Acute ischemic stroke (AIS) is a cerebrovascular disease characterized by high morbidity, disability, and mortality, posing a significant threat to human health. Endovascular treatment has now been established as a key method for AIS management, in which stent retrievers that can mechanically remove blood clots play a key role in this technique. In recent years, stent retrievers have evolved in complexity and functionality to improve the ability of clot removing and surgical safety. However, the present instruments still have limitations on treatment efficiency, vascular adaptability, and operational precision, posing an urgent need for innovation in the design of stent retrievers. This paper systematically reviewed the structural features and working principles of AIS stent retrievers from the perspective of efficacy evaluation metrics, historical development, recent advancements in stent retrieval technology, and future prospects.
Humans ; Ischemic Stroke/surgery* ; Stents ; Endovascular Procedures/methods* ; Thrombectomy/methods* ; Device Removal/methods*

Objective:To investigate the clinical features of patients with congenital atresia of the oval window (CAOW).Methods:A retrospective analysis was conducted on 7 cases (8 ears) of surgically confirmed CAOW treated at our department from July 2018 to July 2024. Among the cases, 1 patient had bilateral CAOW, and 4 patients had unilateral CAOW combined with other types of ossicular chain malformations in the contralateral ear. We collected and analyzed the clinical data, audiological features, and temporal bone HRCT results of all patients.Results:The 7 patients were diagnosed at ages ranging from 8 to 19 years, with a mean age of (13.2±6.9) years. None of the patients exhibited significant auricular deformities. All presented with conductive hearing loss or mixed hearing loss predominantly of the conductive type, with an intact tympanic membrane. The diagnosis of CAOW was confirmed via endoscopic tympanotomy, revealing a concave oval window area on the medial wall of the tympanic cavity, sealed by a bony plate. All 8 ears exhibited additional ossicular chain deformities. Stapes absence was present in all 8 ears. Partial absence of the incus long process was observed in 3 ears, while, abnormal bony connections between the incus long process and the promontory were seen in 4 ears, 1 ear had a short malleolar handle, 1 ear had a smaller than normal malleus volume. In addition, facial nerve deformities were found in 6 ears, with 4 ears showing bifurcation of the facial nerve and 2 ears showing facial nerve obscuration of the oval window. Pure-tone audiometry revealed that 62.5% (5/8 ears) of patients had air conduction (AC) thresholds≥60 dB preoperatively, with a mean pure-tone average (PTA) of (69.0±11.8) dB HL and a mean air-bone gap (ABG) of (52.0±7.0) dB. The mean AC threshold and ABG were higher in the low-frequency (125-1 000 Hz) range compared to the high-frequency (2 000-8 000 Hz) range (both P<0.05). Preoperative HRCT showed abnormalities in all patients, with 7 ears being diagnosable as CAOW. Although the remaining 1 ear could not be diagnosed as CAOW, stapes and incus long process absence were detected. Conclusion:CAOW is rare in clinical, as the patients with non-progressive conductive hearing loss (AC≥60 dB, ABG≥50 dB) since childhood, intact tympanic membrane without malformations of auricle and external auditory canal, and thick bony plate covered the oval window of the HRCT imaging, CAOW should be highly suspected, which could be confirmed by the exploratory tympanotomy.

Objective To quantitatively evaluate the synergy level of Traditional Chinese Medicine(TCM)"three-medical"and advance TCM revitalization and healthcare reform.Methods Sort out the quantitative evalution indictors of the"three-medical"in TCM based on policy texts.Policy-derived evaluation indicators were refined through the Delphi method.The composite system synergy degree model was applied to calculate subsystem order degrees and overall synergy degrees across seven national TCM reform demonstration zones.Results From 2021 to 2023:the mean value of the orderliness of the TCM medical system in the 7 demonstration areas increased from 0.31 to 0.72,the orderliness of the TCM health insurance increased from 0.23 to 0.74,and the orderliness of the Herbal System increased from 0.34 to 0.70.From 2022 to 2023,the average value of synergy between medical and health insurance systems in the field of Chinese medicine in 7 demonstration areas grew from 0.17 to 0.29.The synergy between medical and pharmaceutical systems in the field of Chinese medicine grows from 0.19 to 0.31.The synergy between pharmaceutical and health insurance system in the field of Chinese medicine increased from 0.17 to 0.27.The overall synergy of the"three-medical"system of TCM increased from 0.19 to 0.36.Conclusion The degree of orderliness of the"three-medical"systems of TCM is gradually rising,showing a relatively good development trend in orderliness.The degree of synergy among the"three-medical"total systems of TCM is on the rise,but is still at the level of moderate synergy or below.

[Objective]To investigate the research landscape,predominant themes and emerging trends in scientific research competency cultivation for traditional Chinese medicine(TCM)professional degree postgraduates in China over the past decade,in order to provide a reference for in-depth research on the cultivation of scitifin research capabilities of postgraduates in the professional degree in TCM.[Methods]A systematic literature review was conducted by using the China National Knowledge Infrastructure(CNKI)from January 1,2015 to December 31,2024,focusing on publications related to research capacity development for TCM professional degree programs.CiteSpace 6.4.R1 software was employed to perform bibliometric analyses of authorship patterns,institutional collaborations and keyword co-occurrence networks.[Results]A total of 103 eligible studies were included.The overall publication volume showed a significant increasing trend,with a rapid growth phase from 2020 to 2024,peaking at 18 articles in 2022,reflecting rising attention to this field.Author collaboration network analysis indicated that JIANG Youming and MO Jie topped the list with 3 publications each,while most other authors conducted research independently with limited cooperation.The institutional collaboration network had a density of 0.0096,indicating low inter-institutional cooperation,with Hu'nan University of Chinese Medicine leading in publications(5 articles).Keyword co-occurrence analysis revealed core research hotspots such as"training model""teaching reform""double-track integration".Keyword burst analysis showed prominent terms like"curriculum system""medical-education collaboration""clinical thinking""new medical discipline"from 2015 to 2024,with"new medical discipline"emerging as a recent hotspot reflecting interdisciplinary integration trends.[Conclusion]The number of articles on the scientific research ability cultivation for postgraduates of TCM professional degrees in China has generally increased,and the research scope has continuously expanded.However,there are differences in research levels among different regions.It is necessary to strengthen the cooperation between multi-disciplines and multi-regions,conduct broader and deeper research,and formulate scientific research ability training programs suitable for postgraduates of TCM professional degrees in China to further improve their scientific research ability.

Objective:To compare clinical effectiveness of the ulnar flap of dorsal cutaneous branch of proper palmar digital artery (PPDA) of little finger and the perforator flap of the 4th dorsal metacarpal artery (DMA) for reconstruction of small and medium-sized defects of ulnar palm.Methods:A retrospective case-control study method was employed in this study. From March 2017 to February 2024, a total of 42 patients of small and medium-sized defects of ulnar palm were treated in the Department of Hand Surgery, the Second Hospital of Tangshan. Twenty-four defects were reconstructed by the ulnar flaps of dorsal cutaneous branch of PPDA (PPDA group) of little finger and the rest of 18 defects were reconstructed by the perforator flap of the 4th DMA (DMA group). Sizes of the defects and flaps in PPDA group were 1.5 cm×1.2 cm-5.2 cm×2.3 cm and 1.6 cm×1.3 cm-6.0 cm×2.5 cm, respectively. Dimensions of the defects and flaps in DMA group ranged from 1.7 cm×1.2 cm-5.0 cm×2.4 cm and 2.0 cm×1.5 cm-6.2 cm×2.7 cm, respectively. Donor sites in both groups were all directly closed. Survival of the flaps and wound healing of donor sites were observed between the 2 groups after surgery. And the surgical time, intraoperative blood loss and duration of follow-up of the 2 groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone interviews and WeChat video-clips. Static two-point discrimination (TPD) of the flaps were measured, and appearance of flaps and donor sites were evaluated based on the Michigan Hand Function Questionnaire (MHQ) evaluation criteria and Vancouver Scar Scale (VSS), respectively. The measurement and count data acquired from both groups were compared by independent sample t-test and χ2 tests or Fisher's exact test, respectively. P<0.05 was considered statistically significant. Results:All 24 flaps in PPDA group and 14 flaps in DMA group survived primarily, except 4 flaps in DMA group that had blisters and healed by dressing changes. Primary survival rate of the flaps in PPDA group (100%) was higher than that of DMA group (78%), and the difference was statistically significant ( P<0.05). Donor site incisions in both groups all healed primarily. The surgery time, intraoperative blood loss and duration of follow-up in PPDA and DMA groups were 64.50 min±7.70 min, 87.08 ml±25.11 ml, 15.46 months±3.83 months, and 62.44 min±8.28 min, 91.67 ml±27.28 ml, 16.39 months±3.24 months, respectively, and of which there was no statistically significant difference between the 2 groups ( P>0.05). At the final follow-up, static TPD and MHQ scores for flap appearance in PPDA group were 13.71 mm±2.91 mm and 4.63±0.50, which were better than 15.78 mm±2.78 mm and 4.28±0.46 in DMA group with a statistically significant difference ( P<0.05). VSS scores of donor site appearance in PPDA and DMA groups were (3.38±0.97 and 3.89±1.02, respectively. Although there was no statistically significant difference between the 2 groups ( P>0.05), the donor sites in PPDA group were more concealed and easier accepted by patients. Conclusion:The ulnar flap of dorsal cutaneous branch of PPDA of little finger and the perforator flap of the 4th DMA are both suitable for reconstruction of small and medium-sized defects of ulnar palm. Compared with the perforator flap of the 4th DMA, the ulnar flap of dorsal cutaneous branch of PPDA of little finger has advantages in higher primary survival rate, better flap sensation and appearance with more concealed donor site.

Objective:To analyze the non-medical technology security liability dispute litigation cases in hospitals and propose corresponding countermeasures, for references for optimizing hospital safety management.Methods:Through the China Judgments Online, non-medical technical security liability dispute litigation cases in hospitals (279 cases) nationwide from 2021 to 2023 were collected. Swiss cheese model and content analysis were employed to examine the basic case details, reasons for judgment, types of hospital liability, characteristics of suicide cases, and plaintiffs′ claims regarding.Results:The 279 cases involved 231 hospitals (excluding anonymous and duplicate hospitals) and 279 patients. Among them, there were 144 tertiary hospitals, accounting for 62.34%; The inpatient department was a high-risk area for accidents (103 times, 36.92%); The frequency of falls was the highest (182 times, 65.23%); 210 cases were ruled against the hospital, accounting for 75.27%. From the perspective of court judgment reasons, the precursor of unsafe behavior (122 cases, 58.10%) was the most common primary reason, the proportion of cases which hospital bore the main responsibility was relatively high (46 cases, 71.88%); 50 cases (23.81%) were due to safety hazards in hospital facilities caused by secondary reasons. Among the 41 cases of patient suicide, 36 cases were fatal, 18 cases occurred in general hospitals, and 24 cases were without medical fault.Conclusions:The inpatient department of the hospital was a high-risk area for accidents, and the medical side had a relatively high failure rate; The warning signs of unsafe behavior were easily overlooked, and there were more cases of suicide among patients in general hospitals. It is recommended that hospitals should enhance their safety management systems, establish collaborative tiered nursing teams involving medical and nursing staff, promote the application of artificial intelligence in refined logistical management, and implement a documentation and oversight mechanism for critical procedures.

Objective:To investigate the interventional effects of the Fuzheng Huayu (FZHY) formula and its partial mechanistic role on cholestatic liver fibrosis in mice.Methods:Mdr2 gene knockout (Mdr2－/ －) mice were randomly divided into a model group, FZHY group, and Obeticholic acid group. Wild-type C57BL/6J mice of the same age served as the control group. Mdr2－/ －mice were given the corresponding drugs starting from the first day of 9 weeks of age by oral gavage in each group. The control and model groups were administered 0.3% sodium carboxymethylcellulose by oral gavage and were sacrificed at 12 weeks of age for specimen collection. High-speed biochemistry analyzer was used to detect serum alkaline phosphatase and alanine aminotransferase activity in mice. Hematoxylin-eosin staining and Sirius red staining were used to observe pathological changes in liver tissues. Hydroxyproline content was measured to assess collagen in liver tissues. Immunohistochemical staining, Western blotting, and real-time fluorescence quantitative PCR were used to detect the expression of fibrosis markers Col-I and alpha-smooth muscle actin in liver tissues. The expressional condition of cholangiocyte response markers Epcam, CK7, CK19, as well as Pcna, Mki67, and Ccnd1, inflammatory related factors Ccl2, Ccl5, Tnf-α, Il10, and Cxcl4, phosphorylated peroxisome proliferator-activated receptor alpha (PPARα) and nuclear factor kappa-B (NF-κB) were determined. Comparative analysis among multiple groups was performed using one-way ANOVA. The LSD method was used for comparisons between groups. Two-tailed statistical tests were used.Results:Compared with wild-type mice, Mdr2 －/ － mice had a significant increase in serum alanine aminotransferase and alkaline phosphatase activity ( P<0.001). The percentage of Sirius red-positive staining areas and hydroxyproline content in liver tissues was significantly increased ( P<0.01). The expression of Col-I, α-smooth muscle actin, Epcam, CK7, CK19, Pcna, Mki67, and Ccnd1, and the expression of Ccl2, Ccl5, Tnf-α, Il10, and Cxcl4 were significantly increased ( P<0.01); however, both FZHY and Obeticholic acid significantly reversed the increases in these indicators ( P<0.05; P<0.01). Further results showed that compared to wild-type mice, the expression of PPARα was significantly reduced in liver tissues of Mdr2 －/ － mice, while NF-κB was significantly enhanced ( P<0.01). In contrast, compared to Mdr2-/- mice, the expression of PPARα in the liver tissues of FZHY group mice was significantly increased ( P<0.05), while NF-κB was significantly inhibited ( P<0.05). Conclusion:FZHY can significantly improve liver fibrosis, cholangiocyte response, and inflammation in Mdr2 －/ － mice with spontaneously occurring cholestatic liver fibrosis, and its mechanistic role is related to the regulation of the PPARα/NF-κB pathway.

OBJECTIVES: This study aimed to explore the clinical efficacy of severe early childhood caries (SECC) treatment combined with local anesthesia under general anesthesia. METHODS: A total of 108 children under 6 years old who underwent SECC dental treatment under general anesthesia at the Department of Pediatric Dentistry, Third Affiliated Hospital of Air Force Medical University from March to December 2023 were selected as the study subjects, with American Society of Anesthesiologists (ASA) classification of classⅠor Ⅱ. The study subjects were divided into a control group (n=54) and an experimental group (n=54) by retrieving intraoperative cases and postoperative follow-up records. The control group was given general anesthesia through inhalation combined with nasotracheal intubation, whereas the experimental group was given local anesthesia with 2% lidocaine on each treated tooth on the basis of general anesthesia. The basic information, preoperative anesthesia depth, hemodynamic changes during different surgical procedures, postoperative pain, and adverse reactions in the two groups were recorded and analyzed. RESULTS: No statistically significant difference was found in the basic information and preoperative anesthesia depth between the two groups (P>0.05). Among the three procedures (pulpotomy, root canal treatment, and tooth extraction), the three observed indicators in the experimental group were significantly lower than those in the control group (P<0.05). The proportion of patients in the experimental group who needed to take analgesic measures in accordance with the modified facial pain scale (FPS-R) score was significantly lower than that in the control group at postoperative wakefulness and 2 h after surgery (P<0.05). Meanwhile, no statistically significant difference was observed between the groups at 24 h after surgery (P>0.05). The proportion of patients in the experimental group who needed to take analgesic measures on the basis of the parent posto-perative pain measurement (PPPM) score was significantly lower than that in the control group when they were awake after surgery (P<0.05). No statistically significant difference was found between the groups at 2 and 24 h after surgery (P>0.05). Moreover, no statistically significant difference was observed in the incidence of adverse reactions between the two groups at 24 h after surgery (P>0.05). CONCLUSIONS The combination of local anesthesia during SECC dental treatment under general anesthesia results in minimal changes in intraoperative hemodynamics and mild postoperative pain response, hence worthy of clinical promotion.
Humans ; Anesthesia, General ; Child, Preschool ; Dental Caries/therapy* ; Pain, Postoperative/prevention & control* ; Anesthesia, Local/methods* ; Male ; Hemodynamics ; Female ; Lidocaine/administration & dosage* ; Child ; Anesthetics, Local/administration & dosage* ; Anesthesia, Dental/methods*

Objective To explore the relationship between triglyceride-glucose index(TyG)and acute ischemic stroke with large vessel occlusion(AIS-LVO)of anterior circulation.Methods A retrospective study was conducted on patients with anterior circulation AIS-LVO who underwent emergency endovascular thrombectomy at Neurovascular Center of The First Affiliated Hospital of Naval Medical University from Jan.2018 to Dec.2019.According to modified Rankin scale(mRS)score 90 d after operation,the patients were assigned to favorable outcome group(mRS score 0-2)or unfavorable outcome group(mRS score 3-6),and the TyG was compared.According to the median of TyG,the patients were assigned to low-TyG group(TyG＜8.57)or high-TyG group(TyG ≥8.57),and the clinical data,laboratory indexes,and imaging characteristics were compared.Receiver operating characteristic curve was used to evaluate the predictive value of TyG for poor prognosis.Results A total of 135 patients were enrolled,with 72 in the favorable outcome group and 63 in the unfavorable outcome group.The TyG of the unfavorable outcome group was significantly higher than that of the favorable outcome group(8.82+0.63 vs 8.43+0.60,P＜0.001).There were 67 patients in the low-TyG group and 68 in the high-TyG group.Compared with the low-TyG group,the proportion of patients with hyperlipidemia history(P=0.003),systolic blood pressure at admission(P=0.018),fasting blood glucose level(P＜0.001),and triglyceride level(P＜0.001)were significantly higher in the high-TyG group,the infarct core volume was significantly larger(P=0.025),the high density lipoprotein-cholesterol level was significantly lower(P=0.013),and the mRS score 90 d after operation was significantly higher(3[1,5]vs 1[0,5],P=0.049).The TyG had certain predictive value for poor prognosis in anterior circulation AIS-LVO patients(area under curve value=0.662,95％confidence interval 0.571-0.753).Conclusion TyG is elevated in anterior circulation AIS-LVO patients with poor prognosis,and may be a potential prognostic indicator for anterior circulation AIS-LVO patients.

Objective : To assess and to compare the diagnostic performance of cervical ultrasound and 18F fluorodeoxyglucose(18F-FDG PET/CT) in identifying cervical lymph node metastases in patients with differentiated thyroid cancer(DTC) following total thyroidectomy, focusing on both early and delayed imaging phases. Methods : A retrospective review was performed on 83 DTC patients with DTC who had undergone total thyroidectomy. A total of 143 cervical lymph nodes, comprising both metastatic and non-metastatic nodes, were evaluated using 18F-FDG PET/CT and ultrasound. Sensitivity, specificity, and overall diagnostic accuracy were calculated for each imaging modality. Differences in lymph node detection rates across cervical regions using ultrasound were analyzed, along with nodal size parameters(long and short axis diameters), to investigate potential limitations of ultrasound in this context. Additionally, PET/CT parameters including axial ratio, early and delayed maximum standardized uptake values(SUVmax), and changes in SUVmax between imaging timepoints(ΔSUVmax) were compared between metastatic and non-metastatic lymph nodes to evaluate the diagnostic value and underlying mechanisms of PET/CT in this clinical setting. Results : 18 F-FDG PET/CT demonstrated a sensitivity of 91 . 58% (98/107) , a specificity of 72. 22% (26/36) , and an overall diagnostic accuracy of 86. 71% (124/143) in identifying cervical lymph node metastases post-total thyroidectomy in DTC patients . In comparison , ultrasound showed a lower sensitivity of 50. 47% (54/107) , but a higher specificity of 97. 22% (35/36) , with an overall accuracy of 62. 24% (89/ 143) . Notably , ultrasound exhibited a significantly higher false-negative rate in the first cervical lymph node group compared to the second group [56. 6% (30/53 ) vs 43 . 4% (23/53 ) ; χ2 = 20. 396 , P < 0. 001] . In delayed PET/CT imaging , metastatic lymph nodes showed a significantly increased SUV max compared to early-phase imaging (Z = - 8. 147 , P < 0. 001) . Using an SUV max threshold of 2. 5 , delayed imaging identified a greater number of positive lymph nodes than early imaging ( χ2 = 18. 127 , P < 0. 001) . Furthermore , metastatic lymph nodes exhibi- ted a significantly lower axial ratio than non-metastatic nodes (Z = - 4. 529 , P < 0. 001) . Both early and delayed SUV max values were significantly higher in malignant nodes compared to benign ones (Z = - 3 . 689 , P < 0. 001 and Z = - 4. 550 , P < 0. 001 , respectively) . Additionally , ΔSUV max was markedly elevated in metastatic lymph nodes (Z = - 4. 189 , P < 0. 001) . Conclusion Dual-phase 18 F-FDG PET/CT proves to be superior to ultrasound in di- agnosing cervical lymph node metastasis in patients with differentiated thyroid cancer (DTC) following total thyroid- ectomy . Delayed-phase imaging offers higher tumor-to-background ratio , which enhances the visibility of metastatic lymph nodes . In addition , dual-phase 18 F-FDG PET/CT plays greater advantages in the differential diagnosis be- tween metastatic lymph nodes and non-metastatic lymph nodes .