Objective To explore the therapeutic effect and prognostic influencing factors of endovascular therapy for periprocedural acute ischemic stroke with large vessel occlusion(AIS-LVO)after cardiac surgery,and to analyze the pathological characteristics of thrombi leading to LVO.Methods This study retrospectively and consecutively enrolled patients who experienced AIS-LVO during the perioperative period of cardiac surgery at the Cardiovascular Surgery Department of Guangdong Provincial People's Hospital from June 1,2017,to March 31,2024.The patients were divided into a surgical group and a non-surgical group based on whether they received endovascular treatment.The clinical and imaging data of the patients were collected,including gender,age,hypertension,diabetes,history of smoking,low-density lipoprotein cholesterol,cardiac surgical methods(coronary artery bypass grafting,total arch replacement[TRA],cardiac valve replacement,other types of surgery[valve repair,atrial septal repair,ventricular septal repair,heart transplantation]),time from cardiac surgery to AIS onset,location of vascular occlusion(vertebral-basilar artery,right internal carotid artery,left internal carotid artery),National Institutes of Health stroke scale(NIHSS)score at the onset of stroke,time from stroke onset to puncture,stroke etiology(embolism,arterial dissection,atherosclerotic stenosis),and imaging data including Alberta stroke program early CT score(ASPECTS)of the anterior circulation,ASPECTS of the posterior circulation(pc-ASPECTS)and CT angiography,CT perfusion,etc.The thrombus samples were stained with hematoxylin-eosin and martius scarlet blue staining.According to the proportion of red blood cells(RBC)in the thrombus,the thrombi were classified as erythrocyte-rich thrombi(RBC proportion≥70%),mixed thrombi(RBC proportion 31%-69%),and fibrin-rich thrombi(RBC proportion≤30%).At 90d after stroke onset,the modified Rankin scale(mRS)was used for both outpatient and telephone follow-up.The mRS score 0-2 indicated a good prognosis,3-6 indicated a poor prognosis,and 6 points indicated death.Factors with P＜0.1 in univariate Logistic regression and those factors may influence the prognosis according to clinical experience were included and further analyzed with multivariate Logistic regression to analyze the 90 d prognostic influencing factors after stroke onset for AIS-LVO patients during the perioperative period of cardiac surgery.Results A total of 102 patients who experienced AIS-LVO during the perioperative period of cardiac surgery(68 males,34females,with mean age of[58±14]years)were enrolled in this study,50 were in the non-surgery group and 52 in the surgery group.(1)Significant differences were observed between the surgical and non-surgical group in hypertension(32.7%[17/52]vs.54.0%[27/50],P=0.030),NIHSS score at stroke onset(12.3[12.3,21.8]vs.35.0[18.0,35.0],P＜0.01),vascular occlusion site(P=0.048),cardiac surgery type(P＜0.01),ASPECTS/pc-ASPECTS(9[8,9]vs.4[3,6],P＜0.01),favorable90-day prognosis rate(75.0%[39/52]vs.10.0%[5/50],P＜0.01)and 90-day mortality rate(7.7%[4/52]vs.68.0%[34/50],P＜0.01).Other clinical and imaging data showed no significant differences(all P＞0.05).In the surgery group,86.5%(45/52),7.7%(4/52),and 5.8%(3/52)patients were attributed to embolism,arterial dissection,and atherosclerotic stenosis,respectively.(2)Univariate Logistic regression analysis identified NIHSS score at stroke onset,TRA,endovascular therapy,and ASPECTS/pc-ASPECTS score as prognostic factors affecting the 90-day prognosis after stroke.Set the patient's 90-day prognosis(assign favorable prognosis as 1 and poor prognosis as 0)as dependent variable,incorporate factors with P＜0.1 in the univariate Logistic analysis and location of vascular occlusion in a multivariate Logistic regression analysis.The results showed that high NIHSS score on stroke onset(OR,0.86,95%CI 0.78-0.95,P=0.002)and non endovascular therapy(OR,6.93,95%CI 1.05-45.55,P=0.044)were independent risk factors of poor prognosis 90-day after stroke onset for AIS-LVO patients during the perioperative period of cardiac surgery.(3)Among 45 cardioembolic patients,thrombus samples from 33 patients were analyzed.The analysis revealed no erythrocyte-rich thrombi,3 mixed thrombi,and 30 fibrin-rich thrombi,with 12having a fibrin proportion exceeding 90%.Conclusion Endovascular therapy improved the prognosis and reduces mortality rate in patients with periprocedural AIS-LVO after cardiac surgery,and thrombi in these patients are predominantly fibrin-rich.

Objective To explore the therapeutic effect and prognostic influencing factors of endovascular therapy for periprocedural acute ischemic stroke with large vessel occlusion(AIS-LVO)after cardiac surgery,and to analyze the pathological characteristics of thrombi leading to LVO.Methods This study retrospectively and consecutively enrolled patients who experienced AIS-LVO during the perioperative period of cardiac surgery at the Cardiovascular Surgery Department of Guangdong Provincial People's Hospital from June 1,2017,to March 31,2024.The patients were divided into a surgical group and a non-surgical group based on whether they received endovascular treatment.The clinical and imaging data of the patients were collected,including gender,age,hypertension,diabetes,history of smoking,low-density lipoprotein cholesterol,cardiac surgical methods(coronary artery bypass grafting,total arch replacement[TRA],cardiac valve replacement,other types of surgery[valve repair,atrial septal repair,ventricular septal repair,heart transplantation]),time from cardiac surgery to AIS onset,location of vascular occlusion(vertebral-basilar artery,right internal carotid artery,left internal carotid artery),National Institutes of Health stroke scale(NIHSS)score at the onset of stroke,time from stroke onset to puncture,stroke etiology(embolism,arterial dissection,atherosclerotic stenosis),and imaging data including Alberta stroke program early CT score(ASPECTS)of the anterior circulation,ASPECTS of the posterior circulation(pc-ASPECTS)and CT angiography,CT perfusion,etc.The thrombus samples were stained with hematoxylin-eosin and martius scarlet blue staining.According to the proportion of red blood cells(RBC)in the thrombus,the thrombi were classified as erythrocyte-rich thrombi(RBC proportion≥70%),mixed thrombi(RBC proportion 31%-69%),and fibrin-rich thrombi(RBC proportion≤30%).At 90d after stroke onset,the modified Rankin scale(mRS)was used for both outpatient and telephone follow-up.The mRS score 0-2 indicated a good prognosis,3-6 indicated a poor prognosis,and 6 points indicated death.Factors with P＜0.1 in univariate Logistic regression and those factors may influence the prognosis according to clinical experience were included and further analyzed with multivariate Logistic regression to analyze the 90 d prognostic influencing factors after stroke onset for AIS-LVO patients during the perioperative period of cardiac surgery.Results A total of 102 patients who experienced AIS-LVO during the perioperative period of cardiac surgery(68 males,34females,with mean age of[58±14]years)were enrolled in this study,50 were in the non-surgery group and 52 in the surgery group.(1)Significant differences were observed between the surgical and non-surgical group in hypertension(32.7%[17/52]vs.54.0%[27/50],P=0.030),NIHSS score at stroke onset(12.3[12.3,21.8]vs.35.0[18.0,35.0],P＜0.01),vascular occlusion site(P=0.048),cardiac surgery type(P＜0.01),ASPECTS/pc-ASPECTS(9[8,9]vs.4[3,6],P＜0.01),favorable90-day prognosis rate(75.0%[39/52]vs.10.0%[5/50],P＜0.01)and 90-day mortality rate(7.7%[4/52]vs.68.0%[34/50],P＜0.01).Other clinical and imaging data showed no significant differences(all P＞0.05).In the surgery group,86.5%(45/52),7.7%(4/52),and 5.8%(3/52)patients were attributed to embolism,arterial dissection,and atherosclerotic stenosis,respectively.(2)Univariate Logistic regression analysis identified NIHSS score at stroke onset,TRA,endovascular therapy,and ASPECTS/pc-ASPECTS score as prognostic factors affecting the 90-day prognosis after stroke.Set the patient's 90-day prognosis(assign favorable prognosis as 1 and poor prognosis as 0)as dependent variable,incorporate factors with P＜0.1 in the univariate Logistic analysis and location of vascular occlusion in a multivariate Logistic regression analysis.The results showed that high NIHSS score on stroke onset(OR,0.86,95%CI 0.78-0.95,P=0.002)and non endovascular therapy(OR,6.93,95%CI 1.05-45.55,P=0.044)were independent risk factors of poor prognosis 90-day after stroke onset for AIS-LVO patients during the perioperative period of cardiac surgery.(3)Among 45 cardioembolic patients,thrombus samples from 33 patients were analyzed.The analysis revealed no erythrocyte-rich thrombi,3 mixed thrombi,and 30 fibrin-rich thrombi,with 12having a fibrin proportion exceeding 90%.Conclusion Endovascular therapy improved the prognosis and reduces mortality rate in patients with periprocedural AIS-LVO after cardiac surgery,and thrombi in these patients are predominantly fibrin-rich.

Objective:To explore the structural characteristics of intestinal microflora in children with non-alcoholic fatty liver disease（NAFLD）and the relationship between intestinal microflora and the occurrence as well as development of NAFLD in children.Methods:Fifteen children with NAFLD diagnosed at the First People's Hospital of Yunnan Province from January 2022 to December 2022 were selected as subjects，and 15 healthy children who received routine physical examinations at the outpatient clinic during the same period were randomly selected as healthy control group.The height，weight，waist circumference，blood pressure，blood biochemistry of all children were collected.At the same time，the fresh fecal samples of all children were collected，and the biological information of intestinal flora was analyzed by 16S rRNA sequencing.Results:In the NAFLD group，there were eight males and seven females，with an average age of（11.13±1.77）years.In healthy control group，there were seven males and eight females，with an average age of（9.73±2.25）years.There were no significant differences in sex，age，blood pressure between two groups.Compared with the healthy control group，the levels of body mass index，waist circumference，waist-to-height ratio，alanine aminotransferase，aspartate transaminase，gamma-glutamyl transpeptidase，total bilirubin，direct bilirubin，unconjugated bilirubin，low density lipoprotein cholesterol，uric acid and serum insulin significantly increased and high density lipoprotein cholesterol significantly decreased in NAFLD group（ P<0.05）.The results of species diversity analysis showed that chaol index and observed-species index in NAFLD group were significantly higher than those in healthy control group（ P<0.05）.Species diversity analysis showed that the species with increased abundance in NAFLD group included：Proteobacteria，Gammaproteobacteria，Enterobacteriaceae，Klebsiella，Escherichia-Shigella，Escherichia-Shigella-unclassified.Differential species with increased abundance in the healthy control group included：Bifidobacterium species，Bifidobacterium，Bifidobacteriaceae，Bifidobacteriales，Actinobacteria，Actinobacteriota，Bacteroidia，Bacteroidales，Streptococcus-thermophilus. Conclusion:There are metabolic abnormalities and obvious changes in the structure of intestinal flora in children with NAFLD.Exogenous supplementation of Bifidobacterium，Streptococcus thermophilus and Bacteroides may prevent the occurrence of NAFLD，delay the progression of disease and improve fat deposition in the liver.

Objective To investigate the clinical features of the spectrum of upper gastrointestinal diseases in children and to provide assistance in the prevention,diagnosis and treatment of upper gastrointestinal diseases in children.Methods Clinical data of 424 children aged 2 months to 14 years who were hospitalised for gastroscopy in the paediatrics department of the First People's Hospital of Yunnan Province from January 2018 to June 2023 were collected,and retrospective analyses were performed for the children's clinical presentation,gastroscopy results,and HP infections.Results The symptoms of vomiting and diarrhea in infants were significantly different from those in preschool and school age groups(P＜0.05).The positive rate of lesions under gastroscopy was 96.46％.The main diseases found were non-atrophic gastritis(222 cases),bile reflux gastritis(42 cases),non-atrophic gastritis with erosion(30 cases),duodenitis(25 cases),reflux esophagitis(15 cases)and others(75 cases).Helicobacter pylori(HP)was detected in 300 of the 424 cases,and 105 cases were HP positive,with a detection rate of 35.00％.Conclusion Abdominal pain was the main symptom of upper gastrointestinal diseases in school-age and pre-school children.Vomiting and diarrhea were the main symptoms of upper gastrointestinal diseases in infants.There was no gender difference in HP infection,but there was a difference in age.

Objective To explore whether the ability of intertemporal choice is impaired in schizophrenic patients and in their unaffected siblings.Methods Twenty-five schizophrenia patients,twenty-five unaffected siblings of patients and thirty healthy controls were recruited in the study."Delay-discounting" task and a battery of cognitive neuropsychological assessment were used to examine the intertemporal decision-making.Results (1) the value of k was ((0.005±0.009 in schizophrenia,0.011±0.014 in unaffected siblings and 0.024±0.029 in healthy controls,respectively.There was significant difference in k value among these three groups (F=9.487,P＜0.001).There were significant differences in k value between patients group and healthy controls,and between unaffected siblings and healthy controls (P＜0.05).There was no significant difference between schizophrenia and their unaffected siblings (P＜0.05).(2) Pearson correlation analysis not showed any relationship between neuropsychological test and the value of k.Conclusion The ability of intertemporal choices is impaired in schizophrenia and their unaffected siblings to a great degree.

Objective The aim of this study was to describe nursing student-patient relationship in Yunnan province,and study its influencing factors and practice effectiveness.Methods The multi-phase stratified cluster random sampling method was adopted to investigate 483 internship nursing students in two first class hospitals in Yunnan province.Results Among 483 nursing students,379 (78.5％) students belonged to facilitative relationship,101 (20.9％) students belonged to authoritative relationship,and 3 (0.6％) students belonged to mechanistic relationship.Sociodemographic data and factors related to three type of relationship showed no statistical significance among three types of nursing students.But student's personal and professional growth,student's increased confidence and self-esteem demonstrated statistical significance among three types of nursing students.In student's personal and professional growth,students of authoritative relationship got the lowest score (3.96±0.78) compared with students of mechanistic relationship and facilitative relationship [(4.17±0.29),(4.17±0.54)],F=4.82,P ＜ 0.01.In student's increased confidence and self-esteem,no significant difference was seen.Conclusions Nursing students' perceptions of student-patient relationship are mostly facilitative.And students' personal and professional growth and confidence and self-esteem increased obviously through internship for students with facilitative student-patient relationship.

Objective Toinvestigatetheriskfactorsforleukoaraiosis(LA)inpatientswithlarge arteryatherosclerosis(LAA).Methods Theclinicaldata(age,sex,hypertension,diabetes,smoking, serum lipid level,hyperhomocysteinemia,and numbers of stenosis or occluded cerebral arteries)of 312 patients with LAA classified by the modified stop stroke study trial of Org 10172 in acute stroke treatment (SSS-TOAST ) were analyzed retrospectively. The age-related white matter changes (age related white matter changes,ARWMC)scale was used to evaluate LA. All the 312 patients were divided into non-LA group(n=72)and LA group(n=240)according the T2 weighted magnetic resonance imaging (MRI) and fluid attenuated inversion recovery(FLAIR)sequence,and 3 groups according to the (age-related white matter changes,ARWMC)scores:mild LA,moderate LA,and severe LA groups. The patients with multiple risk factors were analyzed by the univariate and multivariate Logistic regression analyses. Results (1)Of the 312 patients with LA,227 were males (72. 8%). Their average age was 64 ± 11 years,and 240 of them (76. 9%)had LA. Multivariate Logistic regression analysis showed that age (OR,2. 911,95%CI 1. 647-5.146,P=0. 000),hypertension (OR,2. 583,95%CI 1. 373-4.857,P<0. 01),diabetes (OR,1. 882, 95%CI 1. 058-3. 348,P <0. 05),the numbers of stenosis or occlusion arteries (OR,1. 851,95%CI 1.018-3. 367,P<0. 05),and lacunar infarction (LI)(OR,1.493,95%CI 1. 202-1. 853,P<0. 01)were the risk factors for LA. (2)The comparison of the clinical data in patients with different severity in the LA group found that there were significant differences in age,hypertension,diabetes,the numbers of stenosis or occlusionarteries,andLIamongthe3groups(allP<0.05).Conclusion Age,hypertension,diabetes, the numbers of stenosis or occlusion arteries,and LI are the independent risk factors for patients with LAA,and it is associated with the severity of LA.

Objective To investigate the relationship between platelet-activating factor acetylhydrolase gene Arg92His(4, 275; G→A), Ile198Thr(7, 593; T→C) and Val279Phe(9, 994; G→T) mutation and cerebral artery athero-sclerosis stenosis. Methods Six hundred forty-twopatients with cerebral infarction underwent cerebral digital subtrac-tion angiography (DSA).The patients were then divided into cerebral artery atherosclerosis stenosis (CAAS) group(n=477) and control group(n=81) accroding to the site and severity of their cerebral artery stenosis. Furthermore, the CAAS group were divided into intracranial artery stenosis(ICAS) subgroup(n=251), extracranial artery stenosis(ECAS) subgroup (n=115) and extracranial-intracerebral artery stenosis(ECAS) subgroup(n=111). The distributions of genotype and allele frequencies of Arg92His,Ile198Thr and Val279Phe mutation of platelet-activating factor acetylhydrolase gene were ex-amined and comparied in different groups. Results There were significant differences in the distributions of genotype and allele of Arg92His mutation between ICAS subgroup and control group(42.6% vs. 30.3%;23.3% vs. 16.4%, P <0.05). These associations were not detected in ECAS and IECAS subgroups. There was no significant association be-tween Ile198Thr and Val279Phe and stenosis at any site(P>0.05). The distributions of genotype and allele of Arg92His, Ile198Thr and Val279Phe mutation were no significantly difference between CAAS group and control group (P >0.05). Conclusions Arg92His mutation may be associated with intracranial artery atherosclerotic stenosis.

The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored. The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug. 2007 to Nov. 2009 were retrospectively analyzed. In total 132 stents were implanted in the 111 patients. The mortality and rate of neural and non-neural complications were assessed perioperatively. Outcomes [including the frequency of transient ischemic attack (TIA), stroke, or death from vascular diseases) were assessed after operation. NIHSS rating was performed in all cases before and at first week, 6th month and 12th month after the operation. The PTAS success rate was 100%. The degree of stenosis was reduced after PTAS. The total complication rate during perioperative period was 15.3% (the rate of neural complications was 3.6%). Sixty-seven patients were followed up. Three patients (4.48%) developed cerebrovascular events within 1 month, containing one case of TIA, one case of ipsilateral mild stroke and one case of contralateral mild stroke. No severe stroke or death was observed. During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44%), including 2 cases of ipsilateral TIA (2.99%), 2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99%), one case of severe stroke (1.49%). In 13 patients receiving DSA re-examination one year after PTAS, 2 patients (15.38%) had in-stent restenosis. NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P<0.05). It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease. The success rate of PTAS was high, and the rate of complications was lower and the clinical outcomes were satisfactory. PTAS is a safe and effective therapeutic method, though the long-term outcomes need further study.

The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored.The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug.2007 to Nov.2009 were retrospectively analyzed.In total 132 stents were implanted in the 111 patients.The mortality and rate of neural and non-neural complications were assessed perioperatively.Outcomes [including the frequency of transient ischemic attack (TIA),stroke,or death from vascular diseases) were assessed after operation.NIHSS rating was performed in all cases before and at first week,6th month and 12th month after the operation.The PTAS success rate was 100％.The degree of stenosis was reduced after PTAS.The total complication rate during perioperative period was 15.3％ (the rate of neural complications was 3.6％).Sixty-seven patients were followed up.Three patients (4.48％) developed cerebrovascular events within 1 month,containing one case of TIA,one case of ipsilateral mild stroke and one case of contralateral mild stroke.No severe stroke or death was observed.During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44％),including 2 cases of ipsilateral TIA (2.99％),2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99％),one case of severe stroke (1.49％).In 13 patients receiving DSA re-examination one year after PTAS,2 patients (15.38％) had in-stent restenosis.NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P＜0.05).It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease.The success rate of PTAS was high,and the rate of complications was lower and the clinical outcomes were satisfactory.PTAS is a safe and effective therapeutic method,though the long-term outcomes need further study.