Objective To evaluate the effect of structured therapy and education based on personal strength on ischemic stroke. Methods From March,2021 to September,2023,a total of 114 patients with ischemic stroke from the First People's Hos-pital of Kunshan were randomly divided into control group(n=57)and experimental group(n=57).The control group received routine medicine,rehabilitation training and standard health education,while the experimental group received routine medicine,rehabilitation training and structured therapy and education based on personal strength,for six weeks.They were compared with the scores of modified Rankin Scale(mRS),motor-evoked po-tential(MEP)latency and amplitude,modified Barthel Index and Self-Recovery Efficacy Scale score and recur-rence within three months after the start of the study.The scores of Morisky Medication Adherence Scale(MMAS)and Five Facet Mindfulness Questionaire(FFMQ)were also compared. Results After treatment,the score of mRS(t=5.002),MEP latency period(t=9.739)and amplitude(t=4.394),modi-fied Barthel Index(t=11.261),the score of Self-Recovery Efficacy Scale(Z=-2.638),and the scores of MMAS(t=19.521)and FFMQ(t=15.381)were better in the experimental group than in the control group(P<0.05). Conclusion Structured therapy and education based on personal strength could faciliate to improve the recovery and self-management of ischemic stroke patients.

Objective The adaptive synthetic sampling(ADASYN)algorithm and category inverse proportion weighting method weighting method were used to balance the datasets,then multi-classification prediction of cognitive normal(CN),mild cognitive impairment(MCI),and Alzheimer's disease(AD)combined with classifiers were performed.Methods Data were obtained from the Alzheimer's Disease Neuroimaging Initiative(ADNI)database,which was filled in missing values by random forest(RF),and feature subsets were selected by elastic net(EN).We chose ADASYN algorithm and category inverse proportion weighting method processing the category imbalance data,and four models were constructed by combining RF and support vector machine(SVM)respectively:ADASYN-RF,ADASYN-SVM,weighted random forest(WRF),and weighted support vector machine(WSVM).We evaluated the classification performance by macro-P,macro-R,macro-F1,ACC,Kappa value and area under the receiver operating characteristics curve(AUC).Results ADASYN-RF had the best classification performance(Kappa=0.938,AUC=0.980),followed by ADASYN-SVM.The most important classification features obtained using ADASYN-RF were CDRSB,LDELTOTAL,and MMSE,which have been clinically validated.Conclusions Both the ADASYN algorithm and the category inverse proportion weighting method can assist in improving classifier performance,and the ADASYN algorithm is superior.

Objective:To evaluate the rapid diagnostic value of serum novel coronavirus (2019-nCoV) IgM/IgG detection in COVID-19, aiming to further improve the diagnostic and screening system of COVID-19.Methods:Blood samples were collected from 32 patients with COVID-19 (tested positive for 2019-nCoV nucleic acid by RT-PCR and presented with clinical symptoms) and 34 non-COVID-19 patients (tested negative for 2019-nCoV nucleic acid by RT-PCR and clinically confirmed as non-COVID-19 patients). Colloidal gold-based immunochromatography was used for rapid detection of 2019-nCoV IgM/IgG in these samples. The sensitivity and specificity of the test, and the correlation of serum 2019-nCoV IgM/IgG with disease course were analyzed.Results:Among the 32 COVID-19 patients, nine tested positive for 2019-nCoV IgM with a positive rate of 28.1% (9/32) and 25 positive for 2019-nCoV IgG with a positive rate of 78.1% (25/32). The total positive rate was 84.4% (27/32). Two of the 34 non-COVID-19 patients tested positive for 2019-nCoV IgG with a positive rate of 5.9% (2/34), while none of them was positive for 2019-nCoV IgM. The positive rates of serum IgM were 42.9% (3/7), 30.8% (4/13) and 16.7% (2/12) at 10-20 d, 21-30 d and 31-40 d after the patients developed the symptoms of COVID-19, respectively, which showed a decreasing tread with prolonged disease course. The positive rates of serum IgG in COVID-19 patients were 57.1% (4/7), 84.6% (11/13) and 83.3% (10/12) at 10-20 d, 21-30 d and 30-40 d after symptom onset. The rate showed an increasing trend with prolonged disease course and reached the peak in about 21-30 d.Conclusions:Serum 2019-nCoV IgM/IgG detection (using colloidal gold method) had high sensitivity (84.4%) and strong specificity (94.1%) in the diagnosis of 2019-nCoV infection. It had a great value in the diagnosis and screening of COVID-19 and could be used as a valuable complementary method to the COVID-19 diagnostic system due to its advantages of flexibility, rapidity and simplicity.

In order to provide quality rehabilitation care for patients in the hierarchical medical service system,a joint rehabilitation team of general practitioner and specialists from secondary and tertiary hospital was formed in Shanghai Xujiahui Community Health Service Center,and the community rehabilitation has been implemented with "integrated general-specialty" model.This article introduces the characteristics,structure,service contents and advantages of the "integrated general-specialty" rehabilitation service mode,also presents suggestions for solving the existing problems of the mode.

Objective To investigate the clinical efficacy of transjugular intrahepatie portosystemie shunting (TIPS) for recurrent portal hypertension after liver transplantation.Methods The retrospective crosssectional study was conducted.The clinical data of 15 patients with recurrent portal hypertension after liver transplantation who underwent TIPS in the 9th School of Clinical Medicine between January 2008 to June 2016 were collected.Course of TIPS:the portal vein pressure was measured and varicose veins were embolized after puncture,cannulation and angiography.A balloon catheter with diameter of 7 mm or 8 mm was used to dilate the preshunt channel,and a covered stent or bare stent with a diameter of 7,8 or 10 mm was implanted to establish the shunt channel.Portal vein angiography was performed and the portal vein pressure was measured again.Observation indicators:(1) Surgical situations;(2) changes of portal vein pressure before and after TIPS;(3)follow-up and survival situations.Follow-up using outpatient examination was performed to record clinical symptoms at postoperative 1,3,6 and 12 months.Regular hepatic vascular ultrasonography was done at postoperative 1,3,6 and 12 months to detect patency of shunt.The follow-up period was up to June 2018.Measurement data with normal distribution were represented as (x) ±s and analyzed by the paired t test.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.Results (1) Surgical situations:all the 15 patients underwent successful TIPS,without any serious complications or death.Stent implantation situation:bare stent,covered stent and bare stent + covered stent were implanted in 4,8 and 3 patients,respectively.Among the 15 patients,7 mm,8 mm and 10 mm diameter shunt channel were established in 4,8 and 3 patients respectively.(2) Changes of portal vein pressure before and after TIPS:portal vein pressure of the 15 patients decreased from (34±8)mmHg (1 mmHg=0.133 kPa) to (21±7)mmHg before and after TIPS,with a statistically significant difference (t =7.07,P＜0.05).Portal vein pressure gradient decreased from (26± 9)mmHg to (12±5)mmHg before and after TIPS,with a statistically significant difference (t=6.43,P＜0.05).(3) Follow-up and survival situations:15 patients were followed up for 24.0-60.0 months,with a median follow-up time of 37.8 months.Main clinical symptoms:of 12 patients with gastrointestinal hemorrhage,3 had gastrointestinal rehemorrhage mainly due to portal vein pressure rising again caused by shunt restenosis or occlusion,9 had no gastrointestinal rehemorrhage.Of 5 patients with portal vein thrombosis,thrombus was disappeared basically in 3 patients and decreased obviously (no effect on blood flow) in 2 patients.Three patients with refractory ascites were effectively improved after TIPS,however,2 of them were recurred at postoperative 5 months.Postoperative restenosis or occlusion of shunt channel:among 15 patients,7 developed restenosis or occlusion of the shunt channel (including 4 with bare stents).Five of them underwent shunt recanalization and another 2 without special clinical symptoms had no treatment.Hepatic encephalopathy:6 of 15 patients including 1 with 7 nun shunt,3 with 8 mm shunt and 2 with 10 mm shunt developed hepatic encephalopathy,of which grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ hepatic encephalopathy wee detected in 2,3,0 and 1 patients,respectively.Survival situations:of the 15 patients,1 died of hepatic failure at postoperative 6 months,3 were performed liver transplantation again at postoperative 3,8 and 14 months,respectively,11 survived more than 2 years with the longest survival time more than 6 years.Conclusion TIPS is safe and effective for recurrent portal hypertension after liver transplantation for patients who have not effective other treatment.

This study was aimed to investigate the mechanism of Jian-Pi Sheng-Xue (JPSX) granules on iron-deficiency anemia (IDA) rats.Low iron diet was given to establish IDA rat model.Rats were randomly divided into the model control group,normal control group,JPSX granules group,JPSX extract group and the ferrous sulfate group.The hematological indexes and serum ferritin were measured 10 days and 20 day after medication.The results showed that with iron supplements,the levels of hemoglobin (HGB),red blood cell (RBC),hematocrit (HCT) and serum ferritin of the JPSX granules group,JPSX extract group and the ferrous sulfate group were higher than those of the control group.The level of serum ferritin of the JPSX granules group was obviously higher than that of the JPSX extract group and the ferrous sulfate group (P < 0.01).It was concluded that compared with the control group,JPSX granules,JPSX extract and ferrous sulfate can improve symptoms of IDA in rats.And JPSX granules had the best effect.

Objective To observe how different measuring methods of corneal curvature produce affect postoperative corneal a-stigmatism correction after implantation of TORIC artificial lens .Methods To measure 4 teams of age-related cataract patients complicated with regular astigmatism of more than 1 .0D by the procedure of manual keratometer ,IOL Master ,auto keratometer and Pentacam respectively .The Toric artificial lenses were precisely placed in appropriate position in phacoemulsification surgery .We observed the uncorrected visual acuity (UCVA) ,best corrected visual acuity (BCVA) in 1D ,1W ,1M ,3M before and after the sur-gery ,corneal astigmatism after the surgery ,as well as anticipated and consequent residual astigmatism .Results The variance analy-sis of absolute-value deviation between anticipated residual astigmatism (ARA) and best corrected visual acuity (BCVA) is P<0 .0001 ,the above difference was statistically significant ;we consider that the astigmatic deviation measured by the four methods is different ;besides the deviation of paired comparison results between Master-team (0 .322) and auto-team (0 .242) ,auto-team and manual-team (0 .218) ,manual-team and Pentacam-team(0 .107) is more than 0 .05 and not statistically significant ,all the remaining paired comparison results are statistically significant ,(P<0 .05) ,the Pentacam-team (0 .082) is the minimum deviation ,while the IOL Master-team (0 .422) is the maximum one .Conclusion The measuring result to estimate the exact value of Acrysof Toric IOL by Pentacam is more accurate than by other methods .

The tip structure is one of the key factors to determine the performance of left ventricular assist device (LVAD) inflow cannulas. The tip structure influences the thrombosis, hemolysis in cannula and left ventricle and suction leading to obstruction in ventricle. We designed four kinds of inflow cannulas that had different tips and built the numerical models of the four historical used inflow cannulas inserted into the apex of left ventricle. We computed the hemodynamic characteristics of inflow cannulas insertion by Fluent software. We researched the backflow, turbulent flow and pressure distribution of the four inflow cannulas. The results showed that the trumpet tipped inflow cannula had smooth flow velocity distribution without backflow or low velocity flow. The trumpet tipped inflow cannula had the best blood compatibility characteristics. The trumpet structure could prevent obstruction. The caged tipped cannula had serious turbulent flow which could possibly cause thrombosis and the low pressure near left ventricle wall and easily lead to ventricle collapse. The trumpet tipped inflow cannula has the best blood compatibility and is difficult to be obstructed. The trumpet tipped inflow cannula is fit to long-term use LVAD.
Catheters ; Computer Simulation ; Equipment Design ; Heart Failure ; therapy ; Heart-Assist Devices ; adverse effects ; Hemolysis ; Humans ; Numerical Analysis, Computer-Assisted ; Thrombosis ; prevention & control ; Ventricular Dysfunction, Left ; prevention & control

Application of a number of philosophical ideas is instructive in eliminating the opposition on the doctors'right to inform and the patients right to being informed,building a harmonious relations between doctors and patients and correctly understanding and carrying out the informed consent.