Objective:To investigate the dynamic changes of plasma high-mobility group box 1 (HMGB1) and its correlation with functional outcome and symptomatic intracranial hemorrhage (sICH) after endovascular treatment (EVT) in patients with acute large vessel occlusion stroke (ALVOS).Methods:Patients with ALVOS admitted to the Department of Neurology, Zengcheng District, Nanfang Hospital, Southern Medical University from June 2021 to April 2023 were included retrospectively. Plasma HMGB1 before EVT and at 6, 24, and 48 hours after procedure was detected, and the dynamic changes of plasma HMGB1 were compared and analyzed. The primary endpoint was the functional outcome evaluated using the modified Rankin Scale at 90 days of onset. A score of 0-2 was defined as good outcome and >2 was defined as poor outcome. The secondary endpoint was sICH, which was defined as the occurrence of hemorrhagic infarction after EVT and an increase of ≥4 in the National Institutes of Health Stroke Scale (NIHSS) score from baseline. Multivariate logistic regression analysis was used to evaluate the predictive value of HMGB1 for poor outcome and sICH. Results:A total of 73 patients with ALVOS received EVT were included. There were 54 males (74.0%), aged 62±12 years. The median time from onset to door was 90 minutes (interquartile range, 40-180 minutes), and the median time from onset to femoral artery puncture was 181 minutes (interquartile range, 140-280 minutes). Twenty-nine patients (39.7%) underwent bridging intravenous thrombolysis (IVT). At 90 days after onset, 37 patients (50.7%) had poor outcome, and 12 (16.4%) died during follow-up. Eleven patients (15.1%) developed sICH. After EVT, plasma HMGB1 showed a temporal increase, reaching its peak at 48 hours (median, 102.57 μg/L). Subgroup analysis showed that HMGB1 in the bridging IVT group at 6 hours ( P<0.05) and 24 hours ( P<0.05) after procedure were significantly higher than that at baseline. The non-bridging IVT group showed a significant increase at 6 hours after procedure ( P<0.05). There was no statistically significant difference in HMGB1 between the bridging IVT group and the non-bridging IVT group at the same time point. Multivariate logistic regression analysis showed that after adjusting for age, ischemic heart disease, triglycerides, uric acid, baseline NIHSS score, and sICH, the third quartile (adjusted odds ratio 7.087, 95% confidence interval 1.243-40.419; P=0.027) and fourth quartile (adjusted odds ratio 7.544, 95% confidence interval 1.260-45.172; P=0.027) of plasma HMGB1 were independent risk factors for poor outcome at 6 hours after procedure. The postoperative plasma HMGB1 in the sICH group was significantly higher than that in the non-sICH group ( P<0.05), but multivariate analysis showed no independent correlation between plasma HMGB1 and sICH. Conclusion:The elevation of plasma HMGB1 in patients with ALVOS at 6 hours after EVT is independently associated with poor outcome at 90 days after onset, but not with sICH.

Objective:To investigate the current status of maximum tongue pressure (MTP) in cardiac surgery inpatients and analyze its influencing factors, providing a basis for developing personalized nursing measures for high-risk groups.Methods:This cross-sectional study used a convenience sampling method to select cardiac surgery inpatients at Zhongshan Hospital, Fudan University, from January 2022 to April 2023. General and clinical data questionnaires, a swallowing tongue muscle evaluation training device, and a hand dynamometer were used for data collection. The random forest model and Lasso regression were employed to identify key influencing factors, and multiple linear regression was used to analyze the factors affecting MTP.Results:A total of 501 cardiac surgery inpatients meeting the inclusion and exclusion criteria were enrolled, including 308 males and 193 females, with a mean age of (56.94 ± 14.02) years. The mean MTP was (45.92 ± 9.57) kPa. When the lambda (λ) value was 0.181, the model achieved the best fit, identifying 10 key influencing factors in descending order of importance: age, handgrip strength, gender, BMI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), glomerular filtration rate, cardiac function grade, hemoglobin, history of stroke, and history of atrial fibrillation. Age, handgrip strength, low-level BMI, NT-proBNP, and history of stroke were determined as significant factors influencing MTP in cardiac surgery inpatients ( R2 = 0.324, F = 24.92, P<0.05). Conclusions:Nurses should pay close attention to the tongue muscle strength of cardiac surgery inpatients. Early assessment of MTP is essential for older patients, those with low handgrip strength, low BMI, elevated NT-proBNP, or a history of stroke. Targeted early identification and pre-rehabilitation measures should be implemented for patients with weakened tongue muscle strength.

Objective:To investigate the application effect of web-based problem-based learning (WPBL) versus traditional teaching in the teaching of geriatric medicine courses.Methods:PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CBMdisc, and Wanfang Data were searched for clinical studies on the application of WPBL in the teaching of geriatric medicine courses in China and globally published up to October 1, 2023. After literature screening, data extraction, and quality assessment, RevMan5.4.1 was used to perform a systematic review.Results:A total of 14 eligible articles were included in this study, with 1 436 medical students as the subjects and geriatric medicine as the content of teaching. The Meta-analysis showed that WPBL teaching had a better effect than traditional problem-based learning or lecture-based learning in the teaching of geriatric medicine courses and could improve the theoretical examination score [mean difference (MD)=3.53, 95% confidence interval (CI)=1.77-5.29, P<0.001], operational skills (MD=5.92, 95%CI=2.67-9.18, P<0.001), critical thinking ability (MD=9.30, 95%CI=5.43-13.18, P<0.001), and teaching satisfaction (MD=1.75, 95%CI=1.49-2.01, P<0.001) among medical students. Conclusions:WPBL in the teaching of geriatric medicine courses can improve the theoretical examination score, operational skills, critical thinking skills, and teaching satisfaction among medical students.

Objective:To investigate the application effect of web-based problem-based learning (WPBL) versus traditional teaching in the teaching of geriatric medicine courses.Methods:PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CBMdisc, and Wanfang Data were searched for clinical studies on the application of WPBL in the teaching of geriatric medicine courses in China and globally published up to October 1, 2023. After literature screening, data extraction, and quality assessment, RevMan5.4.1 was used to perform a systematic review.Results:A total of 14 eligible articles were included in this study, with 1 436 medical students as the subjects and geriatric medicine as the content of teaching. The Meta-analysis showed that WPBL teaching had a better effect than traditional problem-based learning or lecture-based learning in the teaching of geriatric medicine courses and could improve the theoretical examination score [mean difference (MD)=3.53, 95% confidence interval (CI)=1.77-5.29, P<0.001], operational skills (MD=5.92, 95%CI=2.67-9.18, P<0.001), critical thinking ability (MD=9.30, 95%CI=5.43-13.18, P<0.001), and teaching satisfaction (MD=1.75, 95%CI=1.49-2.01, P<0.001) among medical students. Conclusions:WPBL in the teaching of geriatric medicine courses can improve the theoretical examination score, operational skills, critical thinking skills, and teaching satisfaction among medical students.

Objective:To investigate the current status of maximum tongue pressure (MTP) in cardiac surgery inpatients and analyze its influencing factors, providing a basis for developing personalized nursing measures for high-risk groups.Methods:This cross-sectional study used a convenience sampling method to select cardiac surgery inpatients at Zhongshan Hospital, Fudan University, from January 2022 to April 2023. General and clinical data questionnaires, a swallowing tongue muscle evaluation training device, and a hand dynamometer were used for data collection. The random forest model and Lasso regression were employed to identify key influencing factors, and multiple linear regression was used to analyze the factors affecting MTP.Results:A total of 501 cardiac surgery inpatients meeting the inclusion and exclusion criteria were enrolled, including 308 males and 193 females, with a mean age of (56.94 ± 14.02) years. The mean MTP was (45.92 ± 9.57) kPa. When the lambda (λ) value was 0.181, the model achieved the best fit, identifying 10 key influencing factors in descending order of importance: age, handgrip strength, gender, BMI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), glomerular filtration rate, cardiac function grade, hemoglobin, history of stroke, and history of atrial fibrillation. Age, handgrip strength, low-level BMI, NT-proBNP, and history of stroke were determined as significant factors influencing MTP in cardiac surgery inpatients ( R2 = 0.324, F = 24.92, P<0.05). Conclusions:Nurses should pay close attention to the tongue muscle strength of cardiac surgery inpatients. Early assessment of MTP is essential for older patients, those with low handgrip strength, low BMI, elevated NT-proBNP, or a history of stroke. Targeted early identification and pre-rehabilitation measures should be implemented for patients with weakened tongue muscle strength.

Objective:To explore surgical strategies for acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries.Methods:From January 2019 to March 2023, a total of 29 patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries were included in the study. All patients underwent emergency surgery, with simultaneous intraoperative neck incision and replacement of the unilateral or bilateral carotid arteries. Among them, there were 19 males with a mean age of(49.57±2.14)years old. Preoperative brain CT indicated abnormalities in 15 cases, transient neurological dysfunction occurred in 5 cases, and syncope in 1 case.Results:Procedures included ascending aorta replacement in 10 cases, Bentall procedure in 18 cases, and Wheat procedure in 1 case. Arch operations involved partial arch replacement in 3 cases and Sun’s procedure in 26 cases. Simple left carotid artery replacement was performed in 6 cases, simple right carotid artery replacement in 19 cases, and bilateral carotid artery replacement in 4 cases. Cerebral protection measures during circulatory arrest included unilateral cerebral perfusion in 24 cases and bilateral cerebral perfusion in 5 cases. The mean operation time was(7. 6±0. 3) h, with a mean cardiopulmonary bypass time of(196. 3±8. 7) min, aortic cross-clamp time of(113.2±6.4) min, ischemic time 12(5-16.5) min, and lowest temperature of(26.3±0.4)°C. One patient experienced in-hospital mortality. Postoperatively, new neurological dysfunction occurred in 2 cases, including 1 case with coma and permanent neurological deficit.Conclusion:In patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries, simultaneous carotid artery replacement via neck incision during aortic surgery is a safe and reliable surgical approach.

Objective    To evaluate the involvement of renal artery in acute Stanford type A aortic dissection (TAAD) using CT angiography (CTA) and to analyze the difference of renal function among different types of renal artery involvement. Methods    From January 2016 to November 2017, 151 patients of acute TAAD with renal artery involvement were included in the study. There were 118 males and 33 females, with an average age of 47.93±10.53 years. All patients underwent aortic CTA to confirm the TAAD. According to CTA，involvement of one side of renal artery can be divided into four types: type A, large tear near renal artery orifice, difficult to distinguish true or false lumen; type B, the orifice of the renal artery originates entirely from the false lumen; type C, the orifice of the renal artery originates entirely from the true lumen; type D, renal artery dissection is observed, renal artery intima can be seen. The levels of serum creatinine (sCr) and creatinine clearance (CC) in all groups were analyzed and compared. Results    The results of one-way ANOVA analysis showed that there was no significant difference in sCr or CC among the groups (P>0.05). There was no significant difference in age, sex, proportion of hypertension history and onset time among the above groups (P>0.05). Conclusion    The three most common types of renal artery involvement were BC type, CC type, and AC type. The types of renal artery involvement do not affect renal function.

Objective To explore the risk factors of renal replacement therapy for acute Stanford A aortic dissection patients with acute renal injury (AKI) after Sun's operation.Methods From January 2016 to October 2017,144 patients with Stanford A aortic dissection who underwent Sun's procedure were enrolled in the study.Univariate analysis and logistic regression analysis were used to analyze the risk factors of continuous renal replacement therapy (CRRT).Variables with statistical difference from univariate analysis were included in multivariate logistic regression analysis.Results 8 patients (5.55％)died in hospital.16 patients (11.11％) needed CRRT for AKI.5 of them (31.25％) died in hospital.Of the 11 surviving patients,5 had complete recovery of renal function within 2 weeks after operation and stopped renal replacement therapy.The remaining 6 patients recovered their renal function within 3 months and stopped renal replacement therapy.Univariate analysis showed that there were significant differences in preoperative age,creatinine clearance,peripheral white blood cell count,D-dimer,myoglobin,double renal arteries in false lumen,aortic cross clamp time and red blood cell transfusions between the two groups.The above risk factors were included in multivariate logistic regression.The results showed that double renal arteries in false lumen (OR =24.64,P =0.002),serum creatinine clearance ＜ 85 ml/min (OR =4.99,P =0.02) and red blood cell transfusions (OR =1.17,P ＜ 0.001) were independent risk factors.Conclusion Double renal arteries in false lumen,serum creatinine clearance ＜ 85ml/min and red blood cell transfusions were independent risk factors for CRRT after Sun's procedure for acute Stanford A aortic dissection.For high-risk patients with double renal arteries in false lumen,and markedly decreased creatinine clearance before operation,red blood cell transfusions should be reduced as much as possible to reduce the risk of AKI after operation.

Objective To explore the impact of Cesarean section on newborn′s early suction. Methods A literature review was conducted to summarize the impact of Cesarean section on newborn′s early suction from aspects of sucking behavior, breastfeeding initiation, and breast sensitivity to sucking stimulus. Results Cesarean section has detrimental effect on nerves and muscles which are responsible for sucking behavior. It causes incompatible of sucking dynamics, delayed breastfeeding initiation, ineffective sucking stimulus, and finally, failed lactation and breastfeeding. Conclusions Cesarean section impairs newborn′s early suction.It suggests that our nursing staff should pay attention to related education and encourage the vaginal delivery.Additionally,supports on timely breastfeeding,correct latch-on and sucking gesture should be given to Cesarean newborns immediately after delivery to promote the successful breastfeeding.

Objective    To evaluate the short- and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery. Methods    The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass (CPB) with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed. All of them were males with a mean age of 52±14 years ranging from 20 to 69 years. Hypertension was observed in nine patients, coronary artery disease in five and prior cerebral infarction in one. History of percutaneous coronary intervention was noted in one patient, history of Bentall operation in one, ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one. Results    There was no hospital death. Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one. Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h, respectively. All patients survived and were discharged. One patient was lost to follow-up and no patient died during the follow-up. Postoperative computed tomography revealed good patency of  the anastomotic site between the left subclavian artery and the left common carotid artery. Conclusion    Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.