OBJECTIVE To investigate the efficacy and safety of tirofiban for early neurological deterioration in patients with acute ischemic stroke. METHODS A total of 126 patients with early neurological deterioration of acute ischemic stroke who were admitted to the Department of Neurology， Heji Hospital Affiliated to Changzhi Medical College from January 2022 to December 2023 were selected and divided into observation group and control group according to random number table method， with 63 cases in each group. All patients received standardized treatment such as lipid-lowering and blood pressure-lowering therapy. Based on the standard treatment， patients in the control group additionally took Aspirin enteric-coated tablets 100 mg+Clopidogrel bisulfate tablets 75 mg orally （once a day， for 14 consecutive days）. The patients in the observation group received Tirofiban hydrochloride and sodium chloride injection based on the standardized treatment [first intravenous infusion of 0.40 μg/（kg·min） for 30 min， and then continuous intravenous infusion of 0.10 μg/（kg·min） for 47.5 h]； subsequently， patients were given Aspirin enteric-coated tablets （100 mg） and Clopidogrel bisulfate tablets （75 mg） once a day for 14 consecutive days. The clinical efficacy， the National Institutes of Health Stroke Scale （NIHSS） score， modified Rankin Scale （mRS） score， and hemorheological indexes before and after treatment were compared between the two groups， and the adverse reactions were recorded. RESULTS The total effective rate （87.30%） of the observation group was significantly higher than that of the control group （71.43%） （P＜0.05）. NIHSS scores of the two groups at 1st， 7th and 14th day after treatment， the mRS score at 90th day after treatment， and the platelet aggregation rate， whole blood viscosity， plasma viscosity and fibrinogen at 14th day after treatment were significantly lower than those before treatment in the same group， and the observation group was significantly lower than the control group at the same period （P＜0.05）. The total incidences of adverse reactions such as nausea， headache， fever， gastrointestinal bleeding， oral and nasal mucosal bleeding and thrombocytopenia in both groups of patients were 28.57% respectively， with no statistically significant difference （P＞0.05）. CONCLUSIONS For patients with early neurological deterioration in acute ischemic stroke， the addition of tirofiban can accelerate the recovery of neurological function， improve blood hyperviscosity and platelet aggregation， and improve the prognosis of patients with good safety.

Objective To explore the predictive value of contrast-enhanced ultrasound(CEUS)pa-rameters combined with blood lipids in evaluating vulnerable carotid plaques in patients with is-chemic stroke.Methods A prospective trial was conducted on 120 patients diagnosed with vulner-able carotid plaques in our hospital from January 2023 to May 2024.According to having ischemic stroke or not,60 of them were assigned into ischemic stroke(study group),and the other 60 into control group.Routine ultrasound,CEUS and blood lipid examinations were performed respective-ly in the two groups.The unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis,resistance index and blood lipid levels between the study group and the control group and in the study group with different blood flow grades were analyzed.ROC curve analysis was used to calculate the AUC value.Results There were statistical differences between the study group and the control group in terms of unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis,resistance index and blood flow characteristics(P＜0.01).The study group had significantly higher TC,TG and LDL levels and lower HDL level than the control group(P＜0.01).Obvious differences were observed in unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis and resistance index among the patients from the study group with different blood flow grades(P＜0.05,P＜0.01),so were their TC,TG,LDL and TG levels in them(P＜0.01).For above these patients,the TC,TG and LDL levels were gradually decreased,while that of HDL was increased in turn in the patients with blood flow grades Ⅲ,Ⅱ to Ⅰ(P＜0.01).The blood flow grade was positively correlated with TC,TG and LDL levels(r=0.456,r=0.652,r=0.362,P=0.000),while negatively with HDL level(r=-0.256,P=0.000).ROC curve analysis showed that the AUC value of the combination in the diagnosis was significantly higher than that detected by single detection.Cutoff analysis suggested that CEUS blood flow grade of over Ⅱ,and TC of 5.22 mmol/L,TG of 2.33 mmol/L,LDL of 2.78 mmol/L,and HDL of 0.82 mmol/L were the cutoff values in diagnosing vulnerable carotid plaque for ischemic stroke patients.Conclusion High grade of CEUS blood flow combined with abnormal blood lipid levels may serve as predic-tive indicators for ischemic stroke patients.

Objective To explore the predictive value of contrast-enhanced ultrasound(CEUS)pa-rameters combined with blood lipids in evaluating vulnerable carotid plaques in patients with is-chemic stroke.Methods A prospective trial was conducted on 120 patients diagnosed with vulner-able carotid plaques in our hospital from January 2023 to May 2024.According to having ischemic stroke or not,60 of them were assigned into ischemic stroke(study group),and the other 60 into control group.Routine ultrasound,CEUS and blood lipid examinations were performed respective-ly in the two groups.The unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis,resistance index and blood lipid levels between the study group and the control group and in the study group with different blood flow grades were analyzed.ROC curve analysis was used to calculate the AUC value.Results There were statistical differences between the study group and the control group in terms of unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis,resistance index and blood flow characteristics(P＜0.01).The study group had significantly higher TC,TG and LDL levels and lower HDL level than the control group(P＜0.01).Obvious differences were observed in unstable plaque integral ratio,maximum plaque length,maximum plaque thickness,ulceration plaque,area stenosis,peak velocity at stenosis and resistance index among the patients from the study group with different blood flow grades(P＜0.05,P＜0.01),so were their TC,TG,LDL and TG levels in them(P＜0.01).For above these patients,the TC,TG and LDL levels were gradually decreased,while that of HDL was increased in turn in the patients with blood flow grades Ⅲ,Ⅱ to Ⅰ(P＜0.01).The blood flow grade was positively correlated with TC,TG and LDL levels(r=0.456,r=0.652,r=0.362,P=0.000),while negatively with HDL level(r=-0.256,P=0.000).ROC curve analysis showed that the AUC value of the combination in the diagnosis was significantly higher than that detected by single detection.Cutoff analysis suggested that CEUS blood flow grade of over Ⅱ,and TC of 5.22 mmol/L,TG of 2.33 mmol/L,LDL of 2.78 mmol/L,and HDL of 0.82 mmol/L were the cutoff values in diagnosing vulnerable carotid plaque for ischemic stroke patients.Conclusion High grade of CEUS blood flow combined with abnormal blood lipid levels may serve as predic-tive indicators for ischemic stroke patients.

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.
Humans ; Pylorus/pathology* ; Stomach Neoplasms/pathology* ; Gastrectomy ; Gastroenterostomy ; Lymph Node Excision

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.
Anastomosis, Surgical/methods* ; Esophagogastric Junction/surgery* ; Gastrectomy/methods* ; Gastroesophageal Reflux/surgery* ; Humans ; Quality of Life ; Stomach Neoplasms/surgery*