Objective To investigate the factors affecting the hemorrhagic transformation(HT)and symptomatic intracranial hemorrhage(sICH)in patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)of anterior circulation after receiving endovascular treatment(EVT).Methods A total of 193 patients with AIS-LVO of anterior circulation,who were admitted to the Neurology Department of Anyang Municipal People's Hospital of China from January 2023 to November 2024,were enrolled in this study.There were 84 patients in the HT group and 42 patients in the sICH group.The baseline and clinical data,including gender,age,vascular risk factors(history of hypertension,diabetes,coronary artery disease,atrial fibrillation,coronary stent implantation,valve replacement,smoking),stroke history,pre-operative National Institutes of Health Stroke Scale(NIHSS)scores,laboratory indicators(preoperative D-dimer,neutrophil count,lymphocyte count,postoperative total CO2,and CO2 partial pressure),and perioperative indicators(procedure duration,surgical approach,anesthesia type,and preoperative intravenous thrombolysis),were collected.The clinical data were compared between non-HT group and HT group,as well as between non-sICH group and sICH group,and the independent risk factors for HT and sICH after receiving EVT treatment for AIS-LVO of anterior circulation were analyzed.Results The differences in coronary heart disease(x2=8.443,P=0.004),D-dimer(Z=-3.59,P＜0.001),preoperative NIHSS score(Z=-3.752,P＜0.001),surgical time(Z=-2.529,P=0.011),lesion site(x2=9.951,P=0.019),and moderate to severe stenosis or occlusion of other blood vessels(P=0.025)between the HT group and the non-HT group were statistically significant.The differences in the other baseline indicators and clinical data were not statistically significant(all P＞0.05).The multivariate logistic regression analysis showed that preoperative NIHSS score(OR=1.065,95％CI:1.021-1.110,P＜0.003),tandem lesions(OR=2.805,95％CI:1.306-6.024,P=0.008),coronary heart disease(OR=2.963,95％CI:1.421-6.174,P=0.004),and operation time(OR=1.009,95％CI:1.001-1.016,P=0.019)were the independent risk factors for HT after EVT.No statistically significant differences in baseline data,occlusion site,coexisting other vascular stenosis,and perioperative related indicators existed between the sICH group and the non-sICH group.Conclusion Preoperative NIHSS score,tandem lesion,coronary artery disease,and operation time are the independent risk factors for HT in patients with AIS-LVO of the anterior circulation after receiving EVT.

Objective To investigate the clinical application value of combined pancreaticobiliary brushing under endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of hepatopancreatic ampulla malignant tumours.Methods We retrospectively analyzed 59 patients from January 2013 to December 2023 for ERCP treatment of hepatopancreatic ampulla tumours,and performed combined pancreaticobiliary brushing(combined pancreaticobiliary brushing group,n=10)and biliary duct brushing alone(biliary duct brushing group,n=49)respectively,then compared the positive pathological detection rate of hepatopancreatic ampulla malignant tumours,the magnitude of bilirubin reduction,and the occurrence of postoperative complications between the two groups.Results The positive detection rate of combined pancreaticobiliary brushing for diagnosing ampulla malignant tumours was 70.0％(7/10),and the positive detection rate of biliary duct brushing alone was 22.4％(11/49),and the positive detection rate of pathology in the two groups was statistically significant(P＜0.05);No significant statistical difference was observed in the decrease of bilirubin between the two groups(P＞0.05);There were three cases of post-operative complications in the biliary duct brushing group.There were no postoperative complications in the combined pancreaticobiliary brushing group.Conclusion Compared with bile duct brushing alone,combined pancreaticobiliary brushing is more helpful for the diagnosis of malignant tumours,and does not increase the incidence of complications.It is worthy for clinical application.

Objective To investigate the clinical application value of combined pancreaticobiliary brushing under endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of hepatopancreatic ampulla malignant tumours.Methods We retrospectively analyzed 59 patients from January 2013 to December 2023 for ERCP treatment of hepatopancreatic ampulla tumours,and performed combined pancreaticobiliary brushing(combined pancreaticobiliary brushing group,n=10)and biliary duct brushing alone(biliary duct brushing group,n=49)respectively,then compared the positive pathological detection rate of hepatopancreatic ampulla malignant tumours,the magnitude of bilirubin reduction,and the occurrence of postoperative complications between the two groups.Results The positive detection rate of combined pancreaticobiliary brushing for diagnosing ampulla malignant tumours was 70.0％(7/10),and the positive detection rate of biliary duct brushing alone was 22.4％(11/49),and the positive detection rate of pathology in the two groups was statistically significant(P＜0.05);No significant statistical difference was observed in the decrease of bilirubin between the two groups(P＞0.05);There were three cases of post-operative complications in the biliary duct brushing group.There were no postoperative complications in the combined pancreaticobiliary brushing group.Conclusion Compared with bile duct brushing alone,combined pancreaticobiliary brushing is more helpful for the diagnosis of malignant tumours,and does not increase the incidence of complications.It is worthy for clinical application.

Objective:To compare the therapeutic effects of nasal high-flow oxygen therapy (HFNC) and nasal canal oxygenation (NCO) during breaks off non-invasive ventilation (NIV) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore the feasibility of NIV combined with HFNC in the treatment of AECOPD.Methods:From August 2017 to July 2019, AECOPD patients with type Ⅱrespiratory failure (arterial blood gas pH <7.35, PaCO 2 > 50 mmHg) who were treated with NIV were randomly (random number) assigned to the HFNC group and NCO group at 1:1. The HFNC group received HFNC treatment during breaks from NIV and the NCO group received low-flow NCO during the NIV interval. The primary endpoint was the total respiratory support time. The secondary endpoints were endotracheal intubation, duration of NIV treatment and breaks from NIV, length of ICU stay, total length of hospital stay and so on. Results:Eighty-two patients were randomly assigned to the HFNC group and the NCO group. After secondary exclusion, 36 patients in the HFNC group and 37 patients in the NCO group were included in the analysis. The total respiratory support time in the HFNC group was significantly shorter than that in the NCO group [(74 ± 18) h vs. (93 ± 20) h, P = 0.042]. The total duration of NIV treatment in the HFNC group was significantly shorter than that in the NCO group [(36 ± 11) h vs. (51 ± 13) h, P=0.014]. There was no significant difference of the mean duration of single break from NIV between the two groups, but durations of break from NIV in the HFNC group were significantly longer than those in the NCO group since the third break from NIV ( P < 0.05). The intubation rates of the HFNC and NCO groups were 13.9% and 18.9%, respectively, with no significant difference ( P=0.562). The length of ICU stay in the HFNC group was (4.3 ± 1.7) days, which was shorter than that in the NCO group [(5.8 ± 2.1) days, P=0.045], but there was no significant difference in the total length of hospital stay between the two groups. Heart rate, respiratory rate, percutaneous carbon dioxide partial pressure and dyspnea score during the breaks from NIV in the NCO group were significantly higher than those in the HFNC group, and the comfort score was lower than that in the HFNC group ( P<0.05). Conclusion:For AECOPD patients receiving NIV, compared with NCO, HFNC during breaks from NIV can shorten respiratory support time and length of ICU stay, and improve carbon dioxide retention and dyspnea. HFNC is an ideal complement to NIV therapy in AECOPD patients.