Objective To explore the influence factors of hemorrhagic transformation in the First People's Hospital of Lianyungang in patients with acute anterior circulation ischemic stroke(AIS)after mechanical thrombectomy(MT).Methods We collected the clin-ical data of 354 AIS patients who underwent MT in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2019 to December 2023.They were grouped according to the results of cranial CT reviewed in 24-72h after the MT,and the patients who under-went HT were the HT group,with a total of 208 patients,and the patients who did not have HT were the control group,with a total of 104 patients.The clinical differences between the two groups were compared.Measurement data were analyzed using the Mann-Whitney U test,count data were analyzed using the x2 test,and multivariate Logistic regression analysis was used to identify independent risk factors.Results Compared to control group,the patients of HT group were older,had a higher prevalence of atrial fibrillation,higher preopera-tive NIHSS scores,lower platelet counts,higher glycated hemoglobin levels,and a higher proportion of preoperative thrombolytic therapy(P＜0.05).Multivariate logistic regression analysis indicated that hemoglobin(OR=1.02,95％CI:1.01-1.03,P=0.006)and glycated hemoglobin(OR=1.24,95％CI:1.09-1.40,P＜0.001)were independent influence factors for HT.Platelet count(OR=0.99,95％CI:0.99-0.99,P=0.014)was identified as a protective factor against HT.Conclusion Preoperative hemoglo-bin,glycated hemoglobin,and platelet count are all associated with HT following MT.

Malignant hyperthermia(MH)is a rare perioperative disease with autosomal dominant inheritance,and its pathogenesis involves specific gene mutations.Its clinical feature is that conventional anesthetics can trigger abnormally high metabolic reactions in skeletal muscles.Although the incidence of this disease is low,the condition is dangerous,progresses rapidly,and has a high mortality rate;Its treatment relies on early diagnosis,timely application of the specific drug Dantrolene Sodium,and rapid and orderly comprehensive symptomatic supportive treatment.MH is a critical perioperative emergency that can occur during surgery.It presents with symptoms such as hyperpyrexia,metabolic acidosis,rhabdomyolysis,and dysfunction of multiple organ systems.If not treated promptly,it can quickly lead to life-threatening arrhythmias and cardiac arrest.This condition serves as an essential teaching example in anesthesia crisis resource management.As an effective teaching method,scenario simulation exercises can comprehensively enhance medical staff's personal technical,non-technical,and teamwork abilities through simulating emergency scenarios,teaching assessments,and retrospective discussions,especially suitable for comprehensive management training of fatal diseases.Many countries internationally have incorporated simulation exercises for MH into their routine teaching and training systems.The effectiveness of teaching and training for anesthesiologists in MH and their ability to handle anesthesia crisis events have been continuously improved through a periodic training model.This article systematically reviews the research progress and practical experience of scenario simulation exercises in emergency training for MH,with a focus on exploring how to establish a scenario simulation exercise plan for emergency application and comprehensive symptomatic support treatment of Dantrolene Sodium based on the actual situation in China,providing reference for improving the teaching and training quality of MH and other clinical crisis events.

Objective To explore the influence factors of hemorrhagic transformation in the First People's Hospital of Lianyungang in patients with acute anterior circulation ischemic stroke(AIS)after mechanical thrombectomy(MT).Methods We collected the clin-ical data of 354 AIS patients who underwent MT in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2019 to December 2023.They were grouped according to the results of cranial CT reviewed in 24-72h after the MT,and the patients who under-went HT were the HT group,with a total of 208 patients,and the patients who did not have HT were the control group,with a total of 104 patients.The clinical differences between the two groups were compared.Measurement data were analyzed using the Mann-Whitney U test,count data were analyzed using the x2 test,and multivariate Logistic regression analysis was used to identify independent risk factors.Results Compared to control group,the patients of HT group were older,had a higher prevalence of atrial fibrillation,higher preopera-tive NIHSS scores,lower platelet counts,higher glycated hemoglobin levels,and a higher proportion of preoperative thrombolytic therapy(P＜0.05).Multivariate logistic regression analysis indicated that hemoglobin(OR=1.02,95％CI:1.01-1.03,P=0.006)and glycated hemoglobin(OR=1.24,95％CI:1.09-1.40,P＜0.001)were independent influence factors for HT.Platelet count(OR=0.99,95％CI:0.99-0.99,P=0.014)was identified as a protective factor against HT.Conclusion Preoperative hemoglo-bin,glycated hemoglobin,and platelet count are all associated with HT following MT.

Malignant hyperthermia(MH)is a rare perioperative disease with autosomal dominant inheritance,and its pathogenesis involves specific gene mutations.Its clinical feature is that conventional anesthetics can trigger abnormally high metabolic reactions in skeletal muscles.Although the incidence of this disease is low,the condition is dangerous,progresses rapidly,and has a high mortality rate;Its treatment relies on early diagnosis,timely application of the specific drug Dantrolene Sodium,and rapid and orderly comprehensive symptomatic supportive treatment.MH is a critical perioperative emergency that can occur during surgery.It presents with symptoms such as hyperpyrexia,metabolic acidosis,rhabdomyolysis,and dysfunction of multiple organ systems.If not treated promptly,it can quickly lead to life-threatening arrhythmias and cardiac arrest.This condition serves as an essential teaching example in anesthesia crisis resource management.As an effective teaching method,scenario simulation exercises can comprehensively enhance medical staff's personal technical,non-technical,and teamwork abilities through simulating emergency scenarios,teaching assessments,and retrospective discussions,especially suitable for comprehensive management training of fatal diseases.Many countries internationally have incorporated simulation exercises for MH into their routine teaching and training systems.The effectiveness of teaching and training for anesthesiologists in MH and their ability to handle anesthesia crisis events have been continuously improved through a periodic training model.This article systematically reviews the research progress and practical experience of scenario simulation exercises in emergency training for MH,with a focus on exploring how to establish a scenario simulation exercise plan for emergency application and comprehensive symptomatic support treatment of Dantrolene Sodium based on the actual situation in China,providing reference for improving the teaching and training quality of MH and other clinical crisis events.

The prevention and treatment of adolescent depression and suicide represent a current focal point. Therefore, it is crucial to understand the risk factors for suicide in adolescents with depression, scientifically monitor suicide risk, and conduct a multidisciplinary collaboration. There is still a lack of authoritative, evidence-based guidelines in China on how to assess suicide risk early time and how to take targeted prevention. This paper introduces the bio-psycho-social joint intervention model, aiming to help clinicians comprehensively assess the suicide risk in adolescents with depression. The author discussed comprehensive assessment methods and a collaborative system involving family, school, medical, and community entities working together as more effective interventions.

Digital therapy shows promise in providing precise assessments and enhancing the efficacy of treatments for mental illness,offering advantages such as convenience,flexibility,and the potential to reduce costs by shifting towards preventive care.This article reviews the development and benefits of digital therapy in mental health care and discusses the challenges it faces,including concerns over privacy,ethics,security,acces-sibility issues,digital divides,and the lack of sufficient clinical validation and standardization.It also highlights specific risks to mental health patients and explores potential future developments such as integration with brain-computer interfaces and neurofeedback,the use of robot therapists based on large language models,applications of virtual reality or the metaverse,and combinations with traditional physical treatments and medications.The author calls for urgent policy recommendations to refine regulations,establish unified evidence standards,enhance train-ing and education for healthcare providers and patients,and to build multidisciplinary collaborative mechanisms to advance personalized and effective digital therapy in mental health.

The prevention and treatment of adolescent depression and suicide represent a current focal point. Therefore, it is crucial to understand the risk factors for suicide in adolescents with depression, scientifically monitor suicide risk, and conduct a multidisciplinary collaboration. There is still a lack of authoritative, evidence-based guidelines in China on how to assess suicide risk early time and how to take targeted prevention. This paper introduces the bio-psycho-social joint intervention model, aiming to help clinicians comprehensively assess the suicide risk in adolescents with depression. The author discussed comprehensive assessment methods and a collaborative system involving family, school, medical, and community entities working together as more effective interventions.

Objective:To evaluate the development of hypothermia after spinal anesthesia and risk factors.Methods:Patients undergoing spinal anesthesia in the anesthesia preparation room of our hospital from April 2020 to April 2021 were included. The temperature of the tympanic membrane was measured before spinal anesthesia and immediately after anesthesia and at 5, 10 and 15 min after anesthesia. Patients with tympanic membrane temperature<36 ℃ at any time point were considered as having hypothermia and included in hypothermia group and patients with membrane temperature ≥ 36 ℃ were considered as having no hypothermia and included in non-hypothermia group. The patients′ demographic data, highest anesthesia plane, puncture space of spinal anesthesia, types of anesthetics, preoperative fasting time, and surgical sites were recorded. The multivariate logistic regression analysis was performed to identify the risk factors for hypothermia.Results:A total of 196 patients were finally enrolled. The body temperature was significantly decreased at 5 and 10 min after anesthesia compared with the baseline body temperature before anesthesia and immediately after anesthesia ( P<0.001), and the incidence of hypothermia was 10.2%. The multivariate logistic regression analysis showed that female and high anesthesia plane were independent risk factors for hypothermia, and higher baseline body temperature was an independent protective factor for hypothermia ( P<0.05). Conclusions:Body temperature decreases at 5-10 min after spinal anesthesia, and the occurrence of hypothermia is not a small probability event in the patients undergoing spinal anesthesia; female and higher anesthesia plane are risk factors and higher baseline body temperature is the protective factor.

OBJECTIVES: The intestinal microbial characteristics of patients with simple cerebral infarction (CI) and CI complicated with Type 2 diabetes mellitus (CI-T2DM) are still not clear. This study aims to analyze the differences in the variable characteristics of intestinal flora between patients simply with CI and CI-T2DM. METHODS: This study retrospectively collected the patients who were admitted to the Affiliated Hospital of Putian University from September 2021 to September 2022. The patients were divided into a CI group (n=12) and a CI-T2DM group (n=12). Simultaneously, 12 healthy people were selected as a control group. Total DNA was extracted from feces specimens. Illumina Novaseq sequencing platform was used for metagenomic sequencing. The Knead Data software, Kraken2 software, and Bracken software were applied for sequencing analysis. RESULTS: At phylum level, the average ratio of Firmicutes, Bacteroidetes, and Proteobacteria in the CI-T2DM group were 33.07%, 54.80%, and 7.00%, respectively. In the CI group, the ratios of each were 14.03%, 69.62%, and 11.13%, respectively, while in the control group, the ratios were 50.99%, 37.67%, and 5.24%, respectively. There was significant differences in the distribution of Firmicutes (F=6.130, P=0.011) among the 3 groups. At the family level, compared with the CI group, the relative abundance of Eubacteriaceae (t=8.062, P<0.001) in the CI-T2DM group was significantly increased, while Corynebacteriaceae (t=4.471, P<0.001), Methanobacteriaceae (t=3.406, P=0.003), and Pseudomonadaceae (t=2.352, P=0.028) were decreased significantly. At the genus level, compared with the CI group, there was a relative abundance of Cutibacterium (t=6.242, P<0.001), Eubacterium (t=8.448, P<0.001), and Blautia (t=3.442, P=0.002) in the CI-T2DM group which was significantly increased. In terms of Methanobrevibacter (t=3.466, P=0.002), Pyramidobacter (t=2.846, P=0.009) and Pseudomonas (t=2.352, P=0.028), their distributions were decreased significantly in the CI-T2DM group. At the species level, compared with the CI group, the relative abundance of Cutibacterium acnes (t=6.242, P<0.001) in the CI-T2DM group was significantly increased, while Pseudomonas aeruginosa (t=2.352, P=0.028) was decreased significantly. Still at the genus level, linear discriminant analysis effect size (LEfSe) analysis showed that the distributions of Pseudomonas and Blautia were determined to be the most significantly different between the CI-T2DM and the CI group. At the species level, the total number of operational taxonomic units (OTUs) in the 3 groups was 1 491. There were 169, 221, and 192 kinds of OTUs unique to the CI-T2DM, CI, and control group, respectively. CONCLUSIONS From phylum level to species level, the composition of intestinal flora in the patients with CI-T2DM is different from those in the patients simply with CI. The change in the proportion of Firmicutes, Bacteroidetes and Proteus compared with the healthy population is an important feature of intestinal flora imbalance in the patients with CI and with CI-T2DM. Attention should be paid to the differential distribution of Bacteroides monocytogenes and butyrate producing bacteria.
Humans ; Gastrointestinal Microbiome/genetics* ; Diabetes Mellitus, Type 2/complications* ; Retrospective Studies ; Bacteria/genetics* ; High-Throughput Nucleotide Sequencing

Objective:To investigate and analyze the awareness of malignant hyperthermia (MH) in anesthesiology nurses in mainland China.Methods:From November 2021 to January 2022, anesthesiology nurses of secondary hospitals or above in Chinese mainland were enrolled by convenience sampling and investigated by a self-designed questionnaire on the awareness of MH.The system automatically recorded the situation of questionnaires.Results:A total of 2 058 anesthesiology nurses participated in the survey, distributed in 21 provinces, 2 autonomous regions (Ningxia Hui Autonomous Region, Guangxi Zhuang Autonomous Region) and 4 municipalities directly under the central government, and 2 049 questionnaires were effectively received with effective recovery of 99.56%.The correct answers to questions related to the treatment of MH, characteristics of the disease, classification, susceptible population, screening method of the susceptible population, genetic mode, inducing factors, the first symptoms and the best infusion time of dantrolene, preparation method of domestic dantrolene and the first dose were 86.58%, 82.33%, 58.18%, 50.90%, 50.76%, 50.42%, 45.73%, 32.89%, 51.25%, 48.32% and 46.51%, respectively.Only 27.13% of anesthesiology nurses expressed that dantrolene was available in their hospital.The scores of knowledge about MH among anesthesiology nurses in hospitals of province-level municipalities and provincial capital cities were significantly higher than those in other cities ( P<0.001). The scores of knowledge about MH among the anesthesiology nurses in secondary hospitals were significantly higher than those in tertiary hospitals ( P<0.05). There was no significant difference in the scores of knowledge about MH among anesthesiology nurses with different professional titles, educational backgrounds, and working years ( P>0.05). Conclusions:Anesthesiology nurses in mainland China have insufficient awareness of MH.Popularizing the knowledge about MH and strengthening the awareness of MH in medical staff in the department of anesthesiology throughout the country may be of great significance in improving the diagnosis and treatment of MH in China.