Objective To investigate the efficacy and safety of hybrid surgery for the recanalization of carotid artery occlusion after stenting.Methods Clinical data and results of 17 patients with occlusion after carotid artery stenting and treated with hybrid surgery from June 2016 to April 2023 at the Department of Neurosurgery Cerebral Blood Flow Reconstruction Center of Xuanwu Hospital,Capital Medical University were retrospectively analyzed.According to whether the recanalization was successful,17 patients were divided into the the successful recanalization group and the failed recanalization group.Successful recanalization was defined as achieving modified thrombolysis in cerebral infarction(mTICI)grade ≥2b and residual stenosis＜50％.Baseline data(age,sex,body mass index,smoking history,alcohol consumption history,hypertension history,diabetes history,hyperlipidemia history,coronary heart disease history),clinical data(National Institutes of Health Stroke Scale[NIHSS]score at admission,fasting blood glucose,low density lipoprotein,high density lipoprotein,total cholesterol,triglyceride,occlusion side and segment,combination with severe stenosis or occlusion of the contralateral carotid artery,opening of the anterior communicating artery,opening of the posterior communicating artery,compensation of the external and internal carotid artery,compensation of the pia artery,stump morphology,and time from imaging diagnosis of occlusion to recanalization)were documented and compared between groups.The recanalization of occlusive vessels and perioperative complications were recorded.Imaging and clinical follow-up were performed 3,6 months and≥1 year after surgery.Results Among the 17 patients,the ratio of successful recanalization was 13/17.One patient had re-occlusion after operation,which was re-opened after thrombolysis,but neck hematoma with dyspnea occurred,and recovered after emergency operation.There was no postoperative stroke or death.The incidence of perioperative complications was 1/17.Compared with the successful recanalization group,the levels of high density lipoprotein and total cholesterol in the failed recanalization group were higher,and the differences between the groups were statistically significant(high density lipoprotein[1.3±0.3]mmol/L vs.[0.9±0.3]mmol/L,t=-2.139;total cholesterol:[4.2±0.8]mmol/L vs.[3.1±0.7]mmol/L,t=-2.649;both P＜0.05);There were no significant differences in other baseline data and clinical data(all P＞0.05).Imaging follow-up was completed in 9 of the 13 patients in the successful recanalization group,and the follow-up time was 3.8-36.9 months,with a median follow-up time of 22.8(12.8,34.7)months.Among them,1 patient(1/9)developed restenosis of recanalization vessels at 33.0 months after surgery and underwent stent implantation again.Conclusions The preliminary analysis showed that the occlusion after carotid artery stenting had better recanalization success and lower perioperative complications.In patients with chronic occlusion after carotid stenting,the application of a hybrid surgery for opening may be attempted under multimodal imaging assessment.

Objective To explore the factors influencing the efficacy of conventional Western medicine treatment for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide a basis for individualized clinical treatment.Methods 100 patients with AECOPD were prospectively included in this study,and all of them were given standard treatment plans according to the guidelines.After 3 months of follow-up observation,53 cases were evaluated as effective and included in the effective group;47 cases were evaluated as having no significant effect and included in the ineffective group.Differences in basic characteristics between the two groups in terms of age,duration of COPD,respiratory rate,lung function and consolidated malignancy were compared,and pre-treatment laboratory test indexes and blood gas analysis data were collected for comparison.Results There were significant differences between the two groups in terms of age,duration of COPD,respiratory rate,ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC%),consolidated malignancy,hemoglobin,lymphocytes,C-reactive protein,glutamic-pyruvic transaminase and PaCO2(P<0.05).Univariate logistic regression analysis showed that older age,prolonged COPD duration,increased respiratory rate,decreased FEV1/FVC%,consolidated malignancy,decreased hemoglobin,decreased lymphocyte count,increased C-reactive protein,increased glutamic-pyruvic transaminase,increased lactate,and increased PaCO2 were risk factors for poor treatment outcome in AECOPD.Further multifactorial logistic regression analysis showed that age(P=0.007,OR=1.240),FEV1/FVC%(P=0.014,OR=0.757),hemoglobin(P=0.038,OR=0.954),lymphocyte count(P=0.007,OR=0.488),and lactate(P=0.002 OR=9.964)were independent risk factors affecting the efficacy of AECOPD treatment.ROC curve analysis showed that the AUCs for age,FEV1/FVC%,hemoglobin,lymphocyte count and lactate were 0.728[95%CI(0.627,0.829)],0.681[95%CI(0.576,0.785)],0.686[95%CI(0.582,0.790)],0.629[95%CI(0.520,0.737)]and 0.823[95%CI(0.744,0.902)],respectively,and the combined AUC of the five risk factors for predicting a poor AECOPD treatment outcome was 0.957[95%CI(0.923,0.991).Conclusion Age,FEV1/FVC%,hemoglobin,lymphocyte count and lactate are independent risk factors that influence the treatment outcome of AECOPD patients.The comprehensive analysis of these risk factors can predict the treatment effect of AECOPD more accurately,help clinicians adjust the treatment plan in time,and improve the treatment effect and prognosis.

Objective:To investigate the value of implantable cardiac monitor (ICM) in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods:This was a multi-center, prospective cohort study. Between June 2018 and April 2021, patients over the age of 60 with unexplained syncope at Beijing Hospital, Fuwai Hospital, Beijing Anzhen Hospital and Puren Hospital were enrolled. Patients were divided into 2 groups based on their decision to receive ICM implantation (implantation group and conventional follow-up group). The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up. Kaplan‐Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups. A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results:A total of 198 patients with unexplained syncope, aged (72.9±8.25) years, were followed for 558.0 (296.0,877.0) d, including 98 males (49.5%). There were 100 (50.5%) patients in the implantation group and 98 (49.5%) in the conventional follow-up group. Compared with conventional follow-up group, patients in the implantation group were older, more likely to have comorbidities, had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram, and had a lower body mass index (all P<0.05). During the follow-up period, positive cardiac arrhythmia events were recorded in 58 (58.0%) patients in the ICM group. The diagnosis rate (42.0% (42/100) vs. 4.1% (4/98), P<0.001) and the intervention rate (37.0% (37/100) vs. 2.0% (2/98), P<0.001) of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group (all P<0.001). Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group ( HR=11.66, 95% CI 6.49-20.98, log-rank P<0.001). Multivariate analysis indicated that ICM implantation, previous atrial fibrillation, diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope (all P<0.05). Conclusions:ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope, and increases diagnostic efficiency in patients with unexplained syncope.

Objective:This study investigated the changes of cortical thickness in patients with Parkinson's cognitive dysfunction.Methods:In this cross-sectional study, general clinical data and head magnetic resonance imaging data were collected from Parkinson's disease(PD)patients and healthy controls who were hospitalized or outpatient in the Department of Geriatric Neurology of the First Affiliated Hospital of Kunming Medical University from January 2019 to December 2020.We observed the changes of cortical thickness in each group, and analyzed the correlation between cortical thickness and cognitive dysfunction in PD.Results:Compared with PD normal cognitive group, the cortical thickness of the left superiortemporal gyrus[(2.7±0.1)mm, (2.4±0.1)mm, t=-4.194], left supramarginal[(2.4±0.1)mm, (2.2±0.1)mm, t=-4.845], right insula[(3.0±0.1)mm, (2.7±0.1)mm, t=-4.170], left parahippocampal[(2.8±0.3)mm, (2.4±0.3)mm, t=-4.164]decreased in PD cognitive impairment group(all P<0.05), and cortical thickness of the right parsorbitalis[(2.5±0.2)mm, (2.4±0.2)mm, t=-4.226], left entorhinal[(3.5±0.3)mm, (3.1±0.4)mm, t=-4.583], left inferiortemporal[(2.7±0.2)mm, (2.5±0.1)mm, t=-6.229], left supramarginal[(2.4±0.1)mm, (2.1±0.1)mm, t=-3.236], right fusiform[(2.8±0.1)mm, (2.5±0.1)mm, t=-5.364], right lingual[(2.0±0.1)mm, (1.9±0.1)mm, t=-3.887], right insula[(3.0±0.1)mm, (2.7±0.2)mm, t=-5.326], right isthmuscingulate[(2.6±0.2)mm, (2.3±0.2)mm, t=-3.743]decreased in PD severe cognitive impairment group, the statistical difference was significant(all P<0.05). The cerebral cortex thickness was positively correlated with Mini-Mental State Examination and different cognitive areas, and negatively correlated with Hoehn-Yahrr grading. Conclusions:Local cortical thinning was observed in PD patients with cognitive impairment, whereas cortical involvement was more extensive in PD patients with severe cognitive impairment.

Objective:To analyze the genetic etiology of 487 fetuses with increased nuchal translucency (NT) using copy number variant sequencing (CNV-seq) and explore the relationship between increased NT and chromosomal abnormality.Methods:A retrospective study was performed on 487 fetuses with increased NT who received CNV-seq in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020. These fetuses either had NT of ≥3.0-<3.5 mm (Group A, n=129) or ≥3.5 mm (Group B, n=358), the distribution and incidence of chromosomal abnormalities in the two sets of fetuses were analyzed using Chi square test or Fisher's exact test. Results:Fetuses with abnormal chromosomes accounted for 25.9%(126/487) of cases, including 107 with chromosome aneuploidy (22.0%) and 19 with pathogenic or likely pathogenic copy number variation (CNV, 3.9%). The detection rate of fetal aneuploidy in Group B was higher than that in Group A [14.0% (18/129) vs 24.9% (89/358), χ2=6.58, P=0.010]. However, no significant difference was observed regarding the detection rate of pathogenic or likely pathogenic CNV between the two groups ( χ2=0.30, P=0.584). Conclusions:The risk of fetal chromosome aneuploidy increased with NT thickness, but not with pathogenic or likely pathogenic CNV, which needed further verification due to the small sample size. CNV-seq is an option to detect the conventional detection methods for the genetic etiology of NT thickening fetuses.

In the all-media era, communication channels are increasingly diversified and the modes of communication are undergoing profound changes. Same medical institutions ignore the development of all media, which lead to rigid and backward communication situation, affect the healthy development of medical and health undertakings. Mastering and making good use of the advantages and characteristics of communication in the all-media era will also provide more motivation and possibilities for strengthening ideological work. This paper expounded the significance of strengthening the dissemination of socialist ideology in hospitals, proposed the opportunities and challenges faced by hospitals in strengthening the dissemination of socialist ideology in the all-media era, and then put forward specific coping strategies combined with the actual situation of hospitals.

Although chromosomal mosaic embryos detected by trophectoderm(TE)biopsy offer healthy embryos available for transfer,high-resolution postnatal karyotyping and chromosome testing of the transferred embryos are insufficient.Here,we applied single-cell multi-omics sequenc-ing for seven infants with blastula chromosomal mosaicism detected by TE biopsy.The chromo-some ploidy was examined by single-cell genome analysis,with the cellular identity being identified by single-cell transcriptome analysis.A total of 1616 peripheral leukocytes from seven infants with embryonic chromosomal mosaicism and three control ones with euploid TE biopsy were analyzed.A small number of blood cells showed copy number alterations(CNAs)on seem-ingly random locations at a frequency of 0％-2.5％per infant.However,none of the cells showed CNAs that were the same as those of the corresponding TE biopsies.The blastula chromosomal mosaicism may be fully self-corrected,probably through the selective loss of the aneuploid cells dur-ing development,and the transferred embryos can be born as euploid infants without mosaic CNAs corresponding to the TE biopsies.The results provide a new reference for the evaluations of trans-ferring chromosomal mosaic embryos in certain situations.

Objective:To retrospectively analyze the results of prenatal diagnosis for 67 pedigrees affected with Duchenne muscular dystrophy (DMD) from the Central Plain Region of China and explore the optimal diagnostic strategy.Methods:Probands from the 67 pedigrees were subjected to multiplex ligation-dependent probe amplification (MLPA), next-generation sequencing (NGS) and Sanger sequencing to attain the diagnosis. The fetuses were subjected to prenatal diagnosis, and the results were verified with short tandem repeat (STR) analysis.Results:Among the 67 probands, large deletions, duplications and small mutations have accounted for 73.13% (49/67), 10.45% (7/67), and 16.42% (11/67), respectively. A hotspot deletion has involved exons 45 to 52. There were 11 small mutations, among which four were unreported previously. De novo mutations have accounted for 41.80% (28/67), of which 27 were novel large fragment deletions. Prenatal diagnosis was provided to 39 women who have carried the DMD gene mutations, 10 fetuses were identified as male patients and 7 fetuses were female carriers. Among the prenatal diagnosis results of 28 non-carrier pregnancies, one fetus was a male patient with the same mutation site as the proband. Conclusion:For the prenatal diagnosis of DMD, in addition to known pathogenic mutations, deletion of large fragments should also be excluded. Mothers of probands who do not carry the DMD mutation should also undergo prenatal diagnosis to rule out gonadal mosaicism.

Objective:To investigate the prevalence of frailty in elderly patients with stage 3-5 non-dialysis chronic kidney disease(ND-CKD)and to analyze its related factors.Methods:A cross-sectional study was conducted.Patients ≥65 years old with stage 3-5 CKD who had never undergone dialysis in the nephrology department and the internal medicine department of our hospital between October 2017 to September 2018 were enrolled.Patients were divided into the non-frail group and the frail group according to the Fried frailty phenotype.Clinical data and laboratory results were collected and comprehensive geriatric assessment was carried out to evaluate participants' medication, comorbidities, daily living ability, nutritional status, depression, cognitive and physical performance.The relevant factors for frailty were analyzed.Results:A total of 193 elderly patients with stage 3-5 ND-CKD were enrolled, 106 male and 87 female, including 68 outpatients and 125 inpatients, with a median age of 79.00(73.00, 85.00)years.There were 143 frailty patients(74.1%), including 41 outpatients and 102 inpatients, accounting for 60.3% and 81.6% of the eligible outpatients and inpatients respectively.Multivariable Logistic regression analysis showed that CKD stage( OR=9.74, 95% CI: 1.12-84.54)and polypharmacy( OR=3.69, 95% CI: 1.09-12.42)were associated with frailty in outpatients, and CKD stage( OR=11.75, 95% CI: 1.38-99.99)and malnourishment or risk of malnutrition( OR=4.22, 95% CI: 1.40-12.74)were correlated with frailty in inpatients. Conclusions:The prevalence of frailty is high in elderly patients with stage 3-5 ND-CKD.CKD stage, polypharmacy and malnourishment or the risk of malnutrition are closely correlated with frailty.

Objective:This study investigated the professional identity of administrators in 3rd class hospitals in Shanghai, analyzing the professional identity of administrators and associated factors in public hospitals.Methods:In May 2019, Huashan Hospital conducted a questionnaire survey. Through the analysis of the survey data, this study discussed the correlation between the professional identity degree and the external factors. Three main dimensions of occupational identity were extracted by principal component analysis, namely the professional self-identity, organizational identity and social identity. External influencing factors were analyzed by factor analysis, and five main factors were extracted. Results:It was found that the professional self-identity was much higher than the organizational and social identity. The degree of organizational identity was significantly related to external factors ( r=0.212,0.426,0.146,0.580,0.610, P <0.01). Respect factors ( r=0.553,0.580,0.570) and self-realization factors ( r=0.563,0.610,0.433) had the highest correlation with professional identity. Conclusion:Initiating with improving organizational identity, the authorities and hospitals should establish a scientific and reasonable promotion and incentive mechanism to enhance the degree of professional identity.