Branch atheromatous disease (BAD) is a common type of acute ischemic stroke, accounting for 10% to 15% of all ischemic stroke etiologies. Clinically, it often presents as early neurological deterioration (END) primarily characterized by progressive motor deficits, leading to poor clinical outcomes. The mechanism of END in BAD patients has not been fully elucidated, and there is a lack of effective risk prediction markers and treatment strategies. With the application of high-resolution and high-field magnetic resonance imaging technologies to evaluate the vessel wall of parent artery and the morphology of penetrating artery, the pathogenesis and progression mechanisms of BAD have been further revealed. Some studies have shown that the effectiveness and safety of using enhanced antiplatelet agents such as tirofiban or combining antiplatelet therapy with anticoagulant treatment such as argatroban are gradually emerging. This article will focus on the research progresses in imaging evaluation and treatment of BAD, aiming to enhance clinicians′ understanding of BAD to take early measures to prevent END, reduce recurrence, and improve patient prognosis.

Objective:To explore the application effect of flipped classroom teaching combined with micro-classes and PBL in the training of refresher nurses.Methods:Using the cluster sampling method, 35 refresher nurses from March 2017 to February 2018 were collected as the control group, and 38 refresher nurses from March 2018 to February 2019 were included as the observation group. The control group received the theoretical knowledge training of respiratory specialty by traditional teaching method, and the observation group received theoretical knowledge training of respiratory specialty by using flipped classroom teaching combining micro-classes and PBL. Before and after the training, the special theory assessment with the same difficulty was carried out, and the clinical teaching evaluation was carried out after the training.Results:After the training, the special theory assessment scores of the observation group were significantly higher than those of the control group ( t=7.560, P<0.05), with significant differences. Compared with the control group, the clinical teaching evaluation scores of the nurses in the observation group were significantly improved ( t=24.657, P<0.05), with significant differences, especially in the nurses' learning attitude, learning ability, teaching style and teaching satisfaction scores. Conclusion:The flipped classroom teaching combining micro-classes and PBL can significantly improve the special theory assessment scores of refresher nurses, promote the internalization of specialized knowledge, turn to active learning from the passive mode, change the learning attitude of refresher nurses, improve their recognition of clinical teachers and realize teaching benefits as well as learning benefits.

Objective? To expLore the knowLedge, attitude and practice status quo of puLmonary rehabiLitation among nurses in respiratory department, and to provide theoreticaL basis for cLinicaL training and quaLity controL. Methods? From JuLy to August 2018, a totaL of 134 respiratory nurses who participated in a continuing education training course in Sichuan Province were convenientLy seLected as the research objects. The questionnaire of knowLedge, attitude and practice of Lung rehabiLitation of nursing staff was used to investigate them. The univariate anaLysis of knowLedge, attitude and practice of Lung rehabiLitation of nursing staff were anaLyzed by t test and variance anaLysis. ResuLts? The totaL score of knowLedge, attitude and practice in puLmonary rehabiLitation among nurses was (101.63±19.58). The average scores of the three dimensions from high to Low were attitude (4.07±0.98), practice (3.08±1.09) and knowLedge (3.03±1.01). There were statisticaL differences in the totaL score of knowLedge, attitude and practice of nurses with different professionaL titLes and whether they had received Lung rehabiLitation training or not (P＜0.05). ConcLusions? The knowLedge, attitude and practice of puLmonary rehabiLitation of nursing staff in respiratory department need to be improved. Nursing administrators shouLd strengthen guidance and training of puLmonary rehabiLitation and strengthen nurses' abiLity to impLement puLmonary rehabiLitation so as to ensure the effective impLementation of puLmonary rehabiLitation in cLinicaL work.

Objective? To explore the effects of "prehospital-emergency department-intensive care unit (ICU)" scene simulation teaching on first-aid thinking skills among nursing students. Methods? We selected nursing students from two classes enrolled in 2016, in Suzhou Vocational Health College Nursing School as subjects by convenience sampling. All of the students were divided into experimental group (n=109) and control group (n=99) according to classes. Nursing students of control group adopted the traditional teaching model of case discussion, while nursing students of experimental group were taught with the "prehospital-emergency department-ICU" scene simulation teaching model. After class, the self-designed first-aid thinking skills questionnaire was used to assess nursing students between two groups. Results? After implementation, the first-aid thinking skills of experimental group was better than that of control group with statistical difference (P＜0.05). Conclusions? The application of "prehospital-emergency department-ICU" scene simulation teaching in emergency and critical care nursing education helps to cultivate the first-aid thinking skills for nursing students.

Objective To systematically analyze the research trend of home non-invasive positive pressure ventilation in China. Methods The related literature in CBM database, CNKI database, Wanfang database and VIP database about home non-invasive positive pressure ventilation were reviewed and analyzed by Bibliometric. Results There were 214 articles retrieved, which had an increasing tendency.They were distributed in 135 kinds of journals and 28 provinces.The most research type was the experimental research(39.72%)and the research content focused on clinical effects of home non-invasive ventilation (47.67%). The average duration of researches was 12.33 months and the average interval for follow-up was 6.33 weeks. Conclusions Providing scientific and effective long-term medical support, optimizing the application process of home non-invasive ventilation and formulating scientific clinical standard should be the future research direction.

Objective To explore the characteristics and influencing factors of depressive symptoms among the only-child-lost persons.Methods A total of 841 only-child-lost persons and 674 controls conforming to entering group condition were selected.The difference of SDS score between the two groups and the demographic characteristics distribution differences of depression severity in only-child-lost persons were compared and the influencing factors were analyzed.Results The SDS score had statistical difference between the only-child-lost persons group and control group(P＜0.05),and was correlated to the only-child-lost years and no physical disease;the proportion of mild to moderate depression in the only-child-lost persons of the low cultural level,somatic diseases and middle income level groups was significantly higher than that in the other groups;the only-child-lost persons with low income level,age≤60 years old and high educational level had a higher proportion of severe depression;the Logistic regression analysis showed that the educational level had a significant influence on the depression onset among the only-child-lost persons,the difference was statistically significant(P＜0.05).Conclusion The characteristics of depressive symptoms among the only-child-lost persons are related to their demographic characteristics.

Objective To study the living quality and mental health status in losing-single-child family couples .Methods A total of 841 losing-single-child family couples and 674 family couples with children alive conforming to the entering group condition were random sampled from the three districts of Chongqing main city .The on-site survey was performed by using the general condi-tion questionnaire ,90 Symptom Checklist (SCL-90) ,Self-rating Anxiety Scale (SAS ) ,Self- rating Depression Scale (SDS ) ,Social Support Rating Scale (SSRS) ,Memorial University of Newfoundland Scale of Happiness (MUNSH) and WHO Quality of Life Scale (WHOQOL-BREF) Chinese version .Results There were no differences in gender ,age and culture between the losing-single-child family couples group and family couples with children alive group (P>0 .05);the SCL-90 total score and each factor score , SAS and SDS score in the losing-single-child family couples group were significantly higher than those in family couples with chil-dren alive group(P<0 .05) ,the SSRS score ,MUNSH score and WHOQOL-BREF Chinese version evaluation score were signifi-cantly lower than those in the family couples with children alive group(P<0 .05);the multivariate regression analysis showed that the four regression equations in the social relation field ,environment field ,depression factors and total happiness had statistical sig-nificance (P<0 .05) .Conclusion The living quality ,mental health status and subjective well-being in the losing-single-child family couples are significantly affected ,timely psychological crisis intervention and persistent psychological support and mental health ed-ucation should be give them to improve their psychological health status ,increase the living quality and subjective well-being .

Objective To compare the application effects of different aerosol inhalation methods of continuous non-invasive positive pressure ventilation (NIPPV)in the treatment of the patients with AECOPD combined withⅡ type respiratory failure and offer reference for the appropriate choice of patients' aerosol inhalation methods.Methods With the convenience sampling method, totals of 150 continuous NIPPV patients with AECOPD combined withⅡ type respiratory failure were divided into the observation group and the control group according to the hospitalization time (75 patients in each group). The patients in the control group used NIPPV and the standard oral spray driven by the atomizing pump. In the observation group the aerosol inhalation device was connected between the nasal face mask/nasal mask and the pipeline of the breathing machine. The patients in the observation group used NIPPV combined with the inhalation of atomizing drugs. Patients' oxygen saturation,heart rate, respiratory rate, dyspnea, dry mouth and sore throat, expectoration difficulties and comfort level in the two groups were compared between before and after the aerosol inhalation.Results After the aerosol inhalation,the heart rate and the respiratory rate in the observation group were (98.32±3.39)times/min and (23.16±1.30) times/min respectively, which were significantly lower compared with the control group [heart rate:(100.18±3.16)times/min,t=3.476,P<0.05; respiration rate: (25.67±1.21) times/min,t=12.240,P<0.05].The scores of dry mouth and sore throat, expectoration difficulties, and the comfort level in the observation group were (17.53±2.73), (20.49±3.71)and (17.81±4.47),which were significantly higher compared with the control group [dry mouth and sore throat:(16.48±3.07),t=2.213,P<0.05; expectoration difficulties:(14.43±2.18),t=12.196,P<0.05; comfort level:(16.37±3.74),t=2.140,P<0.05].Conclusions In the process of the continuous NIPPV, the aerosol inhalation device and nasal face mask are connected in the pipeline of the non-invasive breathing machine for the aerosol inhalation treatment, which can improve the therapy effect and the comfort level for patients and decrease the adverse effect level due to the use of the breathing machine.

OBJECTIVETo examine the contribution of insulin related indices on the association between body fat and blood pressure among overweight adults.

METHODSFrom April to May 2014, based on convenience sampling, we recruited overweight and obese volunteer participants aged 20-55 years living in Beijing at least 1 year through a strict examination by doctors in a physical examination center. In this study, we excluded the participants who reported suffering from any severe heart, lung, liver or kidney organic diseases, and abnormal development, disabilities, and secondary obesity caused by other disease. Also participants with use of antihypertensive drugs, hypoglycemic drugs and lipid lowering drugs were excluded for this study. A total of 1 221 participants were investigated in this study. With a simple self-designed questionnaire, the birthdates, sex, drug use, and disease history were examined. Participants' blood pressure (BP), percentage of body fat (PBF), glucose and fasting insulin level were measured. Mediation analysis was used to analyze the total effect of PBF on BP (c), the association between PBF and insulin related indices (a), and the mediation effect of serum fasting insulin level/HOMA-IR/HOMA-%S on relation between PBF and systolic/diastolic blood pressure (SBP/DBP).

RESULTSPBF was positively associated with SBP (c=0.25 ± 0.05 and 0.19 ± 0.03 for male and female, respectively, P<0.001). In males, PBF was positively associated with fasting insulin level and HOMA-IR (a=0.28 ± 0.05 and 0.24 ± 0.05, P<0.001), and negatively associated with HOMA-%S (a=-0.29 ± 0.05, P<0.001); in females, PBF was positively associated with fasting insulin level, HOMA-IR (a=0.21 ± 0.04 and 0.20 ± 0.04, P<0.001), and negatively associated with HOMA-%S (a=-0.13 ± 0.04, P<0.001). In further mediation analysis for female participants, fasting insulin level/HOMA-IR/HOMA-%S played mediation roles in the relation between PBF and SBP, with ratio of mediation of 13.78%,18.3%, and 5.98%. Fasting insulin level/HOMA-IR also mediated the relation between PBF and DBP, with mediation ratio of 11.98% and 14.13%.

CONCLUSIONIn overweight/obese female participants, insulin related indices mediated the relation between PBF and BP.

Adipose Tissue ; physiology ; Adult ; Beijing ; Blood Glucose ; analysis ; Blood Pressure ; Body Mass Index ; Female ; Humans ; Insulin ; physiology ; Insulin Resistance ; Male ; Middle Aged ; Obesity ; physiopathology ; Overweight ; physiopathology ; Risk Factors ; Young Adult

Objective To explore the application of objective structured clinical examination ( OSCE) in the ‘Adult Surgical Nursing’ practical teaching. Methods OSCE testing approaches were designed from September 2014 to January 2015. A total of 52 students in Grade 2013 were tested in practical teaching of‘Adult Surgical Nursing’ using OSCE, which included comprehensive knowledge, trauma nursing, preoperative preparation, operation members′preparation, operation cooperation, professional nursing procedures and judging ability of pictures and videos. The questionnaire surveys and test results analyzation were performed after the test. Results Qualification rate of OSCE test was 100%. Trauma nursing had the lowest score (73.19±4.27) and comprehensive knowledge had the highest score (83.77±4.41). The average index of difficulty and confidence were 0.63-0. 78 and 0. 66-0. 72. According to questionnaire surveys, 96. 2% of nursing students thought the OSCE needed to be promoted, 69.2% of nursing students felt tired during the test and 38.5% of nursing students considered that the localization of test affected students′performance and the time controlling and place selection needed to be improved.Conclusions OSCE has good confidence and could truly report practical skills and comprehensive knowledge of nursing students. Nurses are stratified to the test. It could be optimized and promoted in the ‘Adult Surgical Nursing’ practical teaching.