Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.

Objective: To investigate the efficacy, nursing characteristics, and management of different desensitization strategies before allogeneic hematopoietic stem cell transplantation (allo-HSCT) among patients with high level of human leukocyte antigen (HLA) antibodies. Methods: A retrospective analysis was conducted on 82 patients with high levels of HLA antibodies who underwent allo-HSCT at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematonosis Hospital between January 2020 to November 2023. Patients were divided into two groups based on the desensitization strategy they received: the anti-CD20 monoclonal antibody combined with therapeutic plasma exchange (TPE) group (n=50) and the anti-CD20 monoclonal antibody combined with Protein A immunoabsorption group (n=32). The differences of efficacy between the desensitization strategies were analyzed. The safety of both desensitization strategies were assessed by close monitoring of adverse events throughout the treatment. The nursing characteristics and interventions specific to these strategies were comprehensively summarized. Results: There were no significant differences in age, gender, and diagnosis between the two groups of patients receiving different desensitization strategies (P>0.05). Following desensitization in the immunoadsorption group, the mean fluorescence intensity (MFI) levels of anti-HLA Class I antibody decreased significantly compared to initial screening (P=0.048), while the decrease in MFI values of anti-HLA Class II antibody was not statistically significant (P=0.173). In the TPE group, the MFI levels for both anti-HLA Class I and II antibodies after desensitization decreased significantly compared to initial screening (P=0.025 and 0.028, respectively). Monitoring of adverse events during desensitization treatment, found that patients in the immunoadsorption group experienced mild decreases in blood pressure during the process, with two patients developing severe hypotension. No allergic reactions occurred, and no damage of liver or kidney function was observed after the immunoadsorption. In the immunoadsorption group, a total of 19 patients underwent sera immunoglobulin assays before and after immunoadsorption. Compared to the initial screening, the immunoglobulin G (IgG) levels significantly decreased after immunoadsorption (P<0.001). In TPE group, 12 patients experienced mild hypotension during the plasma exchange process, but no severe hypotension was observed. One patient developed an allergic reaction. After the TPE treatment, no damage of liver or kidney function was observed, nor any decrease of IgG levels. In terms of safety of intravenous access, neither group experienced severe complications such as catheter-related bloodstream infections or deep vein thrombosis. In the TPE group, catheter occlusion occurred during the process of plasma exchange in 2 patients, while no such incident was observed in the immunoadsorption group. Patients of both groups exhibited anxiety and depression before treatment. After psychological care, the scores for anxiety and depression significantly decreased (P<0.001). Conclusion: Both desensitization strategies significantly decreased the HLA antibodies in highly sensitized patients with high level of HLA antibodies undergoing allo-HSCT. For patients receiving immunoabsorption, nursing care should focus on preventing and managing hypotension and implementing infection-prevention measures due to IgG depletion. In contrast, for those undergoing TPE, vigilant monitoring and prompt management of potential allergic reactions are essential components of nursing practice.

Objective To analyze the relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunc-tion(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impair-ment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these pa-tients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and＜18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correla-tion coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P＜0.01).ROC curve analysis indicated that total bur-den score(AUC=0.953,95％CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95％CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95％CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82％,and 8.92％,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P＜0.05,P＜0.01).Their values were significantly lower in the mild than the moder-ate-to-severe cognitive impairment subgroups(P＜0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P＜0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.

Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.

Objective To analyze the relationship of total imaging burden score with blood pressure variability(BPV)and cognitive function in elderly patients with cerebral small vessel disease(CSVD).Methods Clinical data of 182 elderly CSVD patients admitted in our hospital from December 2022 to January 2024 were collected and analyzed retrospectively.According to the results of Chinese Guidelines for Diagnosis and Treatment of CSVD-Related Cognitive Dysfunc-tion(2019),Montreal Cognitive Assessment(MoCA)and other tools for their cognitive impair-ment,they were divided into cognitively impaired group(76 cases)and cognitively normal group(106 cases).The total burden score and BPV indicators[24 h systolic blood pressure coefficient of variation(24 h SBPCV),24 h diastolic blood pressure coefficient of variation(24 h DBPCV)]were compared between the two groups.ROC curve was plotted to evaluate the diagnostic value of total burden score,24 h SBPCV and 24 h DBPCV on cognitive impairment in elderly CSVD patients.Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients.Based on the MoCA score of the cognitively impaired group,these pa-tients were further assigned into mild and moderate-to-severe cognitive impairment subgroups[with a MoCA score of 18-25(43 cases)and＜18(33 cases),respectively].Then the total burden score,24 h SBPCV and 24 h DBPCV were compared between the two subgroups.Pearson correla-tion coefficient was adopted to evaluate the correlation of severity of cognitive impairment with total burden score,24 h SBPCV and 24 h DBPCV in the elderly CSVD patients.Results The total burden score,24 h SBPCV and 24 h DBPCV were significantly higher in the cognitively impaired group than the cognitively normal group(P＜0.01).ROC curve analysis indicated that total bur-den score(AUC=0.953,95％CI:0.926-0.980,P=0.000),24 h SBPCV(AUC=0.850,95％CI:0.795-0.906,P=0.000)and 24 h DBPCV(AUC=0.761,95％CI:0.690-0.832,P=0.000)had good diagnostic efficiency for cognitive impairment in the elderly CSVD patients,with a cut-off value of 1.5,11.82％,and 8.92％,respectively.Multivariate logistic regression analysis revealed that the above three indicators were risk factors for cognitive impairment in the elderly patients with CSVD(P＜0.05,P＜0.01).Their values were significantly lower in the mild than the moder-ate-to-severe cognitive impairment subgroups(P＜0.01).Pearson correlation analysis displayed that MoCA score was negatively correlated with total burden score,24 h SBPCV and 24 h DBPCV in elderly patients with CSVD(r=-0.755,-0.632,-0.601,P＜0.01).Conclusion Detection of total burden score and BPV indicators is beneficial to the assessment of cognitive impairment in elderly CSVD patients.The higher the total burden score and the greater the BPV indicators,the more severe the cognitive impairment is,which may explore new ideas for clinical diagnosis and treatment of CSVD.

Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.

Objective:To explore the association of cerebral venous outflow assessed by CT angiography (CTA) with first pass effect (FPE) in patients with acute anterior circulation large vessel occlusion accepted mechanical thrombectomy (MT).Methods:A retrospective analysis was performed; patients with acute anterior circulation large vessel occlusion accepted MT and CTA in Department of Neurology, Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2021 were consecutively enrolled. Cerebral venous outflow in baseline CTA was evaluated using Cortical Vein Opacification Score (COVES). Patients were categorized into either FPE or non-FPE groups based on recanalization of occluded vessels after initial MT. General information, clinical features, radiological data, and surgery-related data between the 2 groups of patients were collected and compared. Significant variables ( P<0.1) from univariate analysis were included into a multivariable Logistic regression model to explore the relation between COVES and FPE. Predictive value of COVES in FPE was assessed using receiver operating characteristic (ROC) curve. Results:Out of the 143 patients enrolled in this study, 52 were into the FPE group and 91 were into the non-FPE group. Compared with the non-FPE group, the FPE group had higher COVES scores, higher proportion of patients with good cerebral venous drainage (COVES≥3), smaller core infarct volume, and shorter time from femoral artery puncture to vessel recanalization, with significant differences ( P<0.05). Multivariable Logistic regression analysis revealed that COVES was still corelated with FPE after adjusting covariates such as baseline NIHSS scores, core infarct volume, and time from femoral artery puncture to vessel recanalization ( OR=0.730, 95% CI: 0.567-0.940, P=0.015). ROC curve demonstrated that the combined model of COVES with aforementioned factors (COVES scores+baseline NIHSS scores+core infarct volume+time from femoral artery puncture to vessel recanalization) had an area under the curve of 0.757 (95% CI: 0.672-0.841, P<0.001), with sensitivity of 61.5% and specificity of 78.0%. Conclusion:Favorable cerebral venous drainage is an independent predictor for successful FPE in patients with acute anterior circulation large vessel occlusion accepted MT.

Objective To investigate the expression levels of plasma circular RNA PTP4A2(circPTP4A2)and circTLK2 in elderly patients with acute ischemic stroke(AIS)and their predic-tive value for neurological functional outcomes.Methods A total of 122 elderly AIS patients admitted to our department from May 2021 to December 2022 were prospectively recruited,and according to their modified Rankin Scale(mRS)score at 3 months after stroke onset,they were divided into a good outcome group(mRS score≤2,81 cases)and a poor outcome group(mRS score:3-6,41 cases).Their baseline data,and plasma circPTP4A2 and circTLK2 levels were compared between the two groups.Multivariate logistic regression analysis was employed to iden-tify prognostic factors for poor outcomes in the elderly AIS patients.ROC curve analysis was ap-plied to evaluate the prognostic value of circPTP4A2 and circTLK2 for adverse outcomes in the patients.Pearson correlation analysis was performed to assess the relationship of plasma levels of circPTP4A2 and circTLK2 with NIHSS score,as well as mRS score.Results The plasma expres-sion levels of circPTP4A2 and circTLK2 were significantly higher in the poor outcome group than the good outcome group[2.08(0.87,2.77)vs 0.93(0.63,1.20),1.71(0.92,2.80)vs 0.75(0.49,1.09),P＜0.01].Multifactor logistic regression analysis showed that plasma circPTP4A2 and circTLK2 were independent predictive factors for poor functional outcomes in elderly AIS patients(P＜0.01,P＜0.05).ROC curve analysis demonstrated that the AUC value of combined circPTP4A2 and circTLK2 in predicting poor outcome in elderly AIS patients was 0.787(95％CI:0.691-0.883).Pearson correlation analysis revealed that the expression levels of circPTP4A2 and cir-cTLK2 in elderly AIS patients were mildly positively correlated with baseline NIHSS scores(r=0.463,r=0.456;P＜0.01)and moderately positively correlated with mRS scores at 3 months after stroke onset(r=0.682,r=0.604;P＜0.01).Conclusion Plasma circPTP4A2 and circTLK2 may be potential biomarkers for predicting neurological functional outcomes in elderly AIS patients.

Objective To analyze the radiological features of idiopathic pediatric meningiomas and explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery.Methods We retrospectively reviewed 29 cases of pathologically confirmed pediatric meningiomas with pre-operative magnetic resonance imaging in Beijing Tiantan Hospital from November 2014 to July 2018.We assessed the imaging features to explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery. Results Among the 29 cases,7 intraparenchymal meningiomas,5 extraparenchymal meningiomas,4 ventricular meningiomas,and 1 transcranial meningioma were misdiagnosed.Tumor location was significantly associated with possibility of misdiagnoses(
Child ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms/diagnostic imaging* ; Meningioma/diagnostic imaging* ; Retrospective Studies

Meridian theory plays an important role in the guidance of clinical practice of acupuncture and moxibustion. Since the publication of(), the meridian theory has been developed. In the paper, in view of complex science, the topological properties of acupoint-symptom network were analyzed quantitatively by taking acupoint as node and indication as the connection, such as high clustering coefficient and the small world effect. It was the first time to give the abstraction for the topological proof of the high efficiency information transmission property of acupoint-symptom network meridian system at different times. Its quantitative and digitalized significance was analyzed on the development of meridian theory under the complex scientific background so as to provide a new thought and method for the study of meridian theory and acupuncture modernization.