Objective To analyze the clinical features of hyperperfusion syndrome occurring after carotid artery stenting, and to discuss its nursing measures. Methods Among 220 patients who received carotid artery stenting, nine developed hyperperfusion syndrome after stent implantation. Their clinical materials were retrospectively analyzed. The nursing measures, including properly controlling blood pressure, relieving brain edema, monitoring cerebral blood flow, medication with sedation drug, stopping or reducing antiplatelet therapy, close observation of blood pressure and clinical symptoms, cooperation with physicians to control the blood pressure and to dynamically make reexamination, etc. Results Of the nine patients with hyperperfusion syndrome, complete recovery was achieved in eight at the time of discharge and death due to intracranial hemorrhage occurred in one. Conclusion The key point of nursing for patients with hyperperfusion syndrome is close cooperation with physicians to control the patient ’s blood pressure so as to ensure a proper cerebral blood flow.

Objective To search for the distinctive diagnostic features of Crohn's disease and intestinal tuberculosis in clinical manifestations with methods widely used clinically.Methods A retrospective study enrolled 33 Crohn's disease and 34 intestinal tuberculosis inpatients in West China Hospital of Sichuan University from 1996 to 2007.The clinical characteristics and key points of differential diagnosis were analyzed.All the pathological sections were studied again.Results The total duration of symptoms in patients with a diagnosis of Crohn's disease was longer than that in patients with intestinal tuberculosis ( P < 0.05 ).The incidence of eolectomy is significantly higher in Crohn' s disease than in intestinal tuberculosis because of intestinal obstruction or undefined diagnosis ( P < 0.05 ).Hematochezia,extra-intestinal manifestation and ileus occurred significantly more in Crohn's disease than in intestinal tuberculosis( P < 0.05 ).Night sweating and hypoalbuminemia occurred significantly more in intestinal tuberculosis than in Crohn's disease( P <0.05 ).The positive rate of serum antibodies to mycobacterium and increased erythrocyte sedimentation rate is higher in intestinal tuberculosis than in Crohn's disease(P < 0.05).Cobblestone sign and fissure-shape ulcers were only found in Crohn's disease,while circular ulcer occurred significantly more in intestinal tuberculosis( P <0.05).The involvement of stomach,jejunum or ileum was significantly more in Crohn's disease than in intestinal tuberculosis( P < 0.05 ).Granulomas were more common in intestinal tuberculosis than in Crohn's disease( P < 0.05 ) and the site of granulomas was valuable for differential diagnosis.In all the Crohn's disease specimens,lymphoid aggregates in the lamina propria or submucosa were significantly more in surgically reseeted specimens than in endoscopic biopsies (P <0.05).Conclusions There are definitely some different features between the two diseases.It is essential to review the whole clinical data of the patient.The frequency of granulomas and the distribution of chronic inflammation are identified as histological parameters that can be used to differentiate tuberculosis and Crolm's disease.

Objective To analyze the changes and characteristics of cancer incidence and mortality among Jiaxing residents in the past 6 years,and to provide evidence for the prevention and control of cancer incidence and mortality.Methods Registered malignant tumor data from the Zhejiang Chronic Disease Information Monitoring and Management System were collected and analyzed based on the International Statistical Classification of Diseases (ICD-10).The statistical indexes used for analyses included crude incidence,standardized incidence,crude ortality,standardized mortality,potential years of life lost (PYLL),average years of life lost (AYLL),rate of potential years of life (PYLL‰) and so on.Results From 2010 to 2015,the crude incidence,the standardized incidence,the crude mortality,and the standardized mortality were 342.52/105,240.89/105,194.71/105 and 126.27/105,respectively.The crude incidence and mortality for males were both higher than those for females(378.44/105 vs.307.49/105,x2=763.06,P＜0.01;255.31/105vs.135.62/105,x2-3 814.11,P＜0.01).The PYLL,AYLL and PYLL‰ of residents in Jiaxing were 248,307 years,6.16 years and 12.00‰,respectively.The PYLL‰for males was significantly higher than that for females(x2=37073.85,P＜0.01).The AYLL for females was 6.50 years,higher than that for males(5.98 years)(t =125.15,P＜0.01).The incidence of malignant tumors increased with age,especially in the older than 40 age group,with the older than 80 age group showing the highest rate at 1 779.01/105 (x2 =38 840 907,P ＜ 0.01).Rates for Lung cancer (70.59/105),colorectal cancer (39.86/105),liver cancer (29.14/105),breast cancer(26.73/105) and stomach cancer (26.00/105) were the most common malignant tumors in Jiaxing.Conclusions The morbidity and mortality of malignant tumors are showing signs of rising and the incidences of lung cancer and gastrointestinal cancer are particularly pronounced in Jiaxing.In consequence,measures for the prevention and control of malignant tumors should be developed with clearly defined objectives and research on the pathogenesis of malignant tumors should be stepped upto reduce the incidence and mortality of malignant tumors.

Objective To apply the oral gastrointestinal ultrasound contrast agents for evaluating the gastric motility abnor‐mality in the patients with anxiety disorder .Methods Twenty patients with anxiety disorder complicating upper digestive tract symptoms without organic pathological changes were enrolled as the anxiety disorder group .Twenty healthy volunteers were en‐rolled as the control group in this study .The two groups orally took gastrointestinal ultrasound contrast agents .The antral contrac‐tion frequency ,antral contraction amplitude amd MI were measured at each time point .GER was calculated .The the gastric motility parameters in the patients with anxiety disorder were evaluated .Results The antral contraction frequency and MI at initial 2 min had no statistical difference between the anxiety group and the control group .The antral contraction amplitude ,antral contraction frequency amd MI at each time point during 5 -10 min after contrast in the anxiety disorder group were significantly decreased compared with the control group ,and the differences were statistically significant (P< 0 .05) .After 20 min ,GER in the control group was significantly higher than that in the anxiety group ,the difference was statistically significant (P<0 .05) .Conclusion O‐ral gastrointestinal ultrasound contrast agents is a economic ,strongly operable ,non‐invasive and highly repeatable method for evalu‐ating the gastric motility .

OBJECTIVE:To evaluate the prophylactic use of antibiotics in perioperative period in our hospital. METHODS:The prophylactic use of antibiotics in 841 patients in our hospital in the first 3 months was analyzed statistically. RESULTS:841 patients have used antibiotics,and 74.04% of those patients with typeⅠ incision operation used antibiotics for 3 to 7 days. Cephalosporins and Fluoroquinolones were predominantly used for prophylactic purpose. Irrational use of antibiotics was seen in 714 cases. CONCLUSION:The prophylactic use of antibiotics in our hospital is far from rational,thus it is necessary to put "Guideline on Clinical Use of Antimicrobials" into practice.

Objective : To understand the epidemiological characteristics of intentional injury cases in Jiaxing from 2009 to 2016,and to provide basis for prevention and control of intentional injury. Methods: Data from the injury surveillance hospitals in Jiaxing from 2009 to 2016 were collected to learn the distribution and trend of gender,age,injury intention,cause,occurrence place,injured body parts and severity in intentional injury cases. Results: There were 8 089 cases of intentional injury reported by injury surveillance hospitals in Jiaxing from 2009 to 2016,accounting for 3.40% of all injury cases reported（237 912）. A total of 7 489 cases aged between 15 to 64 years old,accounting for 92.58%. There were 6 906 cases of violence and 1 183 cases of suicide or self-inflicted injury,accounting for 85.38% and 14.62%,respectively. The male-female ratio in the cases of violence was 2.54∶1,while the one in the cases of suicide or self-inflicted injury was 1∶1.59. The cases of violence was mainly caused by blunt instruments,accounting for 75.17%（5 191 cases）,while the cases of suicide or self-inflicted injury was mainly caused by poisoning,accounting for 47.76%（565 cases）. The cases of violence mainly occurred in streets,accounting for 29.64%（2 047 cases）,while the cases of suicide or self-inflicted injury mainly occurred at home,accounting for 82.59%（977 cases）. Head was the main injured parts in the cases of violence,accounting for 66.81%（4 614 cases）,while digestive system was the main injured parts in the cases of suicide or self-inflicted injury,accounting for 31.45%（372 cases）. About 0.12% of cases of the violence and 1.44% of cases of suicide or self-inflicted injury caused to death. Conclusion Intentional injury cases in Jiaxing were mainly young or middle aged people. Violence was a common intention of injury in males and suicide or self-inflicted injury was a common intention of injury in females.

Objective To identify the relations of secondary cerebral edema volume with aquaporin 4 (AQP4) and reactive oxygen species (ROS) levels in patients with spontaneous deep supratentorial intracerebral hemorrhage. Methods Forty-seven patients with spontaneous deep supratentorial intracerebral hemorrhage, admitted to our hospital from December 2016 to January 2018, were chosen in our study; on the 1st, 3rd, 14th and 28th d of onset, the hematoma volume and secondary cerebral edema volume were measured by CT scan. Serum AQP4 and ROS levels were measured by ELESA. The relations of perihematomal edema volume with AQP4 and ROS levels in patients with spontaneous deep supratentorial intracerebral hemorrhage were analyzed. Results The hematoma volumes on 14th and 28th d of onset were significantly decreased as compared with those on 1st and 3rd d of onset (P<0.05); the serum AQP4 and ROS levels gradually increased on 1st, 3rd, and 14th d of onset, with significant differences (P<0.05). The cerebral edema volume, and serum AQP4 and ROS levels on 28th d of onset were significantly decreased as compared with those on 3rd and 14th d of onset (P<0.05). Serum AQP4 and ROS levels were positively correlated with cerebral edema volume (r=0.331, P=0.000;r=0.541, P=0.000); serum ROS level was positively correlated with AQP4 level (r=0.298, P=0.000). Conclusion The changes of brain edema volume, and serum AQP4 and ROS levels in patients with spontaneous supratentorial intracerebral hemorrhage are consistent and positively correlated, which suggests that the antioxidant may reduce the AQP4 protein expression, reduce the degree of brain edema, and alleviate the deterioration of patients with spontaneous intracerebral hemorrhage.

Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.

Objective To compare the efficacy and safety of leflunomide (LEF) combined with medium/low dose corticosteroids and full dose of corticosteroids in the treatment of IgA nephropathy. Method Primary IgAN patients diagnosed by renal biopsy with 18?65 years old and eGFR≥30 ml·min?1·(1.73 m2)?1 and proteinuria>0.5 g/24 h were enrolled in a prospective controlled clinical study. They were randomly divided into leflunomide combined with medium/low dose corticosteroids (LEF group) and corticosteroids alone (steroid group). The primary outcomes were (1) end stage renal disease or dialysis (2) 50% increase in serum creatinine above the baseline. Secondary outcome was the remission of proteinuria. Results Ninety patients completed the follow?up. The 24?hour proteinuria at baseline were 2.00(1.10, 2.88) g and 1.87(1.13 ,3.08) g in LEF group and steroid group respectively. Compared with baseline, it was significantly decreased in both groups at 6 months [0.30(0.11, 0.93) g, 0.30(0.14, 1.33) g] and 12 months [0.30(0.09, 0.82) g, 0.32(0.14, 0.66) g], (P<0.05). Estimated glomerular filtration rate (eGFR) at baseline, 6 months and 12 months were (80.39 ± 28.56), (87.12±28.70) and (88.20±30.26) ml·min-1·(1.73 m2)-1. It was decreased in steroid group (P<0.05), while no significant difference was detected in LEF group[baseline (87.63 ± 27.35), 6 months (86.91 ± 32.45), 12 months (90.06 ± 30.00) ml·min-1·(1.73 m2)-1, P>0.05]. At 6 and 12 months, there was no significant difference in terms of 24?hour proteinuria, serum creatinine and eGFR (CKD?EPI) between groups (P>0.05). There was no statistically significant difference in adverse events between groups during the treatment (9/40 cases in LEF group and 11/50 cases in steroid group, P>0.05). The average follow?up was 79 months, and there was no difference in the renal prognosis between the two groups. Multivariate Cox regression analysis revealed that serum creatinine at baseline and renal interstitial inflammatory cell infiltration predicted the risk of the progress of IgA nephropathy. Conclusion Leflunomide plus medium/low dose corticosteroids has a similar effect as full dose of corticosteroids in IgA nephropathy and does not increase the risk for adverse events during the treatment.

Objective:To evaluate the application effect of the "group-based" teaching assistant (TA) guidance model in homogenized clinical skill training.Methods:A pilot study was conducted on the cardiopulmonary resuscitation training course, and 32 students majoring in clinical integrative Chinese and Western medicine (five-year program) who were admitted to Shanghai University of Traditional Chinese Medicine in 2018 were randomly divided into control group ( n = 16) and TA group ( n = 16). The control group received traditional teaching methods, and the TA group was further divided into subgroups A, B, C, and D, with four graduate TAs providing group-based teaching. The groups were compared in terms of their satisfaction and test scores. SPSS 25.0 was used for t-test and analysis of variance. Results:The satisfaction survey showed that compared with the control group, the TA group had significantly higher degree of satisfaction with the increased practical opportunities, clinical skill practical ability, learning effect, and overall satisfaction. The immediate test showed that there was no significant difference in test score between the TA group (85.19±2.93) points and the control group (82.75±4.52) points. The test 30 days later showed that the TA group (83.50±5.13) points had a significantly higher test score than the control group (74.68±3.87) points, and the control group had a significantly lower test score than that in the immediate test ( P <0.001); however, there was no significant difference in the TA group's score between the immediate test and the test 30 days later. Conclusion:The "group-based" TA guidance model has a good effect in homogenized clinical skill training, and has a stable long-term effect, with high student satisfaction.