There is no unified international guidelines or consensus on seizures and epilepsy following acute stroke reperfusion therapy so far.In this review,we briefly summarize its definitions and mechanisms.Post stroke epilepsy after reperfusion treatment is defined as patients with ischemic stroke who have received intravenous thrombolysis and/or endovascular therapy,without other definitive causes or epilepsy history before stroke,have at least two epileptic seizures occurred within 7 days of stroke onset,or at least one epileptic seizures occurred within 30 days of stroke onset.The incidence rate of epilepsy after intravenous thrombolysis is about 6.4%-20.6%,and arterial thrombectomy is about 5%.The pathophysiological mechanism of post stroke epilepsy after reperfusion treatment may be related to local hyperfusion,epileptogenic properties of tPA and hemorrhagic transformation.Higher stroke severity,cortical involvement,middle cerebral artery infarction,and early post-stroke seizures may be predictive factors for post-stroke epilepsy after reperfusion therapy.Levetiracetam and lamotrigine may be effective drugs for post-stroke epilepsy after reperfusion therapy.Sustained seizures after thrombolysis may increase the risk of death.

Objective:To construct and validate a theoretical model of residents′ willingness to participate in tiered medical care based on harmonious management theory, providing reference for promoting the tiered medical care system and aiding governmental decision-making.Methods:Based on the harmonious management theory and literature review, a model capturing residents′ propensity to engage in tiered medical care was formulated. Using convenience sampling method, a questionnaire survey was conducted on 2 067 residents from 24 communities in Zhejiang province from April to May 2022. Descriptive statistical analysis was conducted on the survey results, and multilevel linear regression and structural equation modeling were used to analyze the driving mechanism of residents′ willingness to participate in tiered medical care.Results:The willingness rate of residents to participate in tiered medical care was 69.7%, which was at an average level. Regression insights highlighted the positive influence of policy support perception ( β=0.170, P<0.01), awareness of management mechanisms ( β=0.093, P<0.01), cognitive attitudes ( β=0.102, P<0.01), and trust levels ( β=0.244, P<0.01) on residents′ participation willingness. In contrast, resource allocation perceptions lacked a significant effect ( β=0.065, P>0.05). The structural equation model revealed that cognitive attitudes played a mediating role in the " policy system perception → participation willingness" and " management mechanism perception → participation willingness" pathways, with effect sizes of 0.030 and 0.039, respectively. Trust levels also mediated these paths, with effect sizes of 0.039 and 0.045, and entirely mediated the " resource allocation perception → participation willingness" path, registering an effect size of 0.053. Conclusions:The harmonious management theory can be used to explain the formation mechanism of residents′ willingness to participate in tiered medical care. The government and medical institutions urgently need to further improve residents′ awareness of tiered medical care, focus on enhancing residents′ trust, and further improve policies and management measures such as financial investment, medical insurance reimbursement, and referral systems.

Insomnia symptom is one of the most common types of sleep disturbances.Apart from being a risk factor for psychiatric disorders, insomnia symptom has been found to affect the course of psychiatric disorders and increase the relapse rate of psychiatric disorders.Therefore, insomnia treatment is beneficial to mitigate the psychiatric symptoms among chronic insomnia patients, which may help prevent mental health disorders.On the other hand, insomnia treatment for psychiatric patients is conductive to reduce the harm consequence in social function, which can help improving the prognosis of psychiatric disorders.Cognitive behavior therapy for insomnia (CBT-I) is a first-line treatment for chronic insomnia.This paper reviews the research progress on the efficiency of CBT-I on the psychiatric symptoms of chronic insomnia patients, as well as its application in comorbid psychiatric conditions.Findings from previous research suggested that CBT-I is effective to improve the psychiatric symptoms of insomnia patients through insomnia improvement, and it can also promote the remission of depression and anxiety symptoms, reduce the risk of substance disorder and suicide behaviors, and reduce the impairment of life quality and costs of treatment through insomnia improvement among psychiatric patients comorbid with insomnia, which indicated that CBT-I is a safe and effective treatment for insomnia symptoms in psychiatric patients.Moreover, this paper listed the contraindications and the decision-to-treat algorithm of CBT-I among psychiatric patients, as well as the CBT-I availability and adherence that limited the clinical application.More understanding of CBT-I is beneficial to provide support for a broad clinical application in mental health services.

Objective:To study the clinical characteristics and death risk factors of the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020.Methods:The clinical data were retrospectively analyzed of the 894 patients with fall-related injuries who had been admitted to Department of Trauma Center, The First People's Hospital of Kashgar Prefecture, Xinjiang Uygur Autonomous Region from January 2019 to December 2020. Recorded were the patient's gender, age, location of fall, month of fall, fall height, major injury site, injury severity score (ISS) and Glasgow score (GCS). The clinical characteristics and death risk factors of the fall patients were analyzed.Results:Of the 894 patients, 72.3%(646/894) were male and 86.9%(777/894) fell from a height from 1 to 6 meters. Their ages ranged mainly from 15 to 59 years old (74.3%, 664/894). Home was the most frequent site for falls (60.2%, 538/894) and the patients who fell in summer months (from June to August) were the most (32.3%, 289/894). Twenty-one patients (2.3%, 21/894) died. There were significant differences in the major injury site, blood transfusion, ISS score and GCS score between the dead and survival patients ( P<0.05). The multivariate logistic regression analysis showed that the injury to the head, face and neck [ OR=10.936, 95% CI: 1.177 to 101.627, P=0.035] and GCS score ≤12 [ OR=5.640, 95% CI: 2.658 to 11.968, P< 0.001] were the death risk factors for the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020. Conclusions:In the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020, males aged from 15 to 59 years old were the high-risk group of falls. Months with a high incidence of falls were from June to August. The fall patients with injuries to the head, face and neck and with a GCS score of ≤12 were at a high risk of death.

Metaphorical narrative, as a kind of image, has a remarkable effect on the research of children’s psychological intervention. It is an important way of human cognition of the world, and its essence is the cross-domain mapping between the source domain and the target domain. Taking intractable diseases in children as an example, this paper illustrated the importance of metaphorical narrative in children’s diseases narrative, life and health education, disease science popularization, diseases notification, as well as the treatment communication. This paper aimed to arouse more researchers’ attention to the metaphorical narrative, actively apply metaphorical narrative to clinical practice, guide disease subjects to eliminate fear, accept diseases, so as to achieve the doctor-patients’ vision fusion and positively cooperate with clinical treatment. Not only can an appropriate metaphor help people get out of psychological difficulties, but it can renew a healthy life story.

Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder mainly caused by homozygous deletions that include exon 7 of the survival motor neuron 1 (SMN1) gene. A nearby paralog gene, SMN2, obstructs the specific detection of SMN1. We optimized a duplexed real-time PCR approach using locked nucleic acid (LNA)-modified primers to specifically detect SMN1. Methods: An LNA-modified primer pair with 3´ ends targeting SMN1 specific sites c.835-44g and c.840C was designed, and its specificity was examined by real-time PCR and Sanger Sequencing. A duplexed real-time PCR approach for amplifying SMN1 and control gene albumin (ALB) was developed. A randomized double-blind trial with 97 fresh peripheral blood samples and 25 dried blood spots (DBS) was conducted to evaluate the clinical efficacy of the duplexed approach. This new approach was then used to screen 753 newborn DBS. Results: The LNA-modified primers exhibited enhanced specificity and 6.8% increased efficiency for SMN1 amplification, compared with conventional primers. After stabilizing the SMN1 test by optimizing the duplexed real-time PCR approach, a clinical trial validated that the sensitivity and specificity of our new approach for detecting SMA patients and carriers was 100%. Using this new approach, 15 of the screened 753 newborns were identified as carriers via DBS, while the rest were identified as normal individuals. These data reveal a carrier rate of 1.99% in Hunan province, South Central China. Conclusions We have developed a novel, specific SMN1 detection approach utilizing real-time PCR with LNA-modified primers, which could be applied to both prenatal carrier and newborn screening.

Objective: To explore the effects and correlation of gross motor intervention on social skills of autistic children. To provide new ideas for rehabilitation intervention of autistic children s social ability. Methods: Recruiting 23 autistic children through WeChat in Nanchang, randomly divided into experimental groups (n=13) and control group (n=10). The experimental group underwent 6 weeks of large muscle exercise intervention, in the control group, Test of Gross Motor Development 3 (TGMD3), Social Responsiveness Scale(SRS) and the Autism Social Skills Scale (ASSS) examined changes in social skills, and analyze the relationship between sports and social ability. Results: TGMD-3 score in the intervention group before intervention was (34.31±9.79) and increased significantly after intervention (59.77±13.92)(t=-15.28, P<0.01). There was no statistical significance before and after experiment in the control group (P>0.05). The scores of SRS and ASSS in the experimental group were (96.77±15.79, 97.31±29.22) before the intervention, and (82.92±15.86, 117.62±24.93) after the intervention, and the differences were statistically significant(t=4.55, -5.61, P<0.01). The difference between the SRS and ASSS scores of the control group before and after experiment was not statistically significant(P>0.05). Both the TGMD-3 score and the object manipulation score were related to the SRS total score (r=-0.49, -0.45) and ASSS total score(r=0.54, 0.51)(P<0.05). Conclusion Gross motor intervention can improve the motor and social skills of children with autism, and there is a positive correlation between motor ability and social skills in children with autism.

The clinical data of a child with bronchial Dieulafoy disease treated in Wuhan Children′s Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, was analyzed retrospectively.The patient was a 9-month-old boy, who was admitted to hospital due to " intermittent hematemesis vomiting blood for 6 hours" . Chest CT suggested ground-glass opacity in both lungs.Electronic bronchoscopy showed that the neoplasm bulged into the lumen at the opening of the right inferior lobar bronchus, and fresh blood oozed from the basal segment of the neoplasm during the operation.Bronchial arteriography and transcatheter bronchial artery embolization were performed due to recurrent hemoptysis, during which the patient was diagnosed with bronchial arterial vascular malformation and finally diagnosed with bronchial Dieulafoy disease after consulting the relevant literatures.The disease is infrequent and characterized by rupture hemorrhage of bronchial submucosal malformed artery, the etiology and pathogenesis of which are still unclear, and it may be related to congenital vascular malformation in children.Bronchoscopy for hemoptysis of unknown cause in children should be performed with caution.If small and smooth protruded nodular lesions are seen under the bronchoscope, the bronchial Dieulafoy disease should be considered, and the lesions should not be touched too much or subjected to biopsy blindly.Fatal massive hemorrhage can be avoided by bronchial arteriography and bronchial artery embolization.

Objective:To investigate the high resolution vessel wall imaging (HR-VWI) features of basilar artery (BA) in patients with acute isolated pontine infarction (AIPI) of different infarct types, and explore the pathogenesis of AIPI.Methods:A retrospective analysis of clinical and imaging data of 52 patients with AIPI admitted to our hospital from June 2016 to November 2019 was performed. According to the morphology and location distribution of pontine high-signal lesions in diffusion-weighted imaging (DWI), these patients were divided into paramedian pontine infarction (PPI) group and small deep pontine infarction (SDPI) group. The general clinical data, modified National Institute of Health stroke scale (mNIHSS) scores at admission and discharge, modified Rankin scale (mRS) scores, and incidence of basilar artery plaques and plaque characteristics of basal artery in HR-VWI of patients from the two groups were compared.Results:Among the 52 AIPI patients, there were 28 patients with PPI (54%) and 24 with SDPI (46%). The mNIHSS scores at admission and discharge in the PPI group were significantly higher than those in the SDPI group ( P<0.05). The incidence of basilar artery plaques in PPI group was significantly higher than that in SDPI group (92.9% vs. 62.5%, P<0.05). As compared with SDPI group, PPI group had a significantly higher incidence of right lateral wall plaques, a statistically lower incidence of ventral wall plaques, and a significantly higher incidence of centripetal plaques, and significantly increased maximum thickness of vessel wall ( P<0.05). Conclusion:The AIPI mechanism is generally related to the branch atheromatous disease of basilar artery; PPI patients have more severe clinical symptoms, more serious clogged perforation opening of the basilar artery plaque, more unstable basilar artery plaque than the SDPI group.

With the development of imaging technology, high-resolution magnetic resonance vascular wall imaging technology has been gradually applied to the risk assessment of intracranial aneurysms rupture. It has provided more comprehensive information for clinicians to assess the stability of intracranial aneurysms. This article summarizes the indicators used for assessing the risk of intracranial aneurysms rupture in recent years with high-resolution magnetic resonance vascular wall imaging.