Objective To explore the safety and feasibility of blocking blood flow in interstitial tubal pregnancy treated with laparoscopic opening-taking embryo operation.Methods The clinical data of 98 patients with lump interstitial tubal pregnancies (requesting reserve procreate function) from January 2006 to December 2013 were chosen.Among them,56 patients were in study group (January 2010-December 2013) and 42 patients were in control group (January 2006-December 2009).All patients were treated with opening-taking embryo by laparoscopic operation.In study group,we first blocked the uterine artery and ovarian artery blood supply of pregnancy lump,secondly opened pregnancy lump and stripped gestation sac with hydraulic pressure separation during operation.Whereas,in control group,we opened pregnancy lump and taken out pregnancy tissues according to convention method without blocking blood flow.Operation success rate,operation blood volume,operation time,persistent ectopic pregnancy (PEP) happening rate,fallopian tube unobstructed information,and pregnancy information after operation were compared between two groups.Results In study group,operation success rate was 96.4％,which was significantly higher than that in control group (61.9％) (P ＜0.01) ; operation blood volume was[(20.7 ± 10.4)ml],which was significantly less than that in control group [(60.7 ± 18.4) ml] (P ＜ 0.01) ; operation time [(46.6 ±14.2) min] was significantly shorter than that in control group [(66.5 ± 19.4) min] (P ＜ 0.01) ; there was no PEP in study group,while there were 5 PEPs (11.9％) in control group.Fallopian tube unobstructed rate after operation in study group (76.9％) was significantly higher than that in control group (41.7％) (P ＜ 0.05).Conclusions Application of blocking blood flow in opening-taking embryo by laparoscopic operation on lump interstitial tubal pregnancies is safe and effective.

Objective: To investigate the effect of preoperative play intervention during anesthesia induction in children. Methods: Totally 120 children who met the inclusion criteria undergoing elective surgery divided into control group (n=60) and study group (n=60) by random number table. The study group admitted to the anesthesia induction room, and performed therapeutic play nursing intervention on the children for 60 minutes before the operation. The children in the control group were admitted to the general preoperative waiting room for 60 minutes before the operation, and they were subjected to routine nursing intervention. The children′s anxiety was assessed using modified Yale Perioperative Anxiety Scale (mYPAS) when the children entered the operating room before the intervention and during anesthesia induction; the children′s compliance with anesthesia induction was assessed using the Induction Compliance Checklist (ICC) . Pediatric Anesthesia Emergence Delirium Scale (PAED) score was used to observe emergence agitation. The vital signs of the two groups were observed before and after intervention. Results: There was no significant difference in the mYPAS score between the study group (32.23±4.71) points and the control group (31.58±3.72) points (P>0.05). The mYPAS score (31.92±4.03) points was lower in the study group than in the control group (59.76±5.14) points (t=-33.016, P<0.01). The ICC score of the study group (1.55±0.76) points was lower than the control group (3.04±0.62) points. The PAED score of the study group (4.76±0.92) points was lower than the control group (7.52±1.36) points (t=11.767, -13.020, P<0.05). The systolic blood pressure (96.25±3.06) mmHg (1 mmHg=0.133 kPa), diastolic blood pressure (59.39±2.77) mmHg, heart rate (118.37±15.26) times/min, and respiratory (29.75±3.17) times/min in the study group were lower than the control group (103.46±3.21) mmHg, (62.72±2.94) mmHg, (124.58±16.41) times/min, (34.81±2.96) times/min (t=12.593, 6.385, 2.146, 9.037, P<0.05) . Conclusion Preoperative play intervention for children before anesthesia induction can reduce the anxiety and fear level of children, and the children′s compliance of anesthesia is improved, and reduce the incidence of agitation during recovery.

Objective To explore the intervention effect of low-dose vitamin D on glucose metabolism of patients with impaired glucose regulation. Methods A total of196 subjects receiving oral glucose tolerance test were enrolled in this study, including individuals with normal glucose tolerance ( NGT group, n=67) and indi-viduals with impaired glucose regulation (IGR group, n=129). The IGR group was divided into intervention group ( n=64) and non-intervention group ( n=65) according to vitamin D intervention ( for 1 year) performed or not. Clinical data and biochemical parameters were collected. Results The level of serum 25(OH)D3 was significantly lower in the IGR group than that of normal control group ( P<0. 05) . After 1 year of low-dose vita-min D intervention, insulin sensitivity increased and insulin resistance decreased in the intervention group as compared with non-intervention group. Diabetes developed less frequently in the intervention group ( 25 of 64 [ 39. 1％] ) compared with non-intervention group ( 30 of 65 [ 46. 2％] ) . But there was no significant differ-ent in diabetes prevalence between the two groups. Conclusions Vitamin D intervention can improve insulin sensitivity and reduce insulin resistance in patients with impaired glucose regulation. Low dose vitamin D can improve the abnormal glucose metabolism outcome in patients with impaired glucose regulation.

Objective:To analyze the molecular characteristics of Echovirus 11 (Echo11) strains isolated in Xiangyang, Hubei Province from 2016 to 2017 based on the sequences of VP1 gene.Methods:Rectal and throat swab specimens were collected from children with hand, foot and mouth disease (HFMD) in Xiangyang from 2016 to 2017. Echo11 strains were detected by real-time reverse transcriptase PCR (RT-PCR) and isolated after cultured in human rhabdosarcoma (RD) cells. The VP1 regions of Echo11 strains isolated from RD cells and the whole genomes of three representative Echo11 strains were amplified by conventional RT-PCR and the sequences were analyzed. DNAStar7.0 (MegAlign) and MEGA6.0 (Data) were used to analyze the homology and mutation sites in nucleotide and amino acid sequences. Neighbor-joining method was used to construct phylogenetic trees. Recombination analysis was performed with SimPlot software (BootScanning).Results:A total of 11 Echo11 strains were isolated from 3 494 HFMD cases, accounting for 0.31%. They were highly homologous in the VP1 gene. These strains shared 98.4%-100.0% homology in nucleotide sequences and 98.3%-100.0% homology in amino acid sequences. The homology between the 11 Echo11 strains and the prototype strain (Echo11/Gregory, X80059) was 73.9%-74.8% in nucleotide sequences and 87.7%-88.7% in amino acid sequences. All of the Echo11 strains circulating in Xiangyang were classified into lineage D, having a similarity to the strains circulating in some regions of mainland China since 2013. In multiple regions of the genome, the Echo11 strains isolated in Xiangyang were highly similar to the Henan Echo1 strains in 2010 and the Hubei Echo6 strains in 2015, suggesting there was recombination within the genome of Echo11 strains in Xiangyang.Conclusions:The Echo11 strains circulating in Xiangyang from 2016 to 2017 belonged to lineage D and were recombinant strains.

Objective: : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods: : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results: : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5–77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

Objective: : This study aims to investigate the relationship between aneurysm wall enhancement and clinical rupture risks based on the magnetic resonance vessel wall imaging (MR-VWI) quantitative methods. Methods: : One hundred and eight patients with 127 unruptured aneurysms were prospectively enrolled from Feburary 2016 to October 2017. Aneurysms were divided into high risk (≥10) and intermediate-low risk group (<10) according to the PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier SAH history from another aneurysm, Site of aneurysm) scores. Clinical risk factors, aneurysm morphology, and wall enhancement index (WEI) calculated using 3D MR-VWI were analyzed and compared. Results: : In comparison of high-risk and intermediated-low risk groups, univariate analysis showed that neck width (4.5±3.3 mm vs. 3.4±1.7 mm, p=0.002), the presence of wall enhancement (100.0% vs. 62.9%, p<0.001), and WEI (1.6±0.6 vs. 0.8±0.8, p<0.001) were significantly associated with high rupture risk. Multivariate regression analysis revealed that WEI was the most important factor in predicting high rupture risk (odds ratio, 2.6; 95% confidence interval, 1.4–4.9; p=0.002). The receiver operating characteristic (ROC) curve analysis can efficiently differentiate higher risk aneurysms (area under the curve, 0.780; p<0.001) which have a reliable WEI cutoff value (1.04; sensitivity, 0.833; specificity, 0.67) predictive of high rupture risk. Conclusion : Aneurysms with higher rupture risk based on PHASES score demonstrate increased neck width, wall enhancement, and the enhancement intensity. Higher WEI in unruptured aneurysms has a predictive value for increased rupture risk.

Objective: To study the experience of famous old Traditional Chinese Medicine doctors of Jiangsu, Zhejiangand Shanghai in applying medicinal paste according to the deconstruction analysis of the medical cases formed by miningthe linked data of original cases on the basis of TCM features. Methods: To apply a deconstruction analysis to thesedoctors. medical cases with the quantifiable trend data on the data processing platform of Medcase. Results: This studycollected 472 medical visits, 250 pathogenesis elements, 400 therapies and 529 kinds of herbs. Conclusion: The medicinal pastes are applied by these famous doctors to treat commonly seen consumptive diseases, namely to intervenesub-health status. The chief core indications are lassitude, poor sleep, lumbar soreness and poor appetite; the relatedtongue and pulse conditions are thin or white tongue coating, red or pale tongue proper, and a thready or wiry pulse; thechief pathogenesis elements are deficiency of the liver and kidney, and deficiency of the spleen and kidney; thefrequently used herbs are Radix Astragali seu Hedysari, Rhizoma Atractylodis Macrocephalae, Poria, Radix Angelicae Sinensis, Radix Paeoniae, Radix Glycyrrhizae, Radix Rehmanniae Preparata, etc. The prescriptions for medicinal pastesare made by modifying several basic formulas including Sijunzi Decoction, Siwu Decoction, Bazhen Decoction, DangguiBuxue Decoction, Liuwei Dihuang Pills, and Shengmai Decoction. The common excipients for pastes are Ejiao, rockcandy, Guibanjiao, Lujiaojio, etc. The guide for making the pastes are combined therapies, such as regulating both qi andblood, tonifying both yin and yang, and treating both deficiency and excess.

Objective To compare the predictive values of swirl sign and black hole sign on CT scanning in early hematoma expansion in spontaneous intracerebral hemorrhage (SICH) patients.Methods Two hundred and ten firstly diagnosed SICH patients,admitted to our hospital from January 2012 to December 2018,were enrolled in the study.All patients were divided into hematoma expansion and non-hematoma expansion group according to whether early hematoma expansion appeared;and they were also divided into positive imaging sign group and negative imaging sign group according to whether imaging signs appeared;the clinical and imaging data were compared between these groups,respectively.The accuracies of swirl sign and black hole sign in predicting early hematoma expansion were analyzed using receiver operator characteristic (ROC) curve.Multivariate Logistic regression analysis was performed to determine the independent risk factors for early hematoma expansion.Results (1) In the 57 patients with early hematoma expansion,21 (36.8％) had swirl sign,and 17 (29.8％) had black hole sign;in the 153 patients without hematoma expansion,12 (7.8％) had swirl sign and 22 (14.4％) had black hole sign;the differences between the two groups were statistically significant (P＜0.05).As compared with those in the non-hematoma expansion group,the admission systolic blood pressure increased significantly and number of patients with intraventricular hemorrhage was significantly larger in the hematoma expansion group (P＜0.05).(2) There were no statistical differences in clinical and imaging data between the patients with swirl sign (n=33) and patients without swirl sign (n=177,P＞0.05);the hematoma volume in patients with black hole sign (n=39) was significantly increased as compared with that in patients without black hole sign (n=171,P＜0.05),and there were no statistical differences in other clinical and imaging data between patients with and without black hole sign (P＞0.05).(3) The areas under ROC curve of swirl sign,black hole sign,and "swirl sign combined with black hole sign" were 0.645,0.577,and 0.570,respectively.(4) Multivariate Logistic regression analysis showed that admission systolic blood pressure,swirl sign and black hole sign were independent risk factors for early hematoma expansion (P＜0.05).Conclusion In comparison to black hole sign and "swirl sign combined with black hole sign",the swirl sign has higher predictive value in early hematoma expansion in ICH patients.

Objective:To evaluate the safety and efficacy of stent-assisted coil embolization in patients with recurrent intracranial bifurcation aneurysms,after initial simple coiling or microsurgical clipping.Methods:Clinical data of 20 patients with recurrent intracranial bifurcation aneurysms who initially underwent simple coiling or surgical clipping and subsequently re-treated by stent-assisted coiling embolization at the Radiology Intervention Department of Huashan Hospital between March 2009 and November 2019 were collected and analyzed retrospectively.There were 9 males and 11 females,with a median age of 55.5 years (range:33 to 71 years),including 17 aneurysms initially treated with simple coiling and 3 treated with surgical clipping.All cases were re-treated with stent-assisted coiling,15 using a single stent and 5 employing two stents in a Y-configuration.Peri-and post-operative complications and outcomes were evaluated.Mann-Whitney U tests were performed to compare the follow-up duration between initial treatment and re-treatment.Student′s t tests were used to compare the parent artery angles before re-treatment, after re-treatment and at the last follow-up. The parent artery angle was defined using the proximal main trunk and the stented branch. Results:Immediate complete occlusion (Raymond Ⅰ) was achieved in 18 aneurysms (90.0%) while 2 aneurysms (10.0%) had a residual neck (Raymond Ⅱ).The median follow-up time( M( Q R)) was 8.5(16.3)months,which had no significantly different from the initial treatment follow-up duration (15.5(27.0)months)( U=157.7, P=0.25). During the follow-up period,2 aneurysms (10.0%) with immediate post-operative residual necks recanalized again,including 1 aneurysm re-treated with the Y-configuration stent.Symptomatic thromboembolic complications occurred in 6 patients,including 4 re-treated with the Y-configuration stent.No peri-operative hemorrhagic complications occurred,along with no operation-related permanent disability or death. The parent artery angle increased significantly from pre-operative(90.1±21.1)°to post-operative and the last follow-up ((115.4±28.9)° and (132.6±26.8)°); t=5.14, P<0.01; t=7.78, P<0.01). Conclusion:For recurrent intracranial bifurcation aneurysms after initial surgical clipping or simple coiling,stent assisted coil embolization is proved to be safe and can decrease recurrence rate.

Objective:To evaluate the safety and efficacy of stent-assisted coil embolization in patients with recurrent intracranial bifurcation aneurysms,after initial simple coiling or microsurgical clipping.Methods:Clinical data of 20 patients with recurrent intracranial bifurcation aneurysms who initially underwent simple coiling or surgical clipping and subsequently re-treated by stent-assisted coiling embolization at the Radiology Intervention Department of Huashan Hospital between March 2009 and November 2019 were collected and analyzed retrospectively.There were 9 males and 11 females,with a median age of 55.5 years (range:33 to 71 years),including 17 aneurysms initially treated with simple coiling and 3 treated with surgical clipping.All cases were re-treated with stent-assisted coiling,15 using a single stent and 5 employing two stents in a Y-configuration.Peri-and post-operative complications and outcomes were evaluated.Mann-Whitney U tests were performed to compare the follow-up duration between initial treatment and re-treatment.Student′s t tests were used to compare the parent artery angles before re-treatment, after re-treatment and at the last follow-up. The parent artery angle was defined using the proximal main trunk and the stented branch. Results:Immediate complete occlusion (Raymond Ⅰ) was achieved in 18 aneurysms (90.0%) while 2 aneurysms (10.0%) had a residual neck (Raymond Ⅱ).The median follow-up time( M( Q R)) was 8.5(16.3)months,which had no significantly different from the initial treatment follow-up duration (15.5(27.0)months)( U=157.7, P=0.25). During the follow-up period,2 aneurysms (10.0%) with immediate post-operative residual necks recanalized again,including 1 aneurysm re-treated with the Y-configuration stent.Symptomatic thromboembolic complications occurred in 6 patients,including 4 re-treated with the Y-configuration stent.No peri-operative hemorrhagic complications occurred,along with no operation-related permanent disability or death. The parent artery angle increased significantly from pre-operative(90.1±21.1)°to post-operative and the last follow-up ((115.4±28.9)° and (132.6±26.8)°); t=5.14, P<0.01; t=7.78, P<0.01). Conclusion:For recurrent intracranial bifurcation aneurysms after initial surgical clipping or simple coiling,stent assisted coil embolization is proved to be safe and can decrease recurrence rate.