Objective To discuss the clinical application of medical coordination and hierarchical responsibility system in interventional nursing care which is carried out based on the “Henan Province Model”. Methods From November 2003 to April 2014 at authors’ hospital, medical coordination and hierarchical responsibility system was executed through setting up a ranking system of nursing position , optimizing shift process , dividing physician-nurse medical liability groups , strengthening medical training , implementing medical coordination service mode, etc. The clinical results were compared with those of conventional nursing care that were recorded during the period from May to Oct. of 2013. Results After implementation of medical coordination and hierarchical responsibility system, the quality of medical care, the patent’s satisfaction, the cooperation satisfaction of physicians and nurses were significantly improved. Compared with those before implementation of medical coordination and hierarchical responsibility system , the differences in the above indexes were statistically significant(P<0.01 or P<0.05). Conclusion Based on multidisciplinary joint diagnosis and treatment, and combined with coordination physician-nurse service mode, the enthusiasm of nursing staff can be motivated and the tacit understanding between physicians and nurses as well as the quality of nursing service can be improved. All of the above will promote the development of nursing discipline.

Objective To assess the safety, feasibility, short-and mid-term efficacy of wingspan stent for treating patients with symptomatic intracranial artery stenosis. Methods A total of 113 patients with severe symptomatic intracranial stenosis were enrolled and Gateway-wingspan stenting were performed on all patients. The technical success, the pre- and post-stenting stenosis, perioperative complications, clinical outcome and restenosis rates were recorded, and chi-square test was used for analysis of complication rate by comparing our results with the results of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study and NIH multi-center Wingspan stenting trial. Results The technical success rate was 99. 1% ( 112/113). The mean pre and post-stent stenoses were (80.7 ± 9.3)% and (27.7 ± 9.7)% (χ2 =9.397,P < 0. 05 ). The total complication rate was 4.4% (5/113 ) during the follow-up ( mean 14. 5 months, range 1-28 months), and the frequency of restenosis was 12. 5% (5/40) at 6 months. The primary endpoint events, ischemic stroke, and lesion-related ischemic stroke were lower in our study (4.5%, 3.5%,3.5% ) compared with the results of WASID trial (21.1%, 20. 4%, 15.0% ,P<0. 05). For those with poor outcome in the three high-risk sub-groups which were with more than 70% stenosis, or last event from the treatment was less than 17 days, or NIHSS was above 1, a better outcome was observed in our group (4. 5% ,4. 7% and 2. 0% in our study, 19.0%, 17.0% and 19. 6% in previous study, P < 0. 05). The medium-term efficacy in this group (4. 5% ) significantly improved compared with NIH study ( 14. 0% ,P <0. 05 ). Conclusions Wingspan stenting for symptomatic intracranial arterial stenosis is with good safety,feasibility and low perioperative stroke rate and mortality. The incidence of primary endpoint events and the ischemic events are lower than those of medication group, and the efficacy of stenting is significantly better than medication even in high-risk population.

Objective This paper analyzes the current development trends and present situation of health management specialist in China and aims to lay a foundation for an exploration of the new domestic health management model. Methods Using "health management specialist" as a theme in the CNKI database from June 2005 to May 2018, 476 results were retrieved after refining, and the CiteSpace software was introduced to analyze the network, organization, and time development trends of the key words. The family group was analyzed and verified. Results Research on health management specialist showed an increasing trend between June 2005 and May 2018. By 2013, the annual number of articles fluctuated from 15 to 35. Since 2014, the growth rate has been relatively fast, with the highest volume in 2018, reaching 75; the top four high-frequency keywords were"health management specialist""health management""health examination"and"hierarchical medical system". The regional and institutional distribution of health management specialist is mainly in southern cities. Conclusions The related research on health management specialist shows an increasing trend year by year, and is focused on health management, physical examination, and grading treatment. The distribution of health management specialist in China is obviously uneven.

Enhanced recovery after surgery (ERAS) can accelerate the recovery of patients through optimized perioperative management.As a new concept, ERAS has been applied in many perioperative areas in China.ERAS nursing mode is a nursing mode derived from ERAS concept.Through the integration of perioperative optimized nursing measures and multidisciplinary participation, the process of postoperative rehabilitation is accelerated. The application of ERAS nursing mode in the field of neurosurgery can reduce postoperative pain, promote the recovery of self-care ability, reduce postoperative complications,and improve nursing satisfaction.The implementation of ERAS needs multidisciplinary cooperation and rigorous prospective clinical research to provide high-quality evidence-based support, so as to jointly promote the development and continuous improvement of ERAS nursing model in the field of neurosurgery, so as to benefit the patients.

Lateral violence among nurses is a common problem in nursing industry. It mainly manifests in anxiety and uneasiness, fatigue and headache, high turnover intention, low quality of work and low satisfaction with nursing in various degrees. Lateral violence has brought many adverse effects to the nurses' physical, psychological and nursing quality, and seriously affects the stable development of nursing industry. This paper summarizes the research progress of evaluation methods and intervention strategies of lateral violence among nurses, and provided reference for nursing managers to understand the lateral violence among nurses comprehensively and provide better intervention strategies for lateral violence.

Objective:To use the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) to analyze the cognitive function status of patients after intracranial aneurysms surgery, and to explore its effects on evaluating the cognitive function of patients after intracranial aneurysms surgery.Methods:The patients after intracranial aneurysms surgery treated in the Department of Neurology and Neurosurgery in 3 Class Ⅲ Grade A hospitals in Zhengzhou between November 2018 and June 2019 and healthy controls were selected by convenient sampling. MoCA-BJ and Addenbrooke's Cognitive Examination-Revised (ACE-R) were used to evaluate the cognitive function of 306 patients after intracranial aneurysms surgery and 47 healthy controls. After 14 days, 30 subjects from the healthy control group were randomly selected for the MoCA-BJ test again. Cronbach's α coefficient was used to analyze the internal consistency of MoCA-BJ, and the Pearson correlation coefficient test was used to retest its reliability. ACE-R was employed to determine the convergent validity of MoCA.Results:The Cronbach's α coefficient of MoCA-BJ was 0.910 ( P<0.05) , and the retest reliability was 0.879 ( P<0.01) . The correlation analysis between the total scores of MoCA-BJ and ACE-R showed a positive correlation between the two ( r=0.883, P<0.01) . The optimal cut-off value of MoCA-BJ screening for patients with mild cognitive impairment (MCI) after intracranial aneurysm surgery was 25.5, which was corresponding to 83.0% in its screening sensitivity, 87.9% in specificity, and 0.652 in the Kappa value, showing good consistency. Receiver's operating characteristic curve (ROC) analysis results showed that the area under the curve ( AUC) was 0.924 ( SE=0.019, 95% CI: 0.888-0.960, P<0.01) . Conclusions:MoCA-BJ has good internal consistency reliability, retest reliability and convergent validity, and is suitable for MCI screening of patients after intracranial aneurysm surgery.

Objective:To explore influencing factors of neurological function recovery after combined intracranial revascularization in patients with moyamoya disease.Methods:Using the convenient sampling method, a total of 122 patients with moyamoya disease who were admitted to Henan Provincial People's Hospital from January 2018 to January 2019 were selected as the research objects. Patients with Modified Rankin Scale (mRS) score less than 3 points were set as the good neurological prognosis group ( n=86) , and patients with mRS score greater than or equal to 3 points were set as the poor neurological prognosis group ( n=36) . The clinical data of patients were compared between the two groups. Binary Logistic regression analysis was used to explore risk factors for poor prognosis of neurological function in patients with moyamoya disease after combined intracranial revascularization. Results:Binary Logistic regression analysis showed that Glasgow Coma Score (GCS) , frequent transient ischemic attacks before surgery, Suzuki grade greater than or equal to 3, hypertension, and high systolic high blood pressure were independent risk factors for poor prognosis of neurologic function in patients with moyamoya disease after combined intracranial revascularization ( P<0.05) . Conclusions:Influencing factors for poor neurological outcome after combined intracranial revascularization in patients with moyamoya disease include low GCS score, frequent transient ischemic attacks before surgery, high systolic blood pressure, Suzuki grade greater than or equal to 3 and hypertension. Taking targeted measures may reduce risk of poor neurological prognosis in patients with moyamoya disease.

With the continuous development of modern information technology, the healthcare system has entered the digital health era. The collection and reuse of huge amount of data need to be realized by data mining technology. Due to the high morbidity of stroke, it has accumulated a large amount of data in clinical work, and efficient and precise management of patients can be realized through in-depth mining of health information data. This paper reviewed the current status of the application of data mining in the field of stroke digital health, and summarized the problems in the application and put forward the outlook, in order to provide a reference for the application of data mining technology in stroke digital health.

Objective To explore the changes in macrophage infiltration behavior during the dynamic evolution of thrombi following the formation of acute carotid artery thrombosis occlusion(ACTO).Methods 15 healthy male New Zealand rabbits were selected to establish an ACTO model by causing injury to the rabbit carotid artery using surgical sutures treated with ferric chloride.All rabbits were randomly divided into 5 groups according to the end-point time using the random number table method,namely 24-hour group,1 week group,4week group,8 week group,and 12week group postoperatively,with 3 rabbits in each group.At 24 hours post-operation,the ACTO model was examined by DS A.At 24 hours,1 week,4 weeks,8 weeks,and 12 weeks post-operation,samples were taken from the thrombotic arterial segment of the 3 rabbits in each group and embedded in paraffin.The thrombus samples were stained with hematoxylin-eosin(HE)and Martius scarlet blue(MSB)to analyze changes in thrombus morphology and composition(including red blood cells,fibrin and collagen fibers).Orbit Imaging Analysis software was used for semi-quantitative analysis of the thrombus composition components.Using immunohistochemistry to detect the distribution of MO and M2 macrophages in thrombi,aimed to summarize the dynamic evolution of thrombus morphology,composition,and macrophage infiltration behavior at different stages following ACTO occurrence.Results The 24-hour DSA results indicated that all experimental rabbits successfully established the ACTO model.(1)HE staining showed a continuous increase in thrombus size from 24 hours to 1 week.By 4 weeks,signs of thrombus dissolution appeared,and at 8 weeks,neovascularization was observed within the thrombus.By 12 weeks,signs of fibrosis were evident in the thrombus.(2)MSB staining revealed that during the acute phase of thrombus formation(within 24 hours after surgery),red blood cells were the predominant component initially,but after this period,fibrin and collagen fibers became the main components.(3)The detection results of MO macrophages showed that 24 hours after surgery,MO macrophages in the thrombus were not evenly distributed throughout the thrombus,but mainly gathered at the thrombus edge;at 1 week after surgery,the positive area percentage of MO macrophage in the thrombus increased compared with 24 hours after surgery(thrombus edge:[41.7±27.0]％vs.[24.6±16.7]％,thrombus core:[35.7±19.6]％vs.[11.1±10.4]％,all P＜0.001),and evenly distributed within the thrombus;at 4 weeks after surgery,MO macrophages in the thrombus decreased compared with 1 week after surgery(thrombosis edge:[10.7±6.1]％vs.[41.7±27.0]％,thrombus core:[12.1±8.5]％vs.[35.7±19.6]％,all P＜0.001),the differences were statistically significant.At 4,8,and 12 weeks after surgery,MO macrophages within the thrombus did not change significantly with time(thrombus edge:[10.7±6.1]％,[8.0±7.7]％,and[8.9±5.3]％;thrombus core:[12.1±8.5]％,[9.5±4.2]％,and[15.7±11.0]％),and the differences were not statistically significant(all P＞0.05).In addition,at 12 weeks after surgery,MO macrophages at the thrombus edge was less than the thrombus core([8.9+5.3]％vs.[15.7±11.0]％,P＜0.01).The detection results of M2 macrophages showed that 24 hours after surgery,M2 macrophages in the thrombus were widely distributed throughout the thrombus;at 1 week after surgery,the positive area percentage of M2 macrophages in the thrombus increased compared with 24 hours after surgery(thrombus edge:[22.1±11.3]％vs.[11.4±8.7]％,P＜0.001;thrombus core:[24.5±9.8]％vs.[7.6±6.0]％,P＜0.001);at 4 weeks after surgery,M2 macrophage in the thrombus decreased compared with 1 week after surgery(thrombosis edge:[10.6±3.7]％vs.[22.1±11.3]％,P＜0.001;thrombus core:[9.2±4.3]％vs.[24.5±9.8]％,P＜0.001);at 8 weeks after surgery,M2 macrophages in the thrombus increased compared with 4 weeks after surgery([17.9±8.8]％vs.[9.2±4.3]％,P＜0.001),and the differences were statistically significant.However,M2 macrophages in the thrombus did not change significantly from 8 weeks to 12 weeks after surgery(thrombus edge:[9.4±6.3]％vs.[8.5±5.3]％,P＞0.05;thrombus core:[17.9±8.8]％vs.[14.4±10.0]％,P＞0.05).In addition,at 8 and 12 weeks after surgery,M2 macrophages in the thrombus core was greater than the thrombus edge(8 weeks after surgery:[17.9±8.8]％vs.[9.4±6.3]％,P＜0.001;12weeks after surgery:[14.4±10.0]％vs.[8.5±5.3]％,P＜0.001).Conclusions This study successfully established an ACTO animal model and demonstrated for the first time the dynamic evolution of macrophages within 12 weeks post-thrombus formation.Macrophages may played a significant role in both thrombus formation and fibrinolysis,as well as in the promotion of thrombus dissolution and the formation of new blood vessels within the thrombus which may potentially promote the spontaneous reperfusion of the occluded vessels.The results of this study need further verification.

Objective:To analyze the efficacy of the Post-stroke Depression Prediction Scale (DePreS) combined with the Early Symptom Measurement of Post-Stroke Depression-Short Form (ESMPSD-SF) in predicting post stroke depression (PSD).Methods:This study was a cross-sectional survey, using convenience sampling method to select 185 stroke patients admitted to Henan Provincial People′s Hospital from June 2019 to May 2021 as the research subjects. The DePreS, ESMPSD-SF, and general information questionnaire were used to investigate them.Results:The incidence of PSD was 36.76% (68/185). The DePreS and ESMPSD-SF scores in the PSD patients were (6.29 ± 8.77), (33.83 ± 6.78) points, respectively, significantly higher than those in the non-PSD patients (-2.05 ± 5.70), (26.51 ± 5.56) points, with statistically significant differences ( t=7.06, 7.97, both P<0.05). Logistic regression analysis showed that DePreS and ESMPSD-SF scores, marital status, and the number of comorbidities were predictive factors for PSD occurrence ( P<0.05). The AUC of DePreS for diagnosing PSD was 0.777, with an optimal diagnostic point of 2 points, a sensitivity of 59.42%, and a specificity of 80.71%; the AUC of the ESMPSD-SF for diagnosing PSD was 0.792, with an optimal diagnostic point of 28 points, a sensitivity of 78.26%, and a specificity of 74.14%. The sensitivity, specificity, and AUC of DePreS combined with ESMPSD-SF in the diagnosis of PSD were 82.61%, 83.62%, and 0.886, respectively. The differences were statistically significant compared to the AUC evaluated separately by DePreS or ESMPSD-SF ( Z=3.21, 3.49, both P<0.05). Conclusions:The combination of DePreS and ESMPSD-SF had a higher detection efficiency for PSD, and the combination of the two is more suitable for assessing PSD risk in stroke patients.