ObjectiveTo analyze the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in different risk populations of heart failure complicated with type 2 diabetes. MethodsClinical data of 675 type 2 diabetes patients were retrospectively collected. Lasso-multivariate Logistic regression was used to construct a clinical prediction nomogram model. Based on this， 441 non-heart failure patients were divided into a low-risk group （325 cases） and a high-risk group （116 cases） according to the median risk score of heart failure complicated with type 2 diabetes. TCM diagnostic information （four diagnostic methods） was collected for both groups， and factor analysis was applied to summarize the distribution of TCM syndrome elements in different risk populations. ResultsLasso-multivariate Logistic regression analysis identified age， disease duration， coronary heart disease， old myocardial infarction， arrhythmia， absolute neutrophil count， activated partial thromboplastin time， and α-hydroxybutyrate dehydrogenase as independent risk factors for heart failure complicated with type 2 diabetes. These were used as final predictive factors to construct the nomogram model. Model validation results showed that the area under the curve （AUC） of the receiver operating characteristic （ROC） curve for the modeling group and validation group were 0.934 and 0.935， respectively. The Hosmer-Lemeshow test （modeling group P = 0.996， validation group P = 0.121） indicated good model discrimination. Decision curve analysis showed that the curves for All and None crossed in the upper right corner， indicating high clinical utility. The low-risk and high-risk groups each obtained 14 common factors. Preliminary analysis revealed that the main disease elements in the low-risk group were qi deficiency （175 cases， 53.85%）， dampness （118 cases， 36.31%）， and heat （118 cases， 36.31%）， with the primary locations in the spleen （125 cases， 38.46%） and lungs （99 cases， 30.46%）. In the high-risk group， the main disease elements were yang deficiency （73 cases， 62.93%）， blood stasis （68 cases， 58.62%）， and heat （49 cases， 42.24%）， with the primary locations in the kidney （84 cases， 72.41%） and heart （70 cases， 60.34%）. ConclusionThe overall disease characteristics in different risk populations of type 2 diabetes patients with heart failure are a combination of deficiency and excess， with deficiency being predominant. Deficiency and heat are present throughout. The low-risk population mainly shows qi deficiency with dampness and heat， related to the spleen and lungs. The high-risk population shows yang deficiency with blood stasis and heat， related to the kidneys and heart.

Objective:To assess the feasibility of free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection in patients with supratentorial intracerebral hemorrhage (sICH), and to evaluate the accuracy of catheter placement.Methods:Fifty-two sICH patients received free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection in our hospital from January 2018 to December 2019 were chosen (free-handed conical craniotomy group); 30 sICH patients received frameless stereotactic puncture and drainage at the same time period were selected (stereotactic puncture group). The clinical data of these patients were retrospectively analyzed. The CT results were analyzed, and differences of relative error (RE) as the indicator of catheter placement accuracy were compared between the two groups.Results:Mobile CT was successfully performed in all patients from free-handed conical craniotomy group, and sufficient information was provided for surface projection in all patients. The percentages of patients with satisfactory results of catheter placement (RE<1) in the free-handed conical craniotomy group and stereotactic puncture group were 92.3% and 90.0%; one patients from the free-handed conical craniotomy group had repeated puncture. There was no significant difference in postoperative RE between the two groups (0.52±0.33 vs. 0.53±0.29, P>0.05). Subgroup analysis of different hematoma locations and volumes also showed no statistically significant difference in postoperative RE ( P>0.05). Conclusion:Free-handed conical craniotomy and drainage guided by novel 16-slice mobile CT-assisted surface projection is feasible in sICH patients, and the accuracy of catheter placement is similar with frameless stereotactic puncture and drainage.

Objective To explore the association,consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke.Methods A retrospective cohort survey of 240 patients,admitted to our hospital from September 2012 to December 2017,was performed.All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time,K time,α angle,maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT],activated partial thromboplastin time [APTT],fibrinogen [FIB],international normalized ratio [INR],blood platelet count).The association,consistency,and sensitivity,specificity,positive predictive value,negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed.Results (1) R time and APTT,K time and APTT,α angle and FIB,and α angle and PLT were positively correlated;K time and FIB,R time and PLT,and α angle and APTT were negatively correlated.(2) R time and APTT (κ=0.266,P=0.000),K time and APTT (κ=0.134,P=0.024),and α angle and FIB (κ=0.162,P=0.007) had agreement in identifying hypercoagulability;R time and APTT (κ=0.211,P=0.001),K time and APTT (κ=0.198,P=0.002),and blood platelet count and K (κ=0.388,P=0.000),and α angle and PLT (κ=0.099,P=0.041) had agreement in identifying hypocoagulability.(3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65％ and 58.82％,and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68％ and 47.39％.Conclusions Some parameters has correlations in peroperative period,and has agreement in identifying hypercoagulability and hypocoagulability.Accordingly,routine coagulation tests might be superior in evaluating early neurological deterioration,and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke.

Objective To investigate the prevalence and influential factors of workplace violence (WPV) against nurses in general hospitals of Suzhou. Methods A total of 2110 staff nurses from 13 general hospitals in Suzhou were investigated with the Modified Version of Hospital Workplace Violence Questionnaire. Results During the past one year,68.9% (1454/2110) nurses investigated suffered from WPV.Working departments,marital status, strong support,etc,were the leading impact factors of WPV. Conclusions Nurses′experience of WPV is a prevalent phenomenon in general hospitals of Suzhou. It is urgent for hospital administration to raise attention to WPV and take effective measures,to reduce the occurrence of WPV.

Objective To investigate the status and influencing factors of infusion-related adverse events in third-party cord blood stem cell infusion. Methods A total of 305 patients successfully underwent haploidentical stem cell transplantation combined with the third-party cord blood(CB) infusion,were recruited by convenience sampling from January 2013 to December 2015,in hematological department of a tertiary hospital in Suzhou. A self-developed questionnaire and adverse event assessment scale were used to investigate the influencing factors. Results The rate of infusion-related adverse events was 49.51%,81.82% were related to cardiovascular adverse events with the high-est rate of hypertension(76.14%). Logistic regression analysis showed that age(OR=1.030,95CI%:1.010-1.051),HLA matching between CB and receptor (OR=0.589,95%CI:0.413-0.838),thawed CB cell activity (OR=1.064,95%CI:1.015-1.115)were major influencing factors. Conclusion Nurses should pay attention to patients who are elderly,with low matching HLA and receive thawed CB product with high cell activities,and provide timely nursing care in advance.

Objective To investigate the dynamic changes and analyze the influencing factors of quality of life (QOL) among adult patients undergoing hematopoietic stem cell transplantation (HSCT). Methods Totally 143 HSCT patients were investigated by the common questionnaire, the Perceived Social Support Scale (PSSS) and the Functional Assessment in Cancer Therapy—Bone Marrow Transplant (FACT-BMT) before checked in the purification bin,1 month post transplantation and 3 months post transplantation. Results The QOL were different among different time points of HSCT patients (P<0.05). Multiple factors analysis showed that the factors before checked in the purification bin including social support (OR=4.480, P=0.019), residence (OR=3.167, P=0.036) and disease diagnosis (OR=0.036, P=0.042). The factors 1 month post transplantation included social support (OR=3.573, P=0.018), whether or not the platelets were reconstructed during storage (OR=2.735, P=0.018) and whether there were transplant related complications (OR=0.214, P=0.016). The factors 3 month post transplantation included social support (OR=9.639, P<0.01) and whether there were transplant related complications (OR=0.167, P=0.003). Conclusions The QOL was low among HSCT patients, and it dynamically changed at different points. Social support is the only sustainable influencing factor of quality of life. This prompts us that we should pay abundant attention on social support and use it to improve the QOL of HSCT patients.

Physiological stress,psychological stress and economic pressure that patients undergoing hematopoietic stem cell transplantation (HSCT) suffered,seriously affects patients' quality of life (QOL). This paper reviewed the researches about QOL of HSCT patients,so as to provide references for improving the QOL of HSCT patients.

OBJECTIVETo evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.

METHODSThe clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.

RESULTSFifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).

CONCLUSIONMechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; surgery ; Thrombectomy ; Treatment Outcome

Objective To explore the intra-arterial therapies and prognostic predictors of anterior circulation stroke patients.Methods Fifty-nine anterior circulation stroke patients,admitted to our hospital from May 2011 to June 2014,were divided into two groups:intra-arterial therapy (IAT) group (n=25,thrombolysis in myocardial infarction [TIMI] grade Ⅱ～Ⅲ after IAT) and multi-modal therapy (MMT) group (n=34,onset time longer than 6 h or achieving no good effect afterIAT);their clinical data and follow up data were reviewed and summarized.National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity;and modified Rankin scale (mRS) was performed three months after the stroke to reveal the clinical outcomes.The t test,chi-square test and multivariable Logistic regression analysis were performed to analyze the related prognosis factors.Results The mean age of the patients was 59.8±1.3 years.MMT patients had significantly higher baseline admission NIHSS scores as compared with those inIAT patients (18.3±4.2 vs.12.6±4.3,t=l 1.88,P=0.000);MMT patients had a significantly higher patent flow rate as compared withIAT patients (82.4％ vs.56.0％,x2=4.878,P=0.027).Besides,the MMT patients had a significantly longer time till accepting treatment (5.8±1.4 vs.5.3±0.9,t=4.735,P=0.000);In multivariate analysis,age,time getting treatment,NIHSS scores at discharge are predictors for poor outcomes,while perfect recanalization was associated with favorable outcome.Conclusions MMT can be used for patients with severe admission NIHSS scores,and it may enjoy higher patency rate than IAT.Good vessel recanalization is the only predictor for favorable outcome.

Objective To observe the influence of carotid endarterectomy in cognitive functions of patients with symptomatic carotid stenosis.Methods Forty-three patients admitted to our hospital and performed carotid endarterectomy from February 2013 to August 2014, were enrolled in the study.Cognitive functions of the patients were evaluated by Montreal cognitive function assessment (MoCA) and cerebral blood flow (CBF) by cerebral perfusion CT scan three days before and three months after operation, respectively.According to the MoCA scores after operation, the patients were divided into significant improvement group and non-significant improvement group, and their cerebral hemodynamics indexes were compared.Results (1) As compared with those before operation (24.1±2.2, 0.97±0.08), the MoCA scores (26.02±2.9) and relative cerebral blood volumes (rCBV, 1.00±0.08) three months after operation were significantly different (P＜0.05).(2) The postoperative relative CBF, rCBV and relative mean transmit time in the significant improvement group were significantly improved as compared with those preoperative indexes (P＜0.05);whereas, these values in the non-significant improvement group didn't show significant difference between preoperative and postoperative indexes(P＞0.05).Conclusion Carotid endarterectomy may help to improve the cognitive function in those patients with symtompatic carotid stenosis, and the effect might be associated with the improvement of cerebral perfusion.