Objective:To investigate the application value of indocyanine green videoangiography (ICG-VA) in microsurgical clipping of ruptured posterior communicating artery aneurysms (PCoAA).Methods:Patients with ruptured PCoAA underwent microsurgical clipping and intraoperative ICG-VA at the Department of Neurosurgery, Lianyungang First People's Hospital from January 2020 to July 2022 were included retrospectively. Head CT was reviewed 3 days after operation to determine perioperative complications. CT angiography (CTA) or digital subtraction angiography (DSA) were used to evaluate the monitoring effect of ICG-VA. Glasgow Outcome Scale (GOS) was used to evaluate the clinical outcomes.Results:Thirty-two patients with ruptured PCoAA (a total of 38 aneurysms) were enrolled, including 7 males (21.9%), aged 57.97±8.91 years (range, 40~73). Twenty-seven patients (84.4%) had single aneurysm and 5 (15.6%) had multiple aneurysms (4 patients with 2 aneurysms and 1 with 3 aneurysms). Twenty-four patients (75.0%) had no or mild consciousness disorder, and 8 (25.0%) had moderate to severe consciousness disorder. The aneurysms of all patients were successfully clipped and ICG-VA was performed for a total of 40 times. Five patients with multiple aneurysms underwent precise localization of the parent artery and aneurysmal body using ICG-VA before clipping. After initial clipping, ICG-VA found 3 cases of residual aneurysms. After adjusting or adding aneurismal clips, ICG-VA showed that the residues were eliminated. Three days after the surgery, CT scan showed that 1 patient had right subdural effusion with periventricular infarction, and 1 had subdural effusion. At the final follow-up, CTA or DSA showed no residual aneurysms; the GOS score of 18 patients (56.3%) were 5, 5 patients (15.6%) were 4, and 9 (28.1%) were 3. There were no cases of vegetative state or death.Conclusion:ICG-VA assisted microsurgical clipping of ruptured PCoAA can effectively avoid residual aneurysms and the clinical application value is significant.

Objective To investigate the training needs and suggestions of advanced practice nurses in medical institutions in China,and to provide references for the formulation of training programs for advanced practice nurses.Methods By a convenient sampling method,from May to July in 2023,the heads of nursing nurses in medical institutions in 29 provinces,autonomous regions and municipalities directly under the Central Government were investigated,and the self-designed questionnaires were distributed in the form of electronic questionnaire.Results 1 287 medical institutions participated in the survey,with tertiary hospitals accounting for 65.50％.93.16％of medical institutions had the use needs of advanced practice nurses,and the top 3 professional fields hoping to prioritize in the APN training were in the order of critical illness,emergency treatment and intravenous treatment.Among the APN core competence,the most important one was direct clinical practice(92.77％),followed by professional development(89.43％)and scientific research and evidence-based practice(86.40％).71.72％of medical institutions suggested that the theoretical training time is 4 weeks,combining online and offline training(50.35％),and the clinical practice time should not be less than 12 weeks(97.66％).Theoretical learning course assignment(92.93％),case report(90.83％)and clinical practice reflection diary(88.19％)were the main process evaluation methods,while 1 case study with the completion of the report and defense(87.65％)and 1 evidence-based nursing practice research plan with the completion of a report and defense(77.93％)were the main final evaluation methods.Conclusion Advanced practice nurses are important roles in the process of nursing professional development,and medical institutions in our country have a high demand for the training of advanced practice nurses.It is imperative to carry out the training of advanced practice nurses.The suggestions of medical institutions on the training content and methods focus more on the training of core competence.On this basis,the admission conditions should be clarified,and the training program of advanced practice nurses for China's national conditions should be explored.

Objective:To evaluate the effect of obesity on the displacement of a left-sided double-lumen tube (DLT) during positional changes.Methods:This was a prospective cohort study. Six hundred and two patients who underwent elective chest surgery and required insertion of a left-sided DLT from February 2020 to November 2023 in our hospital were selected and divided into 2 groups based on the body mass index (BMI): obesity group (BMI≥28 kg/m 2,n=208) and non-obesity group (18.5 kg/m 2≤BMI<28 kg/m 2,n=394). General characteristics of patients, history of chest surgery, DLT model, depth of DLT placement in supine position, height/depth of placement (H/D) ratio, and distance of DLT displacement were recorded. DLT displacement was defined as a displacement distance of ≥15 mm. The logistic regression was used for analysis of the relationship between BMI and left DLT shift during positional changes. The receiver operating characteristic curve was used to evaluate the accuracy of BMI in predicting the left-sided DLT displacement during positional changes. Results:Compared with non-obese group, the depth of DLT placement was significantly reduced, the H/D ratio was increased, the distance of DLT displacement was increased, and the incidence of DLT displacement was increased in obese group ( P<0.05). The results of binary logistic regression analysis showed that a BMI≥28 kg/m 2 was an independent risk factor for DLT displacement ( OR value [95% confidence interval]=4.18 (2.36-7.38), P<0.001). The sensitivity of BMI in predicting the left-sided DLT displacement during positional changes was 77.4%, and the specificity was 69.6%, with an optimal cutoff value of 27.48 kg/m 2 and an area under the receiver operating characteristic curve of 0.757. Conclusions:Obesity can increase the probability of the left-sided DLT displacement during positional changes.

Objective:To compare the effects of left paratracheal pressure (LPP) and cricoid pressure (CP) during mask ventilation in obese patients.Methods:Sixty patients of either sex, aged 18-60 yr, with 28 kg/m 2≤body mass index<35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: LPP group and CP group. In LPP group, pressure was applied beside the trachea, above the clavicle towards the vertebral direction, while in CP group, pressure was applied downwards to the cricoid cartilage, with a force of pressure between 25-35 N. The spatial relationship between the esophagus, trachea, and cricoid cartilage, the presence of air shadows in the gastric antrum during mask ventilation, and the cross-sectional area (CSA) of the gastric antrum before and after mask ventilation as well as the airway pressure during mask ventilation were observed. Results:In both groups, the esophagus was located in the left of the trachea in the supraclavicular region. There were no statistically significant differences in the airway pressure during mask ventilation and the CSA of the gastric antrum prior to mask ventilation between the two groups ( P>0.05). Compared to LPP group, the proportion of patients with air shadows in the gastric antrum during mask ventilation was significantly increased, and the CSA of the gastric antrum was increased after mask ventilation in CP group ( P<0.05). Conclusions:Compared to CP, LPP can decrease the development of air entering the stomach during mask ventilation and reduce the CSA of the gastric antrum after mask ventilation in obese patients.

Objective To compare the value of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, CLIF Consortium Acute Decompensation (CLIF-C AD) score, and Freiburg index of post-transjugular intrahepatic portosystemic shunt (TIPS) survival (FIPS) score in predicting the survival of patients undergoing TIPS. Methods A retrospective analysis was performed for the clinical data of 447 patients with liver cirrhosis who underwent TIPS in several hospitals in southwest China, among whom there were 306 patients in the survival group and 62 in the death group. The scores of the above five models were calculated, and a survival analysis was performed based on these models. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Pearson chi-square test was used for comparison of categorical data between groups; a multivariate Cox regression analysis was used for correction analysis of known influencing factors with statistical significance which were not included in the scoring models; the Kaplan-Meier method was used to evaluate the discriminatory ability of each model in identifying risks in the surgical population, and the log-rank test was used for analysis. The area under the receiver operating characteristic curve (AUC), C-index at different time points, and calibration curve were used to evaluate the predictive ability of each scoring model. Results Compared with the death group, the survival group had significantly lower age ( Z =2.884, P < 0.05), higher albumin ( t =3.577, P < 0.05), and Na + ( Z =-3.756, P < 0.05) and significantly lower proportion of patients with alcoholic cirrhosis ( χ 2 =22.674, P < 0.05), aspartate aminotransferase ( Z =2.141, P < 0.05), prothrombin time ( Z =2.486, P < 0.05), international normalized ratio ( Z =2.429, P < 0.05), total bilirubin ( Z =3.754, P < 0.05), severity of ascites ( χ 2 =14.186, P < 0.05), and scores of the five models (all P < 0.05). Survival analysis showed that all scoring models effectively stratified the prognostic risk of the patients undergoing TIPS. Comparison of the C-index of each scoring model at different time points showed that Child-Pugh score had the strongest ability in predicting postoperative survival, followed by MELD-Na score, MELD score, and CLIF-C AD score, and FIPS score had a relatively poor predictive ability; in addition, the prediction efficiency of each score gradually decreased over time. Child-Pugh score had the largest AUC of 0.832 in predicting 1-year survival rate after surgery, and MELD-Na score had the largest AUC of 0.726 in predicting 3-year survival rate after surgery, but FIPS score had a poor ability in predicting 1- and 3-year survival rates. Conclusion All five scoring models can predict the survival of patients with liver cirrhosis after TIPS and can provide effective stratification of prognostic risk for such patients. Child-Pugh score has a better ability in predicting short-term survival, while MELD-Na score has a better ability in predicting long-term survival, but FIPS score has a relatively poor predictive ability in predicting both short-term and long-term survival.

Studies have confirmed that homocysteine is associated with ischemic stroke. This article reviews the correlation between homocysteine and ischemic stroke risk, etiological type, severity, outcome, as well as the research progress of reducing homocysteine to prevent ischemic stroke.

Objective To explore the risk factors of unplanned readmission in patients with acute myocardial infarction in plateau area. Methods The convenience sampling method was used to select 220 patients with acute myocardial infarction in the hospital's internal medicine department from January 2020 to May 2021. The patients were divided into two groups according to whether they had unplanned readmission within one year, 79 patients were included in readmission group, and 141 patients without unplanned readmission were included in non-readmission group. Clinical data of the 220 patients with acute myocardial infarction in plateau area were collected by reviewing electronic medical records, and laboratory examination and angiography examination were performed 1 day before discharge. Univariate and multivariate logistic regression analysis were carried out, and ROC curve risk prediction model was established. Results There were statistically significant differences in age, history of myocardial infarction, history of PCI, history of stroke, blood calcium, and Kilip cardiac function between the two groups (P < 0.05). Logistic regression analysis showed that age ≥60 years old, history of myocardial infarction, history of PCI, history of stroke, blood calcium and Kilip cardiac function grading were positively correlated with unscheduled readmission (P < 0.05). The ROC curve was drawn with the occurrence of unplanned readmission as the state variable. The AUC area was 0.801, the predictive sensitivity was 88.94%, and the specificity was 57.92%. Conclusion Unplanned readmission of AMI patients in plateau areas is related to multiple factors. It is necessary to identify high-risk groups as early as possible in combination with risk factors and develop individualized intervention measures.

Objective:To evaluate the clinical efficacy of microneedle radiofrequency in the treatment of moderate acne vulgaris.Methods:From August 2018 to August 2020, 393 patients (192 males and 201 females, aged 15-38 years) with moderate acne were enrolled in the Department of Dermatology, the First Affiliated Hospital of Shantou University Medical College and Shantou Chaonan Minsheng Hospital, including 201 patients in experimental group and 192 patients in control group. In the experimental group, microneedle radiofrequency therapy was used once every 2 weeks for 3 times in total. The control group adopted the fire needle, once every 2 weeks, a total of 3 times. The efficacy of both groups was evaluated at week 8.Results:A total of 378 patients were actually completed: 196 patients in the experimental group, and 182 patients in the control group. At the eighth week of follow-up, the total effective rate was 81.12% in the experimental group and 70.43% in the control group. The efficacy of the two groups was statistically different (χ 2=4.42, P<0.05). Conclusions:The efficacy of microneedle radiofrequency therapy in the treatment of moderate acne vulgaris is better than that of fire needle, with good tolerance, short recovery period, few adverse reactions and high compliance, which has clinical promotion value.

Objective:To study the risk factors of hemodynamically significant patent ductus arteriosus (hsPDA) in extremely preterm infants (EPI).Method:From July 2017 to April 2020, EPI (gestational age <28 weeks) admitted to the Department of Neonatology of our hospital were included and analyzed retrospectively. According to whether hsPDA existed or not, the infants were assigned into non-hsPDA group and hsPDA group. Demographic findings and possible risk factors of hsPDA were collected.The cumulative fluid overload (FO) within 3 days after birth was calculated. Univariate and multivariate analysis were used to determine the risk factors of hsPDA.Result:A total of 79 infants with gestational age of (27.0±0.9) weeks and birth weight of (987±173)g were enrolled, including 23 cases in non-hsPDA group and 56 cases in hsPDA group. Univariate analysis showed that thrombocytopenia ( P=0.044), respiratory distress syndrome (RDS) treated with pulmonary surfactant (PS) ( P=0.006) and high FO level ( P=0.002) were associated with hsPDA. Multivariate analysis showed that RDS treated with PS ( OR=5.933, 95% CI 1.360~25.883, P=0.018) and high FO level ( OR=1.261, 95% CI 1.063~1.496, P=0.008) were independent risk factors for hsPDA in EPIs. ROC curve analysis showed that the cut-off value of FO was -0.2%, with 85.7% sensitivity and 56.5% specificity distinguishing the presence of hsPDA (AUC=0.712, Youden index=0.422). Conclusion:High level of FO within the first 3 days of life and RDS treated with PS are independent risk factors for hsPDA in EPI. After PS treatment, hemodynamic changes of infants with RDS should be monitored closely. During early fluid management of EPI, FO should be strictly monitored to avoid high FO level.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.