Objective:To assess the value of cerebral small vessel disease (CSVD) burden in predicting prognosis in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO) after endovascular therapy (EVT).Methods:The study was a cross-sectional study. A total of 242 patients with AIS due to anterior circulation LVO received EVT in the First Affiliated Hospital of Nanjing Medical University from February 2018 to September 2022. The clinical and imaging data of all patients were analyzed retrospectively. On follow-up MRI within 7 days after EVT, CSVD features [white matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed, cerebral atrophy] and CSVD burden score (0-5) was evaluated. Modified Rankin scale (mRS) score at 90 days after EVT was assessed. Patients were categorized into a mild burden group (0-1 points) and a moderate-severe burden group (2-5 points) based on CSVD burden score. Meanwhile, patients were categorized into a good prognosis group (0-2 points) and a bad prognosis group (3-6 points) based on mRS score at 90 days after EVT. Mann-Whitney U test and χ2 test were used to compare the difference of clinical and imaging indexes between the 2 groups, and variables with P<0.1 in the univariate analysis were included in the multifactorial logistic regression to screen for independent factors to predict the prognosis. Results:There were 169 patients in the good prognosis group and 73 patients in the bad prognosis group out of 242 patients. Compared with the good prognosis group, age, incidence of hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) scores, incidence of hemorrhagic conversion, CSVD burden scores, incidence of periventricular WMH scores of 3 and/or deep WMH scores≥2, and incidence of moderate-severe cerebral atrophy of patients in the bad prognosis group were higher, and the incidence of complete recanalization was lower (all P<0.05). Multivariate analysis showed hyperlipemia ( OR=8.438, 95% CI 1.691-42.119, P=0.009), baseline NIHSS score ( OR=1.103, 95% CI 1.047-1.162, P<0.001), complete recanalization ( OR=0.131, 95% CI 0.038-0.454, P=0.001) and hemorrhage transformation ( OR=1.952, 95% CI 1.031-3.697, P=0.040) were independent factors for the prognosis of EVT in patients with LVO AIS. There were 157 cases in the mild burden group and 85 cases in the moderate-severe burden group. The 90-day mRS score was higher in the moderate-severe burden group compared with the mild burden group ( Z=-2.24, P=0.025). Conclusion:CSVD burden has some clinical implications in predicting the prognosis of EVT in patients with anterior circulation LVO AIS.

Objective To evaluate the clinical value of optic nerve sheath diameter(ONSD)measured on thin-slice CT scan in the diagnosis and prognostic assessment of cerebral venous sinus thrombosis(CVST).Methods The clinical data of patients with CVST,who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive treatment from January 1,2016 to December 31,2022,were retrospectively analyzed.The difference in ONSD was compared between CVST patients and normal population,the postoperative changes in ONSD was analyzed.Results A total of 49 patients with CVST(CVST group)and 49 normal persons having no brain disorders(control group)were enrolled in this study.In CVST group,the preoperative ONSD was(5.33±0.50)mm,which was significantly higher than(4.40±0.40)mm in control group(P＜0.001),the postoperative ONSD remarkably decreased to(4.98±0.59)mm(P＜0.01).The difference value between postoperative ONSD and preoperative ONSD in the patients receiving pure anticoagulation treatment was not statistically significant different from that in the patients receiving endovascular treatment[(-0.43±0.22)mm vs.(-0.40±0.42)mm,P=0.84].The preoperative ONSD in the patients having intracranial hemorrhage and in the patients having no intracranial hemorrhage was(5.26±0.51)mm and(5.41±0.49)mm respectively(P=0.31),and the difference value between postoperative ONSD and preoperative ONSD was(-0.39±0.40)mm and(-0.45±0.25)mm respectively(P=0.66).At the three-month follow-up visit,the difference in ONSD between the patients having a good prognosis(mRS score being 0-2 points)and the patients having a poor prognosis was not statistically significant(P＞0.05).Conclusion ONSD that is measured on plain head CT scan can be used as a response indicator of elevated intracranial pressure in CVST patients,which can be used to monitor the changes in intracranial pressure before and after treatment,but its value in assessing the curative efficacy of different therapeutic methods needs to be further explored.

Objective To observe the value of automated net water uptake(CTP-aNWU)based on CT perfusion(CTP)for predicting neurological prognosis of acute ischemic stroke(AIS).Methods A total of 145 AIS patients due to anterior circulation large vessel occlusion were retrospectively enrolled,and the clinical data at admission and follow-up were collected.Alberta stroke program early CT score net water uptake(ASPECTS-NWU)was analyzed,and CTP-aNWU of the infarct core was obtained based on CTP and non-contrast CT(NCCT).According to modified Rankin scale(mRS)score 90 days after the onset of infarction,the patients were divided into favorable prognosis group(mRS score≤2,n=54)and poor prognosis group(mRS score＞2,n=91).The clinical data and imaging data were compared between groups,and the independent predictors of neurological prognosis of AIS were evaluated,and the predictive efficacies were assessed.Results There were significant differences in age,admission NIHSS score and admission ASPECTS of patients,as well as in ASPECTS-NWU,CTP-aNWU,infarct core volume,hypoperfusion factor of the lesions between groups(all P＜0.05).The infarct core volume(OR=0.977[0.963 to 0.992],P=0.002)and CTP-aNWU(OR=0.876[0.793 to 0.969],P=0.010)were independent predictors of neurological prognosis of AIS.The area under the curve(AUC)of receiver operating characteristic curve of CTP-aNWU alone for predicting neurological prognosis of AIS patients 90 days after the onset was 0.634(95％CI[0.550,0.713]),which was 0.790(95％CI[0.714,0.853])of CTP-aNWU combined with infarct core volume,and the latter was better than the former(Z=3.500,P＜0.001).Conclusion CTP-aNWU was an independent predictor of neurological prognosis 90 days after the onset of AIS.Combining CTP-aNWU with infarct core volume could improve the predicting efficacy.

The passing of ethical review is a necessary conditions and prerequisite for the development of life science and medical research involving humans. At present, some medical and health institutions have no or insufficient ethical review capabilities. The lack of ethical review ability has become a bottleneck restricting the development of life science and medical research involving humans. According to documents such as Opinions on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Pharmaceutical and Medical Devices, Opinions on Strengthening the Ethical Governance of Science and Technology, institutions can entrust competent institutional ethics review committees or regional ethics review committees in writing to conduct ethical review. Entrustment ethical review provides a viable solution for institutions that need to carry out life science and medical research involving humans but do not have an ethics (review) committee or the ethics (review) committee is not competent to review. To conduct the entrustment ethical review, the entrustment between the principal and the trustee is required. According to The Measures for Ethical Review of Life Sciences and Medical Research Involving Humans, if medical and health institutions and their ethical review committees do not accept the formal entrustment to provide the ethical review opinions for other institutions, the local health authorities at or above the county level will impose administrative penalties and sanctions on the relevant institutions and personnel in accordance with the law. Signing the entrustment ethical review contract, implementing legal compliance entrusted ethical review to protect the rights and interests of the trustee and the principal, and protect the research participants.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To investigate the mid-term efficacy of prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS), urinary retention (UR) or hematuria secondary to benign prostatic hyperplasia (BPH).Methods:This was a retrospective study conducted from February 2014 to December 2018 in 140 patients who underwent PAE for LUTS, UR or hematuria secondary to BPH, including 85 patients with LUTS (60 patients with LUTS and 25 LUTS combined with hematuria), 52 patients with UR (50 patients with UR and 2 UR combined with hematuria) and 3 patients with hematuria. All patients were followed up for 24 months. Clinical success rates were evaluated. Friedman test was performed to compare the differences in International Prostate Symptom Score (IPSS), quality of life (QoL) score, and prostatic volume (PV) between baseline and follow-up time points (3, 6, 12 and 24 months). A post hoc test was performed by the Bonferroni method.Results:Significant differences in IPSS, QoL score and PV between baseline and follow-up time points were observed in 85 patients with LUTS ( P<0.001 for all), and clinical success rates at 3, 6, 12, 24 months after PAE were 95.3% (81/85), 91.8% (78/85), 87.1%(74/85), 83.5%(71/85). The success rate of extubation in patients with UR within 1 month after PAE was 98.1% (51/52). The average interval from PAE to catheter-independence was (6.8±3.7) days, and clinical success rates were 94.1% (48/51), 92.2% (47/51), 88.2% (45/51), 84.3% (43/51), respectively. The interval from PAE to the resolution of hematuria was (3.4±2.5) days, and clinical success rates were 90.0%(27/30), 90.0%(27/30), 83.3%(25/30), 80.0%(24/30), respectively. Conclusions:PAE was an effective treatment option for symptoms secondary to BPH in mid-term follow up.

Guided by the development of new medical science proposed by Ministry of Education and the "Education and Training Plan for Excellent Doctors 2.0", shifted from treatment-oriented to whole life-health cycle, we have explored curriculum ideological and political education in metabolic-related curriculum chain. Firstly, we constructed a core teaching team and had the training of curriculum ideological and political education. The top-level design was made with the integration of moral education into medical education. Secondly, the syllabus was comprehensively revised, containing the connotation of "morality education". The elements relevant to curriculum ideological and political education hidden behind professional courses were excavated. Finally, the mixed teaching mode of online combining with offline was carried out. Metabolism-related curriculum chain, focused on "metabolism, diabetes, obesity and patient education", formed a progressive link from basic medical science to practice to clinical, strengthening the "prevention, treatment and health care" based "one health" philosophy and giving full play to the implicit curriculum ideological and political education hidden behind professional courses. Our practice shows that the implementation of curriculum ideological and political education in metabolism-related curriculum has been accepted by students, and curriculum ideological and political education has been become part of professional courses. The "gene chimera" mode for curriculum ideological and political education incorporation into professional courses needs to be infiltrated imperceptibly, and the effect will be visualized in the future.

ObjectiveTo investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). MethodsA retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P＜0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. ResultsAfter PTBS, 55 patients (221%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio ［OR］=2.2, 95% confidence interval ［CI］: 1.07-4.52, P=0033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-1405, P＜0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-3403, P＜0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. ConclusionHyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS.

Objective To study the effect of ankle taping (restriction of ankle varus and plantar flexion) on biomechanical characteristics of the knee during drop landing on the dominant leg. Methods Eighteen amateur athletes performed the dominant-legged drop landing under two different ankle conditions (with or without taping). Vicon three-dimensional (3D) motion capture system, Kistler force plate and Noraxon surface electromyography (sEMG) system were used to collect kinetic, kinematic and sEMG data for statistical analysis. Results Compared with control group, ankle taping significantly increased flexion angle at initial contact and maximum flexion angle, while significantly decreased the maximum valgus angle. Conclusions The restriction of varus and plantar flexion might reduce the risk of anterior cruciate ligament (ACL) injury. The intervention with ankle taping could modify biomechanical parameters of the knee during drop landing. The ankle taping by restriction of ankle varus and plantar flexion may be an effective measure to prevent ACL injury for collegiate athletes.

To evaluate the safety and efficacy of mechanical thrombectomy with stent-retriver for anterior circulation small vessel occlusion in patients with acute ischemic stroke (AIS).Methods:From a prospectively collected thrombectomy database of consecutive patients with AIS between January 2017 and November 2018, 311 angiographic images were analyzed to assess small vessel occlusions (A 2 and M 2 segments). Patients were categorized into alteplase with thrombectomy group and thrombectomy alone group. The primary outcome was a favorable outcome (modified Rankin Scale scores 0-2) at 90 days. Secondary outcomes were successful recanalization (modified thrombolysis in cerebral infarction 2b or 3), symptomatic intracranial hemorrhage, and 90-day mortality. Results:Small vessel occlusions were identified in 19 patients, including 14 M 2occlusions, two A 2occlusions, and three M 2+A 2 occlusions. Six patients were in the alteplase with thrombectomy group and 13 patients in the thrombectomy alone group. Favorable outcome was achieved in eight of 19 patients at 90 days. Successful recanalization was achieved in 18 patients (18/19), symptomatic intracranial hemorrhage was observed in one patient (1/19), and death was recorded in five patients (5/19). No statistically significant difference was detected between the two groups with regard to successful recanalization (6/6 in the alteplase with thrombectomy group vs 12/13 in the thrombectomy alone group), symptomatic intracranial hemorrhage (0/6 vs 1/13), favorable outcome (2/6 vs 6/13) and death (1/6 vs 4/13; all P>0.05). Conclusion:As to anterior circulation small vessel occlusions, the combination-therapy within 4.5 hours or mechanical thrombectomy alone in extended time window with perfusion evaluation may be both safe and effective.