BACKGROUND:Braided stents are widely used for treating stenotic arteries due to their good flexibility,but they have significant limitations in providing adequate radial support.OBJECTIVE:In response to the lack of radial support of braided stents made of a single material,a mixed braided stent using biodegradable materials with different mechanical parameters was developed to explore the influencing factors affecting the radial mechanical properties of the mixed braided stent.METHODS:Fe-alloy yarn was introduced into the Mg-alloy stents,and the stents with various braiding parameters were analyzed using finite element analysis.The radial support,radial recoil and expansion non-uniformity of the mixed braided stents were evaluated by comparing with ordinary 0.18 mm Mg-alloy stents prepared by yarn.RESULTS AND CONCLUSION:(1)When the Fe-alloy yarn diameters were 0.18 mm and 0.14 mm,the radial support force of the stent increased continuously with the introduction of more and more Fe-alloy yarns.Although the radial support provided was less by the 0.14 mm Fe-alloy yarns than by the same number of 0.18 mm Fe-alloy mixed braided stents,an increase in the number of Fe-alloy yarns resulted in a radial support comparable to that of the thicker Fe-alloy yarns.When the Fe-alloy yarn diameter was 0.10 mm,the radial support of the stents decreased with the increase in the number of Fe-alloy yarns.(2)When the braiding angle was increased,the radial support force of the stents was reduced,but the radial recoil and expansion non-uniformity were improved.By adjusting the braided angle,the lack of radial support force caused by small diameter Fe-alloy yarns could be improved.(3)It is concluded that this method can improve the radial mechanical properties of the stent without increasing the yarn diameter.This not only overcomes the limitation of single-material stents,but also provides a new idea for the design of multi-material stents.

BACKGROUND:Braided stents are widely used for treating stenotic arteries due to their good flexibility,but they have significant limitations in providing adequate radial support.OBJECTIVE:In response to the lack of radial support of braided stents made of a single material,a mixed braided stent using biodegradable materials with different mechanical parameters was developed to explore the influencing factors affecting the radial mechanical properties of the mixed braided stent.METHODS:Fe-alloy yarn was introduced into the Mg-alloy stents,and the stents with various braiding parameters were analyzed using finite element analysis.The radial support,radial recoil and expansion non-uniformity of the mixed braided stents were evaluated by comparing with ordinary 0.18 mm Mg-alloy stents prepared by yarn.RESULTS AND CONCLUSION:(1)When the Fe-alloy yarn diameters were 0.18 mm and 0.14 mm,the radial support force of the stent increased continuously with the introduction of more and more Fe-alloy yarns.Although the radial support provided was less by the 0.14 mm Fe-alloy yarns than by the same number of 0.18 mm Fe-alloy mixed braided stents,an increase in the number of Fe-alloy yarns resulted in a radial support comparable to that of the thicker Fe-alloy yarns.When the Fe-alloy yarn diameter was 0.10 mm,the radial support of the stents decreased with the increase in the number of Fe-alloy yarns.(2)When the braiding angle was increased,the radial support force of the stents was reduced,but the radial recoil and expansion non-uniformity were improved.By adjusting the braided angle,the lack of radial support force caused by small diameter Fe-alloy yarns could be improved.(3)It is concluded that this method can improve the radial mechanical properties of the stent without increasing the yarn diameter.This not only overcomes the limitation of single-material stents,but also provides a new idea for the design of multi-material stents.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Percutaneous left atrial appendage occlusion(LAAO)has emerged as a non-pharmacologic alternative for stroke prevention in non-valvular atrial fibrillation patients.Multiple clinical studies have confirmed that LAAO is safe and effective in the prevention of thromboembolic events for atrial fibrillation patients.With the worldwide recognition of LAAO,it obtains rapid development in the prevention of cardioembolic stroke,but there are still questionable issues worthy of further exploration.The aim of this review is to discuss the effect of LAAO on atrial structure and function,the optimal strategy of LAAO and the best antithrombotic treatment after LAAO.

Atrophic age-related macular degeneration (AMD) does not show obvious loss of visual function in the early stage,so it is not easy to be taken seriously.In the advanced stage,most of the patients suffered from macular area retinal map atrophy,which affected night vision and central vision.Drugs currently used in clinical or clinical trials to treat atrophic AMD include drugs for improving choroidal perfusion,reducing the accumulation of harmful substances,preventing oxidative stress injury,inhibiting inflammatory reactions,as well as neuroprotectants and lipid metabolism drugs.Stem cell transplantation for atrophic AMD is currently the most promising treatment.In theory,it is feasible to replace atrophic AMD with retinal photoreceptor cells and RPE cells derived from human stem cell differentiation.However,there are still many problems to be solved,such as how to improve the efficiency of directional differentiation of seed cells and how to ensure the safe and effective RPE cell transplantation and survival after transplantation.At present,several studies have found that multiple locus mutations are associated with atrophic AMD,so gene therapy also plays an important role in the development of the disease.

Objective To investigate the alteration of the whole brain functional connectivity in patients with minimal hepatic encephalopathy(MHE) by using resting-state functional MRI,and to explore its role in distinguishing the MHE from cirrhotic patients without MHE by using the receiver operator characteristic(ROC) curve.Methods Thirty cirrhotic patients with MHE,32 cirrhotic patients without MHE (non-MHE),and 49 healthy controls underwent standard resting-state functional MRI scan.Whole brain functional connectivities were compared with analysis of variance test to observe the difference among three groups,and then compared with Post-hoc test to investigate the changes between MHE and non-MHE groups.Results There were widespreadly different functional connectivities among three groups.All 115 functional conenctivities showed significant difference among three groups(all P＜0.05).Compared with non-MHE patients,MHE patients showed 6 decreased functional connectivity in the following brain regions (P＜0.05):between left supper temporal gyrus-right orbitofrontal cortex,left Heschl's gyrus-left Rolandic operculum,left Heschl's gyrus-right olfactory cortex,left hippocampus-right amygdala,left putamen-right putamen,and left temporal pole of supper temporal gyrus-right temporal pole of middle temporal gyrus (t=-4.41-3.82,P＜0.01).ROC analysis demonstrated that the left hippocampus-right amygdala had the highest value for differentiating MHE from non-MHE group(AUC=0.78,95％CI 0.66-0.90) with a cutoff value=0.56,sensitivity=73％ and specificity=81％).Conclusion Functional connectivity analysis can be used to observe the functional changes in MHE patient,and has a potential for the early diagnosis of MHE.

Objective To study the clinical effect of continuous lumbar cistern using precision infusion set control and drainage of intracranial infection after craniotomy with Incision healing bad cerebrospinal fluid leakage. Methods From October 2008 to October 2013, 50 cases of postoperative intracranial infection and cerebrospinal fluid leakage patients using continuous lumbar cistern with precision infusion set control cerebrospinal fluid drainage were retrospectively analyzed. Results These 50 patients,after traumatic brain injury after decompressive craniectomy with the poor wound healing 20 cases of cerebrospinal fluid leakage , decompressive craniectomy in hypertensive intracerebral hemorrhage with hydrops under skin flap with 20 cases of cerebrospinal fluid leakage ,all patients recovered and were discharged from the hospital. Conclusion Intracranial infection and cerebrospinal fluid leakage using continuous lumbar cistern with precision infusion set drainage of cerebrospinal fluid ,with systemic application of antibiotics to treatment of post-operative cerebrospinal fluid leakage operation incision heali is a method for safety , good intracranial infection.

ObjectiveTo evaluate the feasibility of gadolinium-enhanced dual energy CT pulmonary angiography (CTPA) in detecting pulmonary embolism (PE).MethodsIn vitro dual energy CT of phantoms of gadolinium and iodinated contrast agents with different diluted ratio was performed,and CT values were measured at different tube voltages.Ten rabbits which were grouped into 3 ml/kg and 5 ml/kg groups underwent dual energy CT scan.CT values of pulmonary artery trunk and the first branch of pulmonary artery were measured.Sponge gelatin were injected into the femoral vein of 6 rabbits to make PE model next day,then lungs were re-imaged with dual energy CT 2 h after embolization.Creatinine was repeatedly measured before and one day after injection of gadolinium via ear marginal vein or femoral vein sampling.One-way ANOVA test and independent student t test were used to analyze the difference of pulmonary artery enhancement between different groups.Results ( 1 ) Compared with iodinated contrast agent,CT value of gadolinium-based contrast agent at 80 kV was higher than those at 140 kV and averageweighted 120 kV.(2) At 140,80,and average weighted 120 kV,CT values of pulmonary artery trunk [CT values were (463.1 ± 118.0),(664.2 ± 188.0),(522.9 ± 137.7) HU] and of the first branch of pulmonary artery [ CT values were (445.1 ± 82.3 ),(606.7 ± 207.2),(493.4 ± 117.3 ) HU ] were higher than those at 3 ml/kg [ CT value of pulmonary artery trunk was ( 258.1 ± 55.1 ),( 384.0 ± 92.3 ),(295.4 ± 73.6) HU,CT value of the first branch of pulmonary artery (245.0 ± 73.2 ),( 309.1 ± 94.2),(263.8 ±78.5) HU;all P ＜0.05].CT values of pulmonary artery trunk and the first branch of pulmonary artery at 80 kV were higher than those at 140 kV and average-weighted 120 kV ( pulmonary artery trunk:F =6.004,P =0.005 ; the first branch of pulmonary artery: F =4.374,P =0.018).In 6 rabbits,CTPA showed the enhancement cut-off of bilateral pulmonary arteries,gadolinium mapping showed decreased perfusion in the corresponding lung lobes,manifested as blue on color-coded map,while normal lung was color coded as red or yellow.Creatinine was higher by 6.7％ and 20.6％ for group 3 ml/kg and 5 ml/kg.ConclusionsWith similar X-ray attenuation characteristics as iodine,gadolinium-based contrast agent can be used to pulmonary contrast-enhanced dual energy CT imaging,simultaneously providing both CTPA and gadolinium maps to detect PE.

OBJECTIVETo compare and evaluate the effectiveness of two kinds of medical drainage bag.

METHODS206 patients were randomly divided into two groups each of which consisted of 103 patients. All the data including four indices, such as the time required to replace the drainage bags, the incidence of the bags detached, draining fluid splashing rates during the replacement of the bags, patient and medical staff satisfaction, were collected and analyzed statistically.

RESULTSThe time required to replace the drainage bags, the incidence of the bags detached and draining fluid splashing rates during the replacement of the bags of the experimental group were significantly lower than those of the control group (P < 0.05), while the patient and medical staff satisfaction were significantly higher than those of the control group (P < 0.05).

CONCLUSIONIt is convenient, quick and time and effort saving to use the neotype medical drainage bags. Hence, the use of neotype medical drainage bags could help to improve the work efficiency, effectively prevent occupational injuries and protect health care workers.