Objective:To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.Methods:Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale(NIHSS)score≤3 and a platelet count<100×109/L were obtained from a multicenter register.Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded.Short-term safety outcomes were in-hospital bleeding events,while the long-term safety outcome was a 1-year all-cause death.The short-term neurological outcomes were evaluated by modified Rankin scale(mRS)score at discharge.Results:A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled.Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge(OR=1.657,95%CI:1.253-2.192,P<0.01)and did not increase the risk of intracranial hemorrhage(OR=2.359,95%CI:0.301-18.503,P>0.05),compared with those without antiplatelet therapy.However,dual-antiplatelet therapy did not bring more neurological benefits(OR=0.923,95%CI:0.690-1.234,P>0.05),but increased the risk of gastrointestinal bleeding(OR= 2.837,95%CI:1.311-6.136,P<0.01)compared with those with mono-antiplatelet therapy.For patients with platelet counts≤75×109/L and>90×109/L,antiplatelet therapy significantly improved neurological functional outcomes(both P<0.05).For those with platelet counts(>75-90)×109/L,antiplatelet therapy resulted in a significant improvement of 1-year survival(P<0.05).For patients even with concurrent coagulation abnormalities,mono-antiplatelet therapy did not increase the risk of various types of bleeding(all P>0.05)but improved neurological functional outcomes(all P<0.01).There was no significant difference in the occurrence of bleeding events,1-year all-cause mortality risk,and neurological functional outcomes between aspirin and clopidogrel(all P>0.05).Conclusions:For non-cardioembolic mild stroke patients with thrombocytopenia,antiplatelet therapy remains a reasonable choice.Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.

Objective:To investigate the Chinese anesthesiologist′s proficiency, training experience and needs of flexible bronchoscope-guided awake flexible bronchoscopy intubation (AFBI) using a questionnaire method.Methods:The cluster sampling was used, and self-designed questionnaires that addressed 54 questions in 5 categories were distributed through WeChat and online platforms. The survey took one month, and the answers were automatically recorded by the WeChat server.Results:A total of 1 250 anesthesiologists participated in the survey in 30 provinces of China, 9 of them were not anesthesiologists, and 1 241 (99.28%) questionnaires were validated. In the valid questionnaires, 52.70% (654) of the anesthesiologists were from tertiary hospitals, and 74.78% (928) of the anesthesiologists were attending physicians or above, only 7.57% (94) of the anesthesiologists had sufficient confidence in AFBI. Twenty-five point two two percent (313) of the anesthesiologists preferred fiberoptic intubation as the first tool when dealing with the anticipated difficult airway. Forty-eight point one one percent (597) of the anesthesiologists had implemented AFBI. Among them, 80.74% (482) had experienced unsuccessful AFBI practices. Eight hundred and ninety-four anesthesiologists had received AFBI training, and the most common AFBI training strategy was theoretical lectures. In addition, the degree of satisfaction regarding the theoretical lectures quality, technical training, clinical practice relativity and non-technical skills training was 21.47% (192), 14.32% (128), 12.3% (110) and 17.90% (160), respectively. The degree of satisfaction with all the 4 training elements mentioned above was 7.27% (65).Conclusions:The awareness and practice of Chinese anesthesiologists in terms of clinical application of AFBI to treat difficult airways need to be strengthened at present, and the lack of high-quality AFBI training may be the key.

Objective:To investigate the effect of virtual reality (VR) attention training on cognitive function in patients with depressive episode.Methods:64 patients diagnosed as major depressive disorder and bipolar disorder depressive episodes according to the DSM-5 criteria were recruited. They were randomized into virtual reality training (VRT) group ( n=23), computerized cognitive remediation therapy (CCRT) group ( n=21) and blank control group ( n=20). Prior to the intervention, seven cognitive functions were assessed with the MATRICS Consensus Cognitive Battery (MCCB)-B version in all patients, via information processing speed (IPS), attention/alertness (ATT), working memory, word learning, visual learning (VL), reasoning and problem solving, and social cognition. VRT group and CCRT group were trained for four weeks at a frequency of five days a week, and half an hour for each day training. Blank control group did not receive any treatment related to attention training. After the training, three groups were assessed by the MCCB-A. The differences of the cognitive functions among three groups were explored by the repeated analysis of ANOVA and paired sample ttest. Results:(1) Before the intervention, there were no differences in all cognitive functions (all P>0.05) among three groups. (2) After four-week interventions, the cognition of IPS, ATT and VL in VRT group (56.74±9.68, 56.48±10.22, 57.83±4.16), CCRT group (48.90±9.77, 49.48±9.51, 55.95±5.52) and the blank control group (50.35±7.93, 47.55±7.80, 47.95±9.90) had significant groups×time interactions ( F=14.06, 12.88, 9.39, all P<0.01); simple effect analysis showed that IPS and ATT scores in VRT group were higher than both CCRT group and the blank control group (all P<0.05), while the VL scores in VRT group and CCRT group were both higher than the blank control group (all P<0.01).(3) Cognitive functions in VRT group significantly improved in IPS, ATT, VL and overall domains compared with the baseline ( t=-9.33, -6.00, -5.13, -6.26, all P<0.01). Conclusion:VR attention training may be more beneficial than CCRT attention training to improve the attention among depressive patients.

Objective:To investigate the character and prevalence of cognitive impairment of patients with bipolar Ⅱ depression (BD-Ⅱ).Methods:124 patients diagnosed as bipolar Ⅱ depression according to the DSM-5 criteria and 124 demographically matched healthy subjects were recruited. Seven cognitive functions were assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery(MCCB) in all participants, including speed of processing (SOP), attention vigilance (AV), working memory (WM), verbal learning (VER), visual learning (VIS), reasoning problem solving (RPS), and social cognition (SC), and the composite. Analysis of covariance was used to test the differences in cognitive function. The number and percentage of cognitive domains impairment which was defined as the cognitive domains scored below standard values by 1, 1.5 and 2 standard deviation (SD) were explored.Results:(1) BD-Ⅱ patients were significantly impaired on seven MCCB domains and the composite scores compared with HC (all P<0.01). Correlation analysis showed that the scores of VER, RPS negatively correlated to the number of episodes ( r=-0.212, P=0.018; r=-0.183, P=0.042); (2) Most healthy control participants were not impaired on any 2 cognitive domains at 1.5 SD (79.84%,99/124) and 2 SD (92.74%,115/124) cut-offs, with the 2.42%-6.45% cognitive impairment at the 1.5 SD cut-off, and 0-4.84% at the 2 SD cut-off accordingly. (3) At the 1.5 SD cut-off, 33.06%,41/124 of the BD-Ⅱ patients were cognitively impaired in two or more domains, while at the 2.0 SD cut-off, 14.52%,18/124 of patients were cognitively impaired. Meanwhile, the incidence of impairment in various cognitive domains was 9.68%-24.19% and 3.23%-15.32%, of which the incidence rate of visual learning impairment was 12.90%, and the incidence rate of impairment in working memory and social cognition was 24.19%. Conclusions:Participants with BD-Ⅱ depression were generally impaired on a greater number of cognitive domains with a higher percentage than the healthy controls, especially on the cognitive domains of working memory, visual learning, and social cognition. And the domains of verbal learning and reasoning problem solving were negatively correlated with the number of episodes.

Objective:To investigate the effect of virtual reality (VR) attention training on cognitive function in patients with depressive episode.Methods:64 patients diagnosed as major depressive disorder and bipolar disorder depressive episodes according to the DSM-5 criteria were recruited. They were randomized into virtual reality training (VRT) group ( n=23), computerized cognitive remediation therapy (CCRT) group ( n=21) and blank control group ( n=20). Prior to the intervention, seven cognitive functions were assessed with the MATRICS Consensus Cognitive Battery (MCCB)-B version in all patients, via information processing speed (IPS), attention/alertness (ATT), working memory, word learning, visual learning (VL), reasoning and problem solving, and social cognition. VRT group and CCRT group were trained for four weeks at a frequency of five days a week, and half an hour for each day training. Blank control group did not receive any treatment related to attention training. After the training, three groups were assessed by the MCCB-A. The differences of the cognitive functions among three groups were explored by the repeated analysis of ANOVA and paired sample ttest. Results:(1) Before the intervention, there were no differences in all cognitive functions (all P>0.05) among three groups. (2) After four-week interventions, the cognition of IPS, ATT and VL in VRT group (56.74±9.68, 56.48±10.22, 57.83±4.16), CCRT group (48.90±9.77, 49.48±9.51, 55.95±5.52) and the blank control group (50.35±7.93, 47.55±7.80, 47.95±9.90) had significant groups×time interactions ( F=14.06, 12.88, 9.39, all P<0.01); simple effect analysis showed that IPS and ATT scores in VRT group were higher than both CCRT group and the blank control group (all P<0.05), while the VL scores in VRT group and CCRT group were both higher than the blank control group (all P<0.01).(3) Cognitive functions in VRT group significantly improved in IPS, ATT, VL and overall domains compared with the baseline ( t=-9.33, -6.00, -5.13, -6.26, all P<0.01). Conclusion:VR attention training may be more beneficial than CCRT attention training to improve the attention among depressive patients.

Objective:To investigate the character and prevalence of cognitive impairment of patients with bipolar Ⅱ depression (BD-Ⅱ).Methods:124 patients diagnosed as bipolar Ⅱ depression according to the DSM-5 criteria and 124 demographically matched healthy subjects were recruited. Seven cognitive functions were assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery(MCCB) in all participants, including speed of processing (SOP), attention vigilance (AV), working memory (WM), verbal learning (VER), visual learning (VIS), reasoning problem solving (RPS), and social cognition (SC), and the composite. Analysis of covariance was used to test the differences in cognitive function. The number and percentage of cognitive domains impairment which was defined as the cognitive domains scored below standard values by 1, 1.5 and 2 standard deviation (SD) were explored.Results:(1) BD-Ⅱ patients were significantly impaired on seven MCCB domains and the composite scores compared with HC (all P<0.01). Correlation analysis showed that the scores of VER, RPS negatively correlated to the number of episodes ( r=-0.212, P=0.018; r=-0.183, P=0.042); (2) Most healthy control participants were not impaired on any 2 cognitive domains at 1.5 SD (79.84%,99/124) and 2 SD (92.74%,115/124) cut-offs, with the 2.42%-6.45% cognitive impairment at the 1.5 SD cut-off, and 0-4.84% at the 2 SD cut-off accordingly. (3) At the 1.5 SD cut-off, 33.06%,41/124 of the BD-Ⅱ patients were cognitively impaired in two or more domains, while at the 2.0 SD cut-off, 14.52%,18/124 of patients were cognitively impaired. Meanwhile, the incidence of impairment in various cognitive domains was 9.68%-24.19% and 3.23%-15.32%, of which the incidence rate of visual learning impairment was 12.90%, and the incidence rate of impairment in working memory and social cognition was 24.19%. Conclusions:Participants with BD-Ⅱ depression were generally impaired on a greater number of cognitive domains with a higher percentage than the healthy controls, especially on the cognitive domains of working memory, visual learning, and social cognition. And the domains of verbal learning and reasoning problem solving were negatively correlated with the number of episodes.