Objective To evaluated the safety and complications of endovasdcular stenting for symptomatic carotid stenosis with surgical high risk.Methods A series of 11 vessels in 9 patients at surgical high risk were treated by endovascular stenting. The complications during the procedures and postoperative periods were analyzed within one to five months. Results All of the operations were successfully performed without any serious complications. During the follow up period (averaging 6 months), there were no complications of TIAs, stokes and restenoses.Conclusions The study suggests that endovascular stenting may be safe and effective for patients at surgical high risk, but further more study is needed.

Objective To investigate short-term hemodynamic changes in selected patients with middle cerebral artery(MCA) stenting by transcranial Doppler sonography(TCD).Methods Stenting was given to 29 cases (31 MCAs) of patients with moderate and severe MCA stenosis if they had recurred symptoms during the standard antiplatelet therapy.TCD was applied to assess the hemodynamic changes in the stenosis segment and stenotic distal segment before stenting, 1 h and 3 d after stenting. Results Angiography showed that the rate of post-procedure residual stenoses of MCA were less than 20%.Compared with the pre-stentinng peak systolic velocity [PSV, (273±77)cm/s], the post-stenting PSV significantly decreased,which was (162±38) cm/s (P＜0.01) at 1 hour and (168±45)cm/s ( P＜0.01)at 3 days, respectively.Three cases (3 MCA) experienced recurrent stenosis-like spectra at stenosis segments 3 d after stenting and brain CT showed that 2 out of 3 cases suffered intracranial hemorrhage,which was potentially induced by hyperperfusion; PSV doubled in the stenotic distal segment in at least 28.6% patients.There was no statistic difference between pre- and post-stenting in the contralateral MCA (P＞0.05).Conclusions Stenting can dramatically improve the hemodynamic compromise of stenosis segments and their distal segments in selected patients with symptomatic MCA stenosis, however, potential hyperperfusion risk might he taken into consideration after MCA stenting.

Objective To assess the feasibility and clinical value of high-resolution magnetic resonance imaging (HRMRI) in patients with symptomatic severe intracranial stenosis (SSIS).Methods HRMRl wasperformed with a 3.0 T MR scanner on 5 patients with symptomatic middle cerebral(n=3) or basilar (n=2) arterial stenosis of≥70% confirmed bv DSA.Image diagnosis Was made on the basis of HRMRI findings of vessel wall at the stenotic segment by 2 neuroradiologists blinded t0 patient's status.Results Three of the five patients were diagnosed to have advanced intracranial atherosclerosis based on the presence of a complex eccentric atherosclerotic plaque containing a large lipid-rich necrotic core with a heterogeneous post-contrast enhancement and with signs of ruptured fibrous cap.Two other patients were likely to suffer from non-atherosclerotic lesion.HRMRI revealed an iso-signal septum in the arterial lumen attaching to the slighfly thickened arterial wall that was iso-signal with a homogeneous post-contrast enhancement in one patient and an obviously concentrically thickened arterial wall with hypo-intense signal on T1 WI and slightly high signal on T2 WI and PDWI and without any post-contrast enhancement in the remaining patient.Conclusions In vivo HRMRI in patients with SSIS is technically feasible.It provides detailed information of intracranial arterial wall at the stenotic segment.

Objective To compare the difference of ultrasound and digital subtraction anginography (DSA) in diagnosing carotid atheriosclerosis. Methods A total of 340 patients of ischemic cerebrovascular disease with carotid atheriosclerosis were examined with ultrasound and DSA. They were divided into cerebral infarction group (n=235) and transient ischemic attack (TIA, n=105), and also were divided into the young-aged group (n=54), middle-aged group (n=137) and old-aged group (n=149) by age. Results Both of the ultrasound and DSA found that the incidence of carotid artery stenosis in cerebral infarction was higher than that in TIA (P<0.05);the incidence that of carotid artery stenosis in old-aged group were higher than that in middle-aged and young-aged group (P<0.05), and in middle-aged group was higher than that in young-aged group. Taking DSA as standard, the accordance rate of ultrasound in diagnosing stenosis, clot and both of them were 89.39%, 80.85%, 87.15%, respectively. Conclusion Carotid artery ultrasound has high sensitivity in diagnosis of carotid atheriosclerosis. Either carotid artery ultrasound or DSA has advantages. With combination of two methods, there will be an important significance in the diagnosis, clinical treatment, assess before operation and follow-up after operation in patients with carotid atheriosclerosis.

Objective To investigate the value of muhi-detector CT (MDCT) low tension dynamic enhanced scanning on the preoperative assessment of advanced gastric cancer.Methods MDCT low tension dynamic enhanced scanning,tumor diagnosis and staging and prediction of surgery operation were performed on 43 cases of advanced gastric cancer.And the above results were compared with pathology results.Results The 36 cases were treated with resection,while 7 cases were treated by gastrointestinal anastomosis.The MDCT had 76.7 ％ (33/43) of accuracy for the preoperative T staging and 74.4 ％ (32/43) of accuracy for the preoperative N staging,respectively.The stomach wall thickness was closely related to serosal invasion (x2 =20.170 9,P ＜ 0.001).Conclusions The MDCT low tension dynamic enhanced scanning can improve the comprehensiveness and accuracy of preoperative staging of T and N in advanced gastric cancer.It is valuable for the preoperative diagnosis and treatment of gastric cancer.

The consensus has been reached on the benefits of surgical drainage. However, catheter-related blockage and retrograde infection remain bottleneck problems in the treatment process. To this end, with Huashan Hospital, Fudan University, as the main inventors, a drainage tube dredging umbrella and anti-retrograde infection kit have been designed and applied for the national utility model patent (patent number: ZL 2023 2 1300036.2). The main body of the kit consists of a catheter dredging umbrella, drainage tube, and drainage bag. Several isolation layers are installed in the drainage bag to form a maze structure and a reflux valve is added, thereby increasing the distance and resistance of liquid reflux, greatly reducing the possibility of liquid reflux entering the drainage tube, so as to reduce the risk of retrograde infection through physical means. When the drainage tube is blocked, the drainage tube and joint tube of the drainage bag can be separated, the unblocking umbrella can be inserted into the blockage through the guide wire, the cannula can be inserted along the guide wire, the guide wire is pulled to release the dredging umbrella in the contraction state, and the dredging umbrella can be pulled back in the expansion state until the blockage is removed from the drainage tube. The operating procedure is standardized and simple. While preventing retrograde infection (anti-retrograde infection kit), the catheter dredging umbrella could effectively address the issue of catheter blockage. It has certain clinical promotion and application value.

Objective To explore the effect of quality control circle ( QCC) on reducing the incidence of pressure ulcer during operation. Methods The quality control circle was organized by who aimed to reduce the incidence of pressure ulcer for patients undergoing operations. A total of 260 cases of operating patients were selected as control group from May 2013 to July 2013 ( Before the QCC group) and investigated the conditions of the pressure ulcer form during operation. By a series of QCC activity, we set target, found out the cause of pressure ulcer during operation, and took countermeasures to improve quality continually. A total of 282 operating patients had been accounted for the incidence of pressure ulcer from October 2013 to December 2013 (after the QCC group). We compared the skin damage related operation, the knowledge control of pressure ulcer among theatre nurses, standard rate of operation posture, et al. Results After the QCC activities, the rate of pressure ulcer was reduced from 9. 3% to 1. 4%, nursing knowledge control of the pressure ulcer among theatre nurses and standard rate of operation posture were improved obviously compared these of group before QCC (P<0. 05). Conclusions The QCC activities can minimize the incidence rate of pressure ulcer, but promote knowledge control of pressure ulcer among theatre and the standard rate of operation posture.

ObjectiveTo explore the mental health status and relevant factors among community residents during the normalization stage of prevention and control of COVID-19. MethodsFrom August 28 to September 7， 2020， an online cross-sectional survey using snowball sampling was conducted among community residents via Wenjuanxing platform， and their mental health status were assessed using Patients' Health Questionnaire Depression Scale-9 item（PHQ-9）， Generalized Anxiety Disorder-7 item（GAD-7）， Insomnia Severity Index（ISI） and Chinese Perceived Stress Scale（CPSS）. ResultsAmong the 476 community residents， the detection rates of depression， anxiety， insomnia and high perceived stress were 32.35%， 21.22%， 24.58% and 48.74%， respectively. In terms of gender， the detection rate of high perceived stress was higher in male than in female（χ²=5.269）； in terms of marital status， the detection rates of depression and anxiety among the unmarried， divorced or widowed residents was higher than those of the married residents（χ²=5.251， 8.851）； in terms of mental health service status， the detection rates of depression， anxiety， insomnia and high perceived stress among residents with mental health service needs was higher than those among residents without the needs（χ²=46.316， 66.934， 20.153， 21.576）， with statistical significance（P<0.05 or 0.01）. Correlation analysis showed that the age of community residents was negatively correlated with CPSS score（r=-0.171， P<0.01）， sleep duration was negatively correlated with PHQ-9， GAD-7 and ISI scores（r=-0.210， -0.247， -0.297， P<0.01）， and time spent following news on COVID-19 per day was negatively correlated with ISI score（r=-0.097， P<0.05）. ConclusionDuring the normalization stage of prevention and control of COVID-19， the majority of community residents experience the symptoms of depression， anxiety， insomnia and high perceived stress. Male and younger residents are more likely to experience high levels of perceived stress. Those with shorter sleep duration and needs for mental health services are more likely to experience symptoms of depression， anxiety and insomnia， and those with short time spent following news on COVID-19 are more likely to experience insomnia symptom.

Objective:To present the surgical details of manual double-layer suturing in patients with obesity combined type 2 diabetes mellitus by three-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy .Methods:Clinical data and follow-up information of 52 obesity combined type 2 diabetes mellitus patients (BMI 27.59-43.71 kg/m2) who underwent three-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy from Jan 2019 to Jul 2022 at Beijing Shijitan hospital were retrospectively analyzed.Results:The procedure was successful in all patients. The median operative time was 120 (90, 120) min, and the median intraoperative bleeding was 20.0 (10.0, 27.5) ml. No fistula or serious surgical complications were observed in the patients at 1 month postoperatively. Compared with the preoperative period, the patient's weight decreased [(93.22±15.21) kg vs. (69.97±11.06) kg, t=21.707, P<0.01], BMI decreased [(33.11±4.09) kg/m 2vs. (24.86±2.95) kg/m 2, t=23.224, P<0.01], and the patient's fasting glucose level decreased [9.52 (7.57, 12.96) mmol/L vs. 5.47 (4.66, 6.39) mmol/L, Z=6.11, P<0.01]. The remission rate of various obesity comorbidities was greatly improved. Conclusion:Under the condition of three-incision laparoscopy, the pure manual duodenal and jejunal double-layer suture method is safe, feasible, and effective for patients with obesity combined with type 2 diabetes mellitus.

Older adults have decreased control of body balance with aging and are prone to fall. As the primary point of contact between human body and ground, footwear is critical for stability of older adults. The relationship between shoe characteristics and stability of older adults was systematically reviewed to determine the effect of footwear characteristics on stability of older adults. The results show that wearing shoes with shoelaces or velcro, low heels, wide outsole and appropriate soles, or using vibrating insoles and arch support insoles can help older adults improve their stability. Excessive sole spring and low sole hardness may have adverse effects on stability of older adults. This study can provide theoretical references for older adults to choose shoes reasonably and for the manufacturers to design and make shoes to prevent falls.