracranial hemorrhage.

Objective To investigate the effectiveness and feasibility of endovascular treatment (EVT) in acute large vessel occlusion (LVO) of anterior circulation,and explore its influencing factors.Methods The clinical data of 302 patients with acute LVO of anterior circulation treated with EVT in our hospital from October 2010 to December 2016 were analyzed retrospectively.Collateral blood flow classification (American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology collateral circulating grading),interventionaI treatment methods,thrombolysisin cerebral infarction (TICI) grading,and National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment were recorded.Incidence and mortality rate of intraoperative and postoperative symptomatic intracranial hemorrhage (sICH) were recorded.The recovery of neurological outcomes was classified by modified Rankin scale (mRS) 90 d after treatment:patients with mRS scores≤2 were divided into a good prognosis group,and those with 3 ≤mRS scores ≤ 6 were divided into a poor prognosis group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of prognosis were further analyzed by multivariate Logistic regression analysis.Results (1)After the operation,ASITN/SIR grading 0-2 was noted in 201 patients,ASITN/SIR grading 3-4 was noted in 101 patients.Two hundred sixty-nine patients (89.0％) had good re-canalization (TICI grading 2b-3) after EVT:66.2％ patients were TICI grading 3,22.8％ patients were TICI grading 2b,5.6％ patients were TICI grading 2a,and 5.4％ patients were TICI grading 1-0.The NIHSS scores on discharge (8.4±3.9) were lower than those on admission (16.8+4.7);sICH rate was 10.9％.(2) On 90 d of follow-up,149 patients (49.3％) enjoyed good prognosis,and 153 patients (50.7％) had poor prognosis;and the mortality was 8.3％.(3) Single factor analysis showed that the differences in age,associated atrial fibrillation,NIHSS scores on admission,times of thrombectomy,and collateral circulating grading between good prognosis group and poor prognosis group were statistically significant (P＜0.05);multivariate Logistic regression analysis showed that NIHSS scores on admission and time from symptom onset to vessel recanalization were prognostic risk factors (OR=1.162,95％CI:1.018-1.329,P=0.016;OR=1.008,95％CI:1.003-1.019,P=0.007).Conclusion EVT is an effective and safe approach for acute LVO of anterior circulation.

Objective To investigate the effect of hyperglycemia at admission in patients with acute ischemic stroke on endovascular treatment outcome.Methods From May 2012 to December 2016,200 consecutive patients with acute ischemic stroke (excluding patients with diabetes mellitus) underwent endovascular mechanical thrombectomy at the Department of Neurosurgery,the First People's Hospital of Changzhou were enrolled retrospectively.They were divided into either a hyperglycemia group (hyperglycemia was defined as glucose ＞7.8 nmol/L at admission,n =57) or a non-hyperglycemia group (n =143) according to the blood glucose levels at admission.The neurological function of the patients was evaluated by the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.The modified thrombolysis in cerebral infarction (mTICI) grade was used to evaluate the degree of recanalization.The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients at 90 d after procedure.The general information of the patients were analyzed,including sex,age,past history,hospitalization time,onset to recanalization time (ORT),TOAST classification of cerebral infarction,and recanalization.The endovascular treatment outcomes of both groups were compared.Results (1) There were no significant differences in TOAST classification,age,hypertension history,atrial fibrillation history,stroke history,coronary heart disease history,ORT,NIHSS at admission between the patients of the two groups (all P ＞ 0.05).(2) There were no significant differences in days of hospitalization,mTICI grade,and number of thrombectomy between the patients of the two groups (P ＞0.05).(3) The discharge mortality and incidence of in-hospital neurological deterioration in the patients of the hyperglycemia group were 28.1％ (16/57) and 31.6％ (18/57) respectively,while those in the non-hyperglycemia group were 14.7％ (21/143) and 18.2％ (26/143) respectively.There were significant differences between the two groups (P =0.028 and 0.039 respectively).Conclusion Hyperglycemia at admission may have adverse effects on the prognosis in patients after receiving mechanical thrombectomy.

Objective To investigate the efficacy of endovascular treatment (EVT) in acute cardioembolic large vessel occlusion (LVO) of anterior circulation and its influencing factors.Methods The clinical data of 83 patients with acute cardioembolic LVO of anterior circulation treated with EVT during June 2014 to June 2016 were analyzed retrospectively.The neurological outcomes in these patients were evaluated by National Institutes of Health Stroke Scale (NIHSS) on admission;cerebral vascular re-canalization after procedure was classified according to thrombolysis in cerebral infarction (TICI) grading;the recovery of neurological outcomes was classified by modified Rankin scale (mRS) at discharge.According to the mRS scores at discharge,these patients were divided into two groups:good curative effect group and poor curative effect group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of surgical outcomes were analyzed by multiple factor Logistic regression analysis.Results Eighty-one patients (97.59％) had good re-canalization (TICI grading 2b-3) after EVT;41 patients (49.40％) had better curative effect (mRS scores ≤3 at discharge),and 42 patients (50.60％) had poor curative effect (mRS scores ≥4 at discharge);postoperative hemorrhagic transformation appeared in 26 patients,and 16 patients (19.28％) accepted decompressive craniectomy resulting from massive cerebral infarction,severe encephaledema or hemorrhagic transformation,and had poor curative effect.The single factor analysis showed that the differences of NIHSS scores on admission,occlusion site,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after operation between the good curative effect group and poor curative effect group were statistically significant (P＜0.05);multiple factor Logistic regression analysis showed that NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure were significantly correlated to the treatment efficacy (OR=1.171,95％CI:1.028-1.333,P=0.017;OR=3.623,95％CI:0.931-14.095,P=0.063;OR=l.012,95％ CI:1.003-1.021,P=0.008;OR=3.146,95％CI:0.875-11.309,P=0.079).Conclusions Endovascular thrombectomy is an effective approach for cardioembolic acute anterior circulation stroke.Furthermore,the influential factors of surgical treatment are NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure.

Objective To implement a two?level community?based health education pattern of schistosomiasis in residents of endemic areas in marshland and lake regions,so as to explore the suitable pattern of health education under hypo?endemic situa?tion. Methods Two schistosomiasis endemic villages in Jiangling County,Hubei Province were collected as study areas,and among which,one village was treated as an intervention group,where the two?level community?based health education pattern as well as regular control measures was implemented;the other village was a control group,where only regular control measures were implemented. The awareness rates on schistosomiasis control,the rates of correct behavior and the compliance rates of ex?amination,treatment and chemotherapy of the two groups before and after the intervention were compared. Results According to the results of the baseline survey in 2014,the awareness rates of schistosomiasis control of the intervention and control groups were 84.00%and 77.45%,respectively,the correct rates of behavior of the two groups were 72.00%and 63.73%,respectively, and the compliance rates of the treatment were 80.36%and 82.28%,respectively,there were no statistically significant differ? ences between all the above rates of the two groups(all P>0.05). After the intervention of the two?level community?based health education,the correct rates of behavior,and the compliance rates of examination and chemotherapy of the two groups were 92.31%and 80.37%,95.11%and 82.55%,84.13%and 63.64%,respectively,and the differences between all the rates above of the two groups were statistically significant(all P<0.05). When compared to those before intervention,the growing rates of the compliance rates of examination,treatment and chemotherapy of the intervention group were 20.97%,15.33%and 23.29%, respectively,while those of control group were 14.27%,4.17%,-3.77%,respectively,the growing rates of the intervention groups were higher than those of the control groups. Conclusions Through the two?level community?based pattern of health edu?cation,the compliance rates of examination and treatment of the residents have improved,and therefore,the pattern is suitable for popularization and application in marshland and lake regions.

Objective To investigate the preliminary experience of mechanical thrombectomy with a tri-axial system of the Solitaire AB stent through a Neuro delivery catheter to treat intracranial large artery occlusion. Methods A tri-axial system was used to deliver the Solitaire AB stent through a Neuro delivery catheter to provide intracranial aspiration in close proximity to the stent. This technique was used in 1 case of acute middle cerebral artery occlusion and 1 case of acute basilar artery occlusion. Results Successful revascularization was achieved in these 2 cases. Thrombolysis in cerebral infarction (TICI)score was 3. The clot length of acute middle cerebral artery occlusion was 3 cm and the modified Rankin Scale (mRS)score of this case was 3 at 90 days follow-up. Another patient with acute bilateral vertebral occlusion was revealed successful recanalization by angiography. Conclusion The results suggest that this technique of a tri-axial system used of the Solitaire stent through a Neuro delivery catheter can effectively retrieve clots from the occlusive artery and minimize the chance of antegrade blood flow dislodging the thrombus.

Objective To build a high quality diagnosis system for schistosomiasis surveillance in the situation of low infec-tion in Jianglin County. Methods The network laboratory for schistosomiasis diagnosis was built according to the national crite-ria in Jianglin County in 2012. Results The network laboratory for schistosomiasis diagnosis was established successfully and the operation was quiet well. Conclusion The establishment and operation of the laboratory play an important role in the real-ization of schistosomiasis elimination.

Objective To evaluate the cost-effectiveness of the comprehensive control measures carrying out in schistosomia-sis endemic inner embankment of marshland and lake regions from 2006 to 2010,so as to provide the reference for further rational allocation of limited health resources and ultimately speeding up the procedure of schistosomiasis elimination. Methods With ref-erence to the requirements of the national schistosomiasis transmission control and phase goals for schistosomiasis control in Hubei Province,Jiangling County,one schistosomiasis control pilot of Hubei Province combined with the National Health and Family Planning Commission and Ministry of Agriculture,was selected for the study. A definition of the infection rates of human and do- mestic animals was used for endemic villages stratified by different layers(i.e.,the village with the infection rates of human and domestic animals ≥3% belonged to the first layer,≥ 1% belonged to the second layer;<1% belonged to the third layer). By us- ing the stratification method and cost-effectiveness analysis,the endemic villages stratified with the different layers were investi- gated and all the data of schistosomiasis endemic situation,cost and effectiveness of schistosomiasis control were collected and comprehensively analyzed from 2006 to 2010. Results In the effectiveness of schistosomiasis control,by the end of 2010, there were no first layer villages,there were 114 second layer villages,and there were 18 third layer villages in Jiangling Coun- ty. In the former first layer villages,the schistosomiasis patients decreased year by year ultimately to 0;but in the second and third layer villages,the schistosomiasis patients increased. In the fecal treatment and management,the coverage rates of harm- less sanitary latrines were 27.45% in 2009 and 48.74% in 2010 respectively in the second layer villages,whereas there were no harmless sanitary latrines in the first and third layer villages. In the 5 years,the input of comprehensive control measures was 10 266 3900 Yuan,much higher than the human and buffalo examinations and treatments,Oncomelania hupensis snail investi- gation and elimination(4 183 000 Yuan)and other labor inputs(2 239 500Yuan). In the ratio of cost-effectiveness,the annual ratio of unit cost(1% reduction of human and buffalo infection and 1 hm2 reduction of snail areas)increased yearly. In addition, the semi-logarithmic stability trend analysis of health inputs and cost showed that there was a stable balance between inputs and cost in the different layers(logarithmic values of any two layers of pair-wise comparison were <1,and in the third layer villages, the annual average logarithmic values of 5 years were <1). Whereas,in the first and second layer villages,the annual average cost was fluctuated(the costs was higher than the inputs). Conclusion The schistosomiasis situation is reduced year by year in Jiangling County from 2006 to 2010. Whereas,the main infection source(buffaloes)still exists and the present control mea- sures including fecal management should be further strengthened. In the resource allocation,in the field of health,the annual distribution of key inputs and unit-cost control also has a further space of adjustment.

Objective To analyze the spatial-time distribution characteristics of schistosomiasis in Jiangling County ,Hubei Province from 2006 to 2011. Methods The surveillance data of schistosomiasis of Jiangling County from 2006 to 2011 were col-lected,and a spatial database was established. The spatial-time permutation cluster analysis was performed by SaTScan 9.1.1 to detect the spatial-time cluster areas of schistosomiasis,and a risk map was drawn by ArcGIS 10.0. Results Compared to 2006, the infection rates of human,cattle and Oncomelania hupensis snails decreased by 47.67%,93.34%and 52.41%,respectively in 2011. The space-time permutation clustering analysis of the infection rates of human,cattle and snails showed 4,3 and 4 clusters,respectively,and all the clustered areas were distributed in inner embankment areas. Conclusions From 2006 to 2011,the schistosomiasis endemic situation presents a decline trend in Jiangling County. The detected cluster areas are the im-portant areas for schistosomiasis control. The space-time permutation statistics could be used in the analysis of endemic situation of schistosomiasis.