Objective:To investigate the predictive role of relative diffusion-weighted imaging (DWI) signal intensity (DWI-rSI) in outcome in patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after endovascular therapy (EVT).Methods:Patients with anterior circulation large vessel occlusion stroke due to cardioembolic embolism underwent EVT and successful recanalization at the Affiliated Hospital of Yangzhou University from March 2017 to March 2023 were retrospectively included. According to the modified Rankin Scale score 3 months after procedure, the patients were divided into a good outcome group (0-2 points) and a poor outcome group (3-6 points). Multivariate logistic regression analysis was used to identify independent predictive factors for poor outcome. Results:A total of 59 patients were enrolled, including 29 males (49.2%), median age of 74 years (interquartile range, 68-80 years). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (12-21), and the median DWI Alberta Stroke Program Early CT Score (ASPECTS) was 8 (5-9). Thirty-two patients (54.2%) had good outcome, and 27 (45.8%) had poor outcome. Among them, 9 patients (15.3%) died (6 died from cerebral herniation after malignant brain edema, 2 died from complications, and 1 died from severe intracranial hemorrhage after procedure). Twenty-one patients (35.6%) experienced hemorrhagic transformation, including 12 (20.3%) with symptomatic intracranial hemorrhage. There were significant differences in baseline systolic blood pressure, NIHSS score, DWI-ASPECTS, DWI-rSI, and incidence of symptomatic intracranial hemorrhage between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that baseline systolic blood pressure (odds ratio 0.977, 95% confidence interval 0.919-0.991; P=0.015) and DWI-rSI (odds ratio 11.809, 95% confidence interval 1.932-72.170; P=0.008) were the independent predictors for poor outcome. Conclusion:DWI-rSI can predict the outcome of patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after EVT.

Objective:To investigate the effect of regional leptomeningeal collateral circulation (rLMC) score based on CT angiography (CTA) and onset-to-reperfusion time (OTR) on the outcome after endovascular treatment (EVT) in patients with anterior circulation acute large vessel occlusive stroke (ACA-LVOS).Methods:Patients with ACA-LVOS underwent EVT in the Department of Neurology, the Affiliated Hospital of Yangzhou University from July 2017 to July 2023 were included retrospectively. The rLMC score 0-10 was defined as poor collateral circulation, and 11-20 were defined as good collateral circulation. At 90 days after EVT, the modified Rankin Scale (mRS) was used to evaluate the outcome. A score of 0-2 was defined as a good outcome and 3-6 were defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome after EVT. Results:A total of 144 patients with ACA-LVOS underwent EVT were enrolled, including 78 males (54.2%), median aged 73 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, the median baseline Alberta Stroke Program Early CT Score (ASPECTS) was 9, and the median OTR was 330.5 minutes. Eighty patients (55.6%) had good collateral circulation, 63 (43.8%) had poor outcome, including 13 deaths. Univariate analysis showed that there were significant differences in hypertension, previous stroke history, smoking, triglycerides, baseline NIHSS score, baseline ASPECTS, OTR, and collateral circulation status between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that good collateral circulation (odds ratio [ OR] 0.223, 95% confidence interval [ CI] 0.077-0.643; P=0.005) was an independent predictor of good outcome. In the poor collateral circulation group, longer OTR was an independent predictor of poor outcome ( OR 1.020, 95% CI 1.008-1.032; P=0.001). In the good collateral circulation group, longer OTR was not an independent risk factor for poor outcome ( OR 1.005, 95% CI 1.000-1.010; P=0.062). Conclusion:rLMC score based on CTA and OTR are the independent predictors of the outcome after EVT in patients with ACA-LVOS.

Objective:To translate the health literate healthcare organization 10 item questionnaire(HLHO-10) into Chinese and examine its reliability and validity.Methods:The Chinese version of HLHO-10 questionnaire(HLHO-10-C) was developed by following the Brislin translation model of translation, back translation, cultural adaptation and questionnaire epistemological survey.Five experts and 1 071 medical staff from 24 healthcare organizations in Zhejiang province were selected to conduct the validity and reliability test of the HLHO-10-C.Results:The content validity indices at the item level and total questionnaire level of HLHO-10-C were from 0.8 to 1.0 and 0.96 respectively, and the results of the exploratory factor analysis showed good structural validity.Conclusions:HLHO-10-C proves adequate reliability and validity to serve as a tool for healthcare organizations in evaluating and becoming HLHO. It can also help the implementation of the Healthy China Initiative(2019—2030), which is a performance assessment mechanism for health education and promotion of healthcare providers and health care organizations.

Objective: To evaluate the degree of trust of patients in community traditional Chinese medicine(TCM)physicians, based on the TCM service capability promotion program, and to analyze the impacts by TCM prevention and health care service. Methods: 1 391 patients at 22 primary health service centers in 3 cities from Zhejiang province were investigated using the Chinese version of Wake Forest Physician Trust Scale(WFPTS)in September, 2017. Quantitative and qualitative variables were described by mean±SD, and ratio respectively. Differences were compared by t test, ANOVA and Kruskal-Wallis test. Results: Chinese version of WFPTS had good reliability and validity in measuring community TCM physicians. The average scoring of patients′ trust in community TCM physicians was 38.00±6.42, while their benevolence and competence were 19.14±3.41, 18.82±3.50 respectively.For patients with different demographic characteristics, their quantity and the way to acquire and utilize TCM prevention and health care service had different degrees of trust in community TCM physicians. Patients′ gender, age, awareness and utilization of TCM prevention and health care service, etc. affect the degree of trust in community TCM physicians. Conclusions Patients have higher degree of trust in community TCM physicians, and improving the rate of awareness and utilization of TCM prevention has positive impacts on the degree of trust in these physicians. It is proposed that health knowledge education be strengthened and skills of community TCM physicians′ capacity be enhanced through various ways.

Objective:To review the research progress on the quality evaluation and improvement of pain management in China.Method:Retrieve studies on quality evaluation and improvement of pain management in China in Chinese sci-tech periodical database to make analysis to the literatures selected on a theoretical basis of "structure-process-result" quality management mode.Results:In terms of structural element, most studies have focused on human resources, such as pain training for nurses, but being less concerned about environmental settings, drug stock. In terms of process element, most studies focus on several aspects of pain management at the same time but few focusing on a single aspect. As for result element, satisfaction and pain degree were the most frequently used evaluation indicators.Conclusion:Experimental research and and study on acute pain are mainly used for studies on quality evaluation and improvement of pain management and the types of pain. There are few studies about process element. It is suggested for scholars in China to try to adopt qualitative research to expand and deepen the research content from the structural elements of pain management, the quality evaluation and improvement of chronic tumor pain and chronic non-cancerous pain management.

Objective:To construct a postoperative pain management quality evaluation index system so as to provide an effective tool for postoperative pain management quality by hospital.Methods:From August 2017 to December 2018, original indexes were built based on Donabedian theory and literature research method, and primary indexes were constructed by group discussion. Delphi method was used to two rounds of consultation among 15 postoperative pain management experts to set up the final indexes, and index weight was defined with the analytic hierarchy process.Results:The postoperative pain management quality evaluation index system included 3 first-level indexes, 8 second-level indexes and 32 third-level indexes. The weights of 3 first-level indexes (structure, process and outcome) were 0.2, 0.4 and 0.4 respectively. Top 3 combined weights of second-level included the antalgic effect (0.266 7) , pain evaluation and re-evaluation (0.160 0) , antalgic therapy (0.160 0) . Top 3 combined weights of third-level included the incidence of moderate-severe active pain (0.143 9) , incidence of moderate-severe rest pain (0.079 2) and the sufficient rate of antalgic health education (0.073 0) . The Kendall coefficient of concordance of two rounds of expert consultation were 0.21 and 0.25 with statistical differences ( P<0.01) . Conclusions:The postoperative pain management quality evaluation index system the has all-round, scientific and reasonable content and can reflect the characteristics of multi-link and multidisciplinary cooperation of postoperative pain management which is worthy of clinical promotion.

Objective To investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. Methods From January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. Results A total of 38 patients were enrolled, 19 (50. 00％) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50. 00％, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71. 05％) and 11 had poor outcomes (28. 95％). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89. 47％ vs. 2. 63％; P = 0. 029), and there was no significant difference between the incidence of sICH within 7 days (15. 79％ vs. 5. 26％; P = 0. 604) and 90-day mortality (0％ vs. 10. 53％; P = 0. 486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62. 96％ vs. 18. 18％; P = 0. 029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0. 103, 95％ confidence interval 0. 015-0. 714; P = 0. 021). Conclusion Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion.

Objective: To evaluate the effect and implementation of auricular acupressure therapy (AAT) in the treatment of acute and chronic non-cancerous pain. Methods: Computer search China Knowledge Network, China Biomedical Literature Disc (CBM), Wanfang Database, Weip Chinese Science and Technology Journal Database, PubMed, Web of Science, EMbase, Ebsco, Cochrane databases, a randomized controlled trial of AAT in the treatment of acute and chronic non-cancerous pain was included. The main outcome of AAT treatment for pain was pain intensity and analgesic drug use. Results: Of the 29 studies included, 93.1% (27/29) indicated that AAT was effective in relieving pain and/or reducing the amount of analgesic drugs; 15 and 12 of them were for acute and chronic non-cancerous pain, respectively. In the positive study with specific information description, 100% (27/27) selected the acupoints of the nervous system, 70.4% (19/27) chose the acupoints corresponding to the pain site, and 92.6% (25/27) used the seeds of the king to retain the seeds. Bean material, 81.0% (17/21) was self-administered by adult patients after successful mission; 12/13 of acute pain studies in AAT lasted for 7 days, 8/11 of chronic non-cancer Sexual pain treatment ranged from 14-28 days; 12/25 of the study was pressed 3-4 times/d, and 36.0% (9/25) of the study lasted 2-5 minutes per test; 16/17 The study used "Deqi" as the appropriate standard for pressing. Conclusion The included studies have shown that AAT can effectively alleviate 88.2% (15/17) of acute pain and 100% (12/12) of chronic non-cancerous pain. AAT can be performed with auricular acupoints and pain points corresponding to auricular points. The seed is not kept as a pressed bean material, and the adult patient himself is pressed to take the patient′s "getting gas". The duration of AAT is related to the type of pain. Although there is no uniform data on the number of auricular compressions/d and the length of each compression, there is a certain tendency.

0bjective To translate and revise《knowledge and attitudes survey regarding pain》(KASRP)(2014), and to test the reliability and validity of the Chinese version of KASRP (2014) and to conduct application testing. Methods Compared with the original English versions of KASRP 2014 and 2008 , the adjusted or newly added items were translated into Chinese through repeated review process, and 140 nurses were conveniently sampled for questionnaire survey. At the same time, 35 subjects were repeatedly measured at intervals of 3 weeks.The internal consistency coefficient and the test-retest were used to assess the reliability , and the content validity and construct validity were used to assess the validity. Results The total Cronbach α coefficient of the questionnaire was 0.717; the test-retest reliability was 0.765; accumulating contribution rate of 14 factors was 67.815% ; the expert evaluation result was: the average score of 4 items among 6 different items was 5 points, which was"extremely applicable"; the average score of 2 items was≥4 points, which was "applicable". The number of correct answers for the respondents was 12-27, and the average answer was 19.28 ± 3.11. The answer rate was between 29% and 66% , with an average of (47 ± 8)% . Conclusion The Chinese version of KASRP (2014) has good reliability and validity and application results.

Objective? To explore the application of active pain assessment in pain management of enhanced recovery after surgery. Methods? From April 2017 to November 2017, we selected 120 patients with abdominal operation of enhanced recovery after surgery (ERAS) ward in hepatobiliary surgery at the Affiliated Hospital of Xuzhou Medical University by convenient and purposive sampling. All of the patients were divided into control group (n=60) and observation group (n=60) with the method of random number table. Control group carried out routine pain nursing of ERAS. On the basis of that in control group, observation group implemented postoperative pain management with the active pain assessment scale. We compared the times of effective cough and turning over in bed within 24 hours after surgery, pain score of function activity for the first time, time of out-of-bed activity and passage of gas by anus for the first time. Results? Between control group and observation group, the times of effective cough were (3.867±1.454) and (6.483±2.313) respectively with a statistical difference (P＜0.01); the times of turning over in bed were (4.450±1.596) and (6.133±1.874) respectively with a statistical difference (P＜0.01); the pain scores of function activity for the first time were (5.864±1.524) and (3.725±1.572) respectively with a statistical difference (P＜0.01); the time of out-of-bed activity for the first time was (12.483±5.147) hours and (8.800±3.564) hours respectively with a statistical difference (P＜0.01);the time of passage of gas by anus for the first time was (13.264±3.514) hours and (8.345±1.725) hours respectively with a statistical difference (P＜0.01). Conclusions? ERAS combined with active pain assessment is practical. Active pain assessment could effectively evaluate the postoperative painless management,ensure that the postoperative functional exercise is carried out and promote patient rehabilitation.