Objective To evaluate the therapeutic efficacy of stenting combined with medication versus medication alone in treating severe extracranial carotid artery stenosis.Methods This prospective,multicenter cohort study enrolled 337 patients with carotid artery stenosis ranging from 70%to 99%.Based on patient preference,they were divided into two groups:a stent combined with medication group(antiplatelet drugs+statins,n=169)and a medication-only group(n=168).The study assessed perioperative safety and the incidence of recurrent cerebrovascular events related to the target vessel within one year.Results The success rate of the stent combined with medication group was 100%.There was one case of hyperperfusion-related intracranial hemorrhage during the perioperative period(1/169)The patient recovered well after medical treatment.There was no statistically significant difference in perioperative complications between the two groups(P=0.318).During the 1-year follow-up,the stent combined with medication group(3/169)had a significantly lower incidence of recurrent ischemic stroke compared to the medication-only group(15/168),with a statistically significant difference(P=0.003).Univariate analysis showed that gender(χ2=4.372,P=0.037),stenosis rate≥85%(χ2=10.738,P=0.001),and non-stent treatment(χ2=7.171,P=0.007)were risk factors for recurrent stroke.However,the number of recurrent ischemic strokes in females was relatively small and after adjusting the chi-square test,the difference was not statistically significant(P=0.075).Logistic regression analysis revealed that stenosis rate≥85%(OR=115.925,95%CI:2.077-122.102,P=0.008)and non-stent treatment(OR=0.158,95%CI:0.044-0.564,P=0.004)were independent risk factors for recurrent cerebrovascular events within one year.Conclusions In patients with≥85%extracranial carotid artery stenosis,stenting combined with medication reduces recurrent ischemic cerebrovascular events within 1 year.

Objective To evaluate the therapeutic efficacy of stenting combined with medication versus medication alone in treating severe extracranial carotid artery stenosis.Methods This prospective,multicenter cohort study enrolled 337 patients with carotid artery stenosis ranging from 70%to 99%.Based on patient preference,they were divided into two groups:a stent combined with medication group(antiplatelet drugs+statins,n=169)and a medication-only group(n=168).The study assessed perioperative safety and the incidence of recurrent cerebrovascular events related to the target vessel within one year.Results The success rate of the stent combined with medication group was 100%.There was one case of hyperperfusion-related intracranial hemorrhage during the perioperative period(1/169)The patient recovered well after medical treatment.There was no statistically significant difference in perioperative complications between the two groups(P=0.318).During the 1-year follow-up,the stent combined with medication group(3/169)had a significantly lower incidence of recurrent ischemic stroke compared to the medication-only group(15/168),with a statistically significant difference(P=0.003).Univariate analysis showed that gender(χ2=4.372,P=0.037),stenosis rate≥85%(χ2=10.738,P=0.001),and non-stent treatment(χ2=7.171,P=0.007)were risk factors for recurrent stroke.However,the number of recurrent ischemic strokes in females was relatively small and after adjusting the chi-square test,the difference was not statistically significant(P=0.075).Logistic regression analysis revealed that stenosis rate≥85%(OR=115.925,95%CI:2.077-122.102,P=0.008)and non-stent treatment(OR=0.158,95%CI:0.044-0.564,P=0.004)were independent risk factors for recurrent cerebrovascular events within one year.Conclusions In patients with≥85%extracranial carotid artery stenosis,stenting combined with medication reduces recurrent ischemic cerebrovascular events within 1 year.

Objective: To investigate the incidence trend of tuberculosis in Haidong City, Qinghai Province from 2006 to 2020, and the effects of age, period, and cohort on tuberculosis incidence, so as to provide the basis for enhancing the prevention and control for tuberculosis. Methods: Data of tuberculosis cases in Haidong City from 2006 to 2020 were collected from the Chinese Disease Prevention and Control Information System. Incidence rates were calculated and standardized using data from the Sixth National Population Census in 2010. The trends in incidence of tuberculosis were analyzed by annual percent change (APC). Effects of age, period and cohort on the incidence of tuberculosis were analyzed by an age-period-cohort model. Results: The crude incidence rates of tuberculosis in Haidong City from 2006 to 2020 ranged from 37.69/105 to 100.93/105, and the standardized incidence rates ranged from 42.85/105 to 115.24/105. The standardized incidence rates from 2006 to 2015 showed a decreasing trend (APC=-7.148%, P<0.05), while there was no significant trend observed from 2015 to 2020 (all P>0.05). The age-period-cohort model analysis showed that the highest incidence risk of tuberculosis in Haidong City from 2006 to 2020 was observed in the age group of 20-<25 years (RR=2.973, 95%CI: 2.353-3.756), followed by the age group of 80-<85 years (RR=2.785, 95%CI: 2.206-3.516). The incidence risk of tuberculosis was higher in the period from 2016 to 2020 (RR=1.253, 95%CI: 1.203-1.306) compared to the period from 2011 to 2015 (RR=0.796, 95%CI: 0.770-0.823). Tuberculosis incidence risk was the highest in the birth cohort from 1936 to 1940 (RR=3.050, 95%CI: 2.356-3.949), and then gradually decreased over time thereafter. Conclusions The incidence of tuberculosis in Haidong City showed a decreasing trend from 2006 to 2015, while there was no significant trend observed from 2015 to 2020. The incidence risk of tuberculosis was higher in the age groups of 20-<25 years and 80-<85 years, and the risk decreased for those born in more recent years.

Objective:To investigate the current situation and influencing factors of clinical nurses'clinical decision-making ability,and provide a reference and evidence for improving and enhancing the correct clinical decision-making ability of clinical nurses.Methods:A total of 300 clinical nurses in Shaanxi Province were selected as the research subjects by using the convenience sampling method.The General Information Questionnaire,Clinical Decision-Making Scale,and Comprehensive Decision-Making Style Scale were used to conduct the investigation and study.The influencing factors of clinical nurses'clinical decision-making ability were analyzed by using single-factor analysis and multivariate linear regression.Results:The total score of clinical nurses'clinical decision-making ability was(163.85±13.78)points,reaching the high-level standard of clinical decision-making ability(146.68-200.00)points.The results of Spearman rank correlation analysis showed that there was a significant positive correlation between the total score and the score of each dimension of clinical decision-making ability and the score of rational decision-making style(P<0.05).The score of the dimension of searching for information or new information was only negatively correlated with the score of intuitive-impulsive decision-making style(P<0.05).Avoidant decision-making style was negatively correlated with the scores of seeking information or new information,clarifying goals and values,the total score of clinical decision-making ability,and the dimensions of finding alternative solutions(P<0.05).The results of multiple linear regression showed that rational decision-making style can positively affect clinical nurses'clinical decision-making ability,while avoidance decision-making style can negatively affect it.Conclusion:The clinical nurses'clinical decision-making ability has been maintained at a relatively constant high level,and it is greatly influenced by rational and avoidant decision-making styles.Medical managers need to organize targeted training activities and other measures to promote the construction of clinical nurses'rational decision-making style and minimize the influence of avoidant decision-making style,thus improving the clinical nurses'clinical decision-making ability.

Objective:To investigate the clinical efficacy of ginkgo biloba extract dense tablets combined with pitavastatin in the treatment of elderly stable coronary heart disease (SCAD), as well as its impact on patients′ thrombotic status, neutrophil-to-lymphocyte ratio (NLR), and serum high-sensitivity C-reactive protein (hs-CRP) levels.Methods:A prospective study was conducted on 82 elderly SCAD patients admitted to the 928th Hospital of PLA Joint Logistics Support Force from October 2019 to December 2020. The patients were divided into an observation group and a control group using a random number table method, with 41 patients in each group. The control group received oral pitavastatin calcium tablets, while the observation group received oral ginkgo biloba extract dense tablets on the basis of the control group. After 8 weeks of continuous treatment, the clinical efficacy of the two groups was observed. The frequency of angina attacks, thrombotic status indicators [D-dimer (D-D), fibrinogen (FIB)], peripheral blood NLR, serum hs-CRP levels were compared before and after treatment between the two groups. The incidence of adverse reactions was compared between the two groups.Results:The total effective rate of the observation group was 78.05%(32/41), which was significantly higher than 56.10%(23/41) of the control group, and the difference was statistically significant ( P<0.05). After treatment, the frequency of angina attacks [weekly attack times, duration of single attack, severity (weekly nitroglycerin usage)] in both groups significantly improved compared with before treatment (all P<0.05), and the observation group improved more significantly (all P<0.05). After treatment, plasma D-D and FIB levels in both groups significantly decreased compared with before treatment (all P<0.05), and the observation group decreased more significantly (all P<0.05). Peripheral blood NLR and serum hs-CRP levels in both groups significantly decreased compared with before treatment (all P<0.05), and the observation group was significantly lower than the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group [9.76%(4/41) vs 7.32%(3/41)] ( P>0.05). Conclusions:The overall efficacy of ginkgo biloba extract dense tablets combined with pitavastatin in the treatment of elderly SCAD is exact, which can effectively improve patients′ angina attacks, thrombotic status and inflammatory state with good safety.

Echocardiogram is vital for the diagnosis of cardiac disease. The heart has complex hemodynamics requiring an advanced ultrasound imaging mode. Cardiac ultrasound vector flow imaging is capable of measuring the actual magnitude and direction of the blood flow velocity, obtaining the quantitative parameters of hemodynamics, and then providing more information for clinical research and diagnosis. This study mainly reviewed several different vector flow imaging techniques for cardiac flow and presented the implementation difficulties, and proposed a diverging wave based high frame rate cardiac ultrasound vector flow imaging. The study discussed the limitation of current ultrasound technology used in the cardiac flow measurement, analyzed and demonstrated the specific reasons for these implementation difficulties and the potential future development.
Blood Flow Velocity ; Heart/physiology* ; Hemodynamics ; Ultrasonography

Objective:To observe the efficacy and safety of albumin paclitaxel in patients with advanced breast cancer.Methods:A retrospective analysis was performed on 138 patients with advanced breast cancer admitted to Xiangyang Central Hospital from June 2018 to June 2021. The patients were divided into groups according to molecular type, number of treatment lines for albumin paclitaxel, number of metastatic sites, specific metastatic sites, past use of docetaxel and paclitaxel and combination therapy of albumin paclitaxel. Median progression-free survival (mPFS) and treatment-related adverse reactions in different subgroups treated with albumin paclitaxel were investigated. Survival curves were plotted by Kaplan-Meier method and log-rank test was performed, and multivariate analysis was performed by Cox model.Results:The mPFS of the overall population was 8.2 months. The mPFS of triple negative breast cancer, human epidermal growth factor receptor-2 (HER-2) positive breast cancer and Luminal breast cancer were 6.4 months, 11.2 months and 8.1 months respectively, with a statistically significant difference (χ 2=7.42, P=0.025) . The mPFS of patients treated with first- and second-line albumin paclitaxel was 9.5 months, and the mPFS of patients treated with third- to seventh-line was 6.3 months (χ 2=3.86, P=0.049) . The mPFS of patients with ≤3 metastatic sites was 8.1 months, and the mPFS of patients with >3 metastatic sites was 7.0 months (χ 2=0.38, P=0.535) . The mPFS of patients with liver and brain metastases was 6.8 months, and the mPFS of patients with extrahepatic and extracerebral metastases was 9.6 months (χ 2=7.53, P=0.006) . The mPFS of patients who had previously treated with docetaxel and paclitaxel was 8.2 months, and the mPFS of patients who had not previously received docetaxel or paclitaxel was 9.6 months (χ 2=0.03, P=0.862) . The mPFS of patients with albumin paclitaxel combined with targeted therapy, combined with immunotherapy, combined with chemotherapy and monotherapy were 12.1, 7.8, 9.0 and 7.1 months respectively, with a statistically significant difference (χ 2=8.96, P=0.030) . Multivariate analysis showed that molecular type (triple negative breast cancer RR=1.87, 95% CI: 1.24-4.22, P=0.008; HER-2 positive breast cancer RR=0.63, 95% CI: 0.52-0.94, P=0.042) , number of treatment lines ( RR=0.67, 95% CI: 0.32-0.86, P=0.011) , specific metastatic sites ( RR=1.26, 95% CI: 1.12-2.75, P=0.014) and combination therapy (combined with targeted therapy RR=0.74, 95% CI: 0.16-0.86, P=0.021; combined with chemotherapy RR=0.93, 95% CI: 0.48-0.96, P=0.045; combined with immunotherapy RR=0.81, 95% CI: 0.17-0.78, P=0.032) were independent factors for prognosis. The main adverse reactions were alopecia, neutropenia, peripheral neurotoxicity and rash, and there was no death caused by adverse reactions. Conclusion:Albumin paclitaxel is effective in the treatment of advanced breast cancer with controllable adverse reactions.

Objective:To analyze the value of minute ventilation to carbon dioxide production slope (VE/VCO 2 slope) combined with peak systolic blood pressure (SBP) in predicting prognosis for patients with chronic heart failure (CHF). Methods:A total of 170 patients with CHF who visited the Cardiac Rehabilitation Center of Tongji Hospital Affiliated to Tongji University and completed cardiopulmonary exercise test from March 2007 to December 2018 were enrolled in the study. The clinical data, cardiopulmonary exercise testing results and follow-up information of patients were collected to explore the predictors of all-cause mortality in patients with CHF.Results:The median follow-up time was 647 (182-1 764) days. All-cause death occurred in 34 patients. Compared with surviving patients, the proportion of diabetes and angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB) use in fatal patients was significantly higher ( P<0.01). The VE/VCO 2 slope and peak SBP*VE/VCO 2 in the fatal patients were significantly higher, and the peak oxygen consumption (peak VO 2) was lower than those in the surviving patients ( P<0.01). The areas under the receiver operating characteristic curve (AUC) of VE/VCO 2 slope and peak SBP*VE/VCO 2 in predicting all-cause mortality in patients with CHF were 0.648 ( P=0.008) and 0.681 ( P=0.001), respectively; the optimal thresholds were >40.95 ( P=0.008) and > 5 423.50 mmHg (1 mmHg=0.133 kPa, P=0.006), the sensitivity was 0.559 and 0.588, and the specificity was 0.728 and 0.735, respectively. Multivariate Cox regression analysis showed that after adjusting for age, gender, diabetes and ACEI/ARB use, VE/VCO 2 slope ( HR=2.12, P=0.036) and peak SBP*VE/VCO 2 ( HR=2.42, P=0.016) were independent risk factors for all-cause mortality in patients with CHF. Conclusion:Compared to the traditional index VE/VCO 2 slope, a novel index peak SBP* VE/VCO 2 provides a relatively better predictive value for all-cause death of CHF patients.

Objective Diagnosis related groups ( DRGs) is a system to classify hospital cases into groups , which is effective in the control of medical cost .The article was to explore the DRGs grouping method and quality control indexes of cerebrovascular dis -ease in Nanjing first-class hospitals at grade 3. Methods Polytomous logistic regression for ordinal response was used in the factor analysis of hospitalization cost .E -CHAID decision tree method was applied in the DRGs grouping of cerebrovascular patients . Results Totally 9095 cases were enrolled in this study with the average age was (64.52 ±14.85).The average of stay lengths and expenses were (11.77 ±9.26)d and (25921.04 ±23096.76)rmb respectively.Hospitalization expense was associated with neurologi-cal surgery, main diagnosis, interventional surgery, main complication and ICU days.Taking neurological surgery as the first forced variable, cerebrovascular cases could be divided into 14 DRGs groups. Conclusion The terminal quality control index , the step warning index and case maximum index of cerebrovascular disease established by the DRGs grouping method are suitable in the area .

The hospital grade assessment is an effective approach to measure the comprehensive strength and the overall level of a hospital, and it is also an effective carrier which can promote the standardized management , improve the quality of connotation and accelerate the development of the hospital .This article aims to expound the effective and concrete methods for preparation in the hospi -tal grade assessment by introducing the practice and experience of Jinling Hospital in grade assessement .It also points out that:defi-ning the purpose of the assessment is the fundation , having a thorough grasp of the assessment criteria is the basis , having a compre-hensive knowledge of the hospital is the premise , establishing and implementing the plan strictly is the crux .All these might be helpful to promote the hospital grade assessment .