Bedridden patients mostly use the back cushion object,raise the bedside position,and other methods to obtain the semi-decumbent position.However,the existing methods have shortcomings such as insufficient execution,wrong angle estimation,weak consciousness,forgetting,decreased comfort,easy to cause pressure sore and aspiration pneumonia.To solve the shortcomings of the existing eating position placement method,the department of geriatric medicine team of Tongxiang City Hospital of Traditional Chinese Medicine designed a bed-rest pillow for bed patients to eat or other requirements of semi-lying position,and obtained the National Utility Model Patent of China(patent number:ZL 202122859891.4).This device places the pillow on a flat bed,with the back of the pillow next to the head of the bed for support and to prevent sliding.The patient was placed in a retainer slot,head in the first retainer slot,shoulder and back in the second retainer slot,waist and abdomen in the third retainer slot,and hands on the armrests on both sides of the pillow.The use of pillows for bedridden patients is simple and easy to learn,convenient,economical and practical,time-saving and labor-saving,and convenient supervision and inspection,which can reduce complications such as aspiration and pressure ulcers,thereby reducing the economic burden of the patient,improving the quality of life,and improving the satisfaction of patients and their families,and is worthy of clinical promotion and use.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the changes in the morphology, structure and function of the bladders and their effects on the upper urinary tract dilatation(UUTD) after lumbosacral nerve transecting in rats.Methods:A total of 45 female SD rats were included, randomly divided into 3 groups with 15 rats in each group. Two groups were performed bilateral lumbar 6(L6) and cauda equina nerve shearing to establish neurogenic bladder(NB) model, which were nerve transected for 4 weeks(NB-4W) group and nerve transected for 12 weeks(NB-12W) group. Another group was performed bilateral L6 nerves and cauda equine exposing but not transecting, which was sham-operation (Sham) group. Cystometry and renal ultrasound examination were performed and rats in each group were killed to collect the kidney and bladder tissues in NB-4W group at 4 weeks, in Sham group and NB-12W group at 12 weeks after operation. HE, Masson staining, immunohistochemical staining and western blot were used to detect histological changes, expression of transforming growth factor-β1(TGF-β1) and α-smooth muscle actin(α-SMA).Results:All rats in NB-4W and NB-12W group showed acontractile detrusor. In the NB-4W and NB-12W group, the maximum cystometric capacity [(5.84±0.33) ml and (3.13±0.35) ml], the detrusor leak point pressure [(25.41±0.86) cm H 2O and (27.36±2.04) cm H 2O] (1 cm H 2O = 0.098 kPa), were significantly higher than those in the Sham group [(0.98±0.14) ml, (7.13±0.90) cm H 2O, both P<0.05]. Compliance in NB-4W group [(0.28±0.21) ml/cm H 2O] and NB-12W group [(0.17±0.12) ml/cm H 2O] were significantly lower than that of the Sham group [(0.34±0.26) ml/cm H 2O], and the compliance of NB-12W group was lower than that of NB-4W group significantly (all P<0.05). HE staining of the bladder showed that the inflammatory cell infiltration was obvious in the NB-4W and NB-12W group. Bladder collagen volume fractions in NB-4W group [(30.5±1.5) %] and NB-12W group [(45.2±3.8) %] were both higher than that of Sham group [(20.7±2.2) %, both P<0.05]. The expression of TGF-β1 and α-SMA in the bladder tissue of NB-4W group were higher than those of sham group, and that of NB-12W group were higher than NB-4W group. In NB-4W group and NB-12W group, 3 (20.0 %) and 7 (46.7 %) rats were found hydronephrosis, respectively. Additionally, HE staining showed that the degree of renal tubule injury and the number of inflammatory cell infiltration in the NB-4W and NB-12W group were higher than those in the Sham group. Masson staining showed that the volume fraction of collagen in kidneys of NB-4W and NB-12W group were (13.1±1.4) % and (21.6±1.9) %, respectively, which were significantly higher than that in sham operation group [(4.6±0.7) %, both P<0.05]. Conclusions:Bilateral L6 + cauda equina nerve transecting can induce NB with hydronephrosis in parts of rats. The degree of bladder fibrosis gradually increased with the time of nerve transection, and the incidence and severity of UUTD also increased with the time of nerve transection.

Objective: To assess the relationship between hemoglobin A₁c (HbA₁c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction. Methods: From January 2014 to June 2016, in the Lianyungang Hospital Affiliated to Xuzhou Medical University, 426 patients with acute anterior circulation infarction were included. The blood sugar status before stroke was expressed by HbA₁c. HbA₁c and fasting blood glucose (FBG) were measured on the second day after admission. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission. The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge. CT or MRI/SWI examination was performed to determine whether there was HT. Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction. Results: Of the 426 patients enrolled, 93 (21.8%) appeared HT, 60 (14.1%) had hemorrhagic cerebral infarction (HI) and 33 (7.7%) had parenchymal hemorrhage (PH). Multivariate analysis showed that HbA₁c and infarct volume were independent predictor of HT. When patients were grouped according to fasting blood glucose (FBG<7.8 mmol/L or ≥ 7.8 mmol/L), the predictive effect of HbA₁c on HT was found in both groups. In multiple Logistic regression analysis, HbA₁c was also a predictor of poor prognosis after stroke (OR=1.482, 95% CI 1.228 -1.788). Conclusions In patients with ischemic stroke, elevated HbA₁c is independently associated with post-infarction HT, and this result doesn′t change even in patients with well-controlled blood glucose. HbA₁c is also a predictor of poor prognosis after stroke. These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Objective:To explore the influence of blood pressure during peri-thrombolysis period (from admission to 24 h after thrombolysis) in intracranial hemorrhage, improvement of neurological function, primary endpoint event (recurrence of symptomatic stroke) and secondary endpoint events (complex cardiovascular and cerebrovascular events, and all-cause death) in patients with acute ischemic stroke.Methods:A total of 422 patients with acute ischemic stroke who underwent intravenous thrombolysis with alteplase during hospitalization at National Center for Stroke in Lianyungang from January 2015 to March 2019 were followed up for 90 d. According to the quintile of mean systolic and diastolic blood pressures during peri-thrombolysis period, they were divided into group of blood pressure <130.00 mmHg (Q1), group of blood pressure of 130.00-140.49 mmHg (Q2), group of blood pressure of 140.50-147.99 mmHg (Q3), group of blood pressure of 148.00-158.00 mmHg (Q4), and group of blood pressure >158.00 mmHg (Q5), and group of blood pressure <71.30 mmHg (G1), group of blood pressure of 71.30-76.19 mmHg (G2), group of blood pressure of 76.20-81.89 mmHg (G3), group of blood pressure of 81.90-90.79 mmHg (G4), group of blood pressure >90.79 mmHg (G5). Univariate and multivariate Logistic regression analyse were used to evaluate the relations of blood pressure with postoperative intracranial hemorrhage and neurological function improvement. Kaplan-Meier curve, Log-rank test and multivariate Cox proportional risk model were used to evaluate the relations of blood pressure with primary endpoint event and secondary endpoint events.Results:(1) After adjusting for confounding factors, multivariate Logistic regression analysis showed that the risk of postoperative intracranial hemorrhage in patients from Q2 was significantly lower than that in patients from Q5 ( OR= 0.160, 95%CI: 0.031-0.827, P=0.029). (2) After adjusting for confounding factors, multivariate Logistic regression analysis showed that the probability of postoperative improvement of nerve function in patients from Q2 and Q3 was significantly higher than that in patients from Q5 ( OR=2.144, 95%CI: 1.043-4.407, P=0.038; OR=2.224, 95%CI: 1.105-4.479, P=0.025); the probability of postoperative improvement of nerve function in patients from G3 and G4 was significantly higher than that in patients from G5 ( OR= 2.153, 95%CI: 1.081-4.287, P=0.029; OR=2.182, 95%CI: 1.131-4.210, P=0.020). (3) After adjusting for confounding factors, multivariate Cox proportional risk model showed that the risk of primary endpoint event in patients from Q1 and Q2 was significantly lower than that in patients from Q5 ( HR=0.079, 95%CI: 0.010-0.613, P=0.015; HR=0.211, 95%CI: 0.062-0.724, P=0.013). (4) After adjusting for confounding factors, multivariate Cox proportional risk model showed that the risk of secondary endpoint events in patients from Q1, Q2, Q3 and Q4 was significantly lower than that in patients from Q5 ( HR=0.246, 95%CI: 0.100-0.607, P=0.002; HR=0.360, 95%CI: 0.177-0.732, P=0.005; HR=0.448, 95%CI: 0.246-0.817, P=0.009; HR=0.467, 95%CI: 0.252-0.867, P=0.016). Conclusion:The risks of postoperative intracranial hemorrhage, primary endpoint event and secondary endpoint events in patients with acute ischemic stroke decrease with the decrease of systolic blood pressure during peri-thrombolysis period; moderate blood pressures (systolic blood pressure: 130.00-147.99 mmHg; diastolic blood pressure:76.20-90.79 mmHg) are beneficial for improvement of neurological function.

To introduce professor Gao Yuchun's clinical experience and treating characteristics of facial paralysis treated with acupuncture and moxibustion. Professor Gao pays attention to yangming when he selects acupoints for clinical syndrome, and directs acupoints selection based on syndrome differentiation in different levels of jingjin, meridians and zangfu; he praises opposing needling technique and reinforcing the deficiency and reducing the excess highly; the acupuncture manipulation is gentle,shallow and slow for reducing the healthy side and reinforcing the affected side, and through losing its excess to complement its deficiency; besides, he stresses needle retaining time and distinguishes reinforcing and reducing. Facial paralysis is treated with key factors such as acupoints selecting based on yangming, acupuncture manipulation, needle retaining time, etc. And the spleen and stomach is fine and good at transportation and transformation; the meridians is harmonious; the qi and blood is smooth. The clinical efficacy is enhanced finally.
Acupuncture Points ; Acupuncture Therapy ; history ; methods ; Aged, 80 and over ; China ; Facial Paralysis ; history ; therapy ; History, 20th Century ; History, 21st Century ; Humans

OBJECTIVETo photoelastically investigate the difference in load distribution of Tension More (TM) implants with different conical angle designs.

METHODSThe following five groups of implants of different conical angles were designed: cylinder implant, upper 1/3 TM implant (taper length of 3 mm); 1/2 TM implant (taper length of 5 mm); lower 1/3 TM implant (taper length of 7 mm); and bottom TM implant (taper length of 10 mm). The implants were centrally located in individually photoelastic models consisting of a simulated trabecular bone and a 1 mm-thick layer of cortical bone. Vertical and 45° oblique static loads were applied at the center of the superstructures. The resulting stresses were monitored photoelastically and recorded photographically. RESULTS With vertical loading, the cylinder implant showed higher stress levels in the cortical bone and trabecular bone than the upper 1/3 TM implant, 1/2 TM implant, and lower 1/3 TM implant. The four groups of TM implants showed lower stress levels in the cortical bone than the cylinder implant under oblique loads. The least favorable stress concentration in cortical bone was observed in the upper 1/3 TM implant under vertical and oblique loads.

CONCLUSIONTM implants of rational conical angle designs seem to be effective in stress distribution. For all designs and load directions, the upper 1/3 TM implant is the most favorable around the crest.

Objective To investigate the relationship between microalbuminuria (MAU) and the risk factor for acute ischemic stroke,the severity of the disease and outcomes.Methods A total of 156 consecutive patients with acute ischemic stroke were enrolled prospectively.They were randomly divided into either an MAU positive group (≥ 30 mg/g) or an MAU negative group (＜ 30 mg/g) according to urinary albumin/creatinine ratio (UACR).They were also randomly divided into either a good outcome group (0-2) or a poor outcome group (＞2) according to the modified Rankin scale (mRS) scores.The various demographic and clinical data were compared,and the poor outcome of acute ischemic stroke and the independent factors of positive MAU were analyzes.Results A total of 156 patients with acute ischemic stroke were enrolled,including 84 males and 72 female; aged 53 to 78 years (mean 65.4 ± 6.2); the time from onset to admission was 1.5 to 28 h; 94 patients had good outcomes,62 had poor outcomes,and no one died; MAU was positive in 76 patients and MAU was negative in 80 ones.Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.992,95％ confidence interval [CI] 1.108-2.374; P =0.015),complicated with diabetes (OR 2.497,95％ CI 1.177-5.298; P =0.017) and atrial fibrilhtion (OR 2.338,95％ CI 1.062-5.148; P =0.035),high serum homocysteine (Hcy) level (OR 2.541,95％ CI 1.073-6.02; P =0.047) and UACR (OR 2.130,95％ CI 1.396-3.017; P =0.001),MAU positive (OR 3.291,95％ CI 1.681-6.444; P =0.001),high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 9.196,95％ CI 2.828-19.815; P＜ 0.001) were the independent risk factors for poor outcomes in patients with acute ischemic stroke.There were significant differences in the proportion of the patients complicated with diabetes (P =0.038) and fasting blood glucose level (P =0.025),serum Hey level (P =0.022),and carotid intima-media thickness (IMT) (P =0.019) between the MAU positive group and the MAU negative group.The proportion of anterior circulation infarction was lower (P =0.033),the rates of the baseline NIHSS score (P =0.003) and poor outcome were higher in the MAU positive group (P ＜ 0.001).Multivariate logistic regression analysis showed that increased diabetes (OR 2.237,95％ CI 1.036-4.829; P =0.040) and fasting blood glucose (OR 1.223,95％ CI 1.145-1.673; P =0.027),the increased Hey level (OR 2.542,95％ CI 1.047-6.612; P=0.025),carotid artery IMT (OR 1.295,95％ CI 1.106-1.362; P =0.023) and baseline NIHSS score (OR1.206,95％ CI 1.044-1.219; P =0.023) were correlated independently with the positive MAU in patients with acute ischemic stroke.Conclusions Positive MAU is one of the independent risk factors for poor outcomes of acute ischemic stroke,it is closely associated with some risk factors for acute ischemic stroke,and it has a significant impact on the severity of acute ischemic stroke and outcomes.

Objective To evaluate the clinical value of MRA on the abnormal vessels in Moyamoya and cerebral revascularization , and to evaluate PWI in the observation of cerebral hemodynamics before and after cerebral revascularization.Methods Twenty-four patients with Moyamoya disease ascertained by DSA received cerebral revascularization on one side.MRA and PWI were performed for all patients before and after the operation , while DSA was performed after operation in nine patients to compare the images of MRA and DSA by three experienced radiologists.Perfusion parameters in terminal branches of middle cerebral artery ( MCA) on the operative side were compared with those on the contralateral sides and the cerebellum , including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and delay time ( DT) , as well as relative ratio ( values on the operative side/values on the contralateral side , and values on the operative side/values on the cerebellar region ) of perfusion parameters (rCBF, rCBV, rMTT and rDT) were calculated.Comparisons of the data between different groups were performed using paired Student′s t test.Results MRA was similar to DSA in displaying the internal carotid artery , main branches stenosis, Moyamoya vessels, and cerebral revascularization.DSA was better in displaying collateral vessels than MRA, but primary images of MRA provided anatomic and pathologic information of cerebral parenchyma.After the operations , rCBF (1.30 ±0.27) and rCBV (1.26 ±0.21) of MCA perfusion regions on the operative and the contralateral sides were higher than rCBF (0.73 ±0.15) and rCBV (0.98 ±0.12) before the operation significantly (t=-7.19,-6.64,P<0.05).rMTT (1.06 ±0.20) and rDT (1.07 ± 0.18) after the operation were lower than rMTT(1.53 ±0.34)and rDT (1.40 ±0.26) before the operation (t=5.62,5.40,P<0.05) .In MCA perfusion regions on the operative and cerebellar sides , rCBF(1.93 ± 0.34)and rCBV(2.25 ±0.35)were higher than rCBF(0.88 ±0.18)and rCBV(1.16 ±0.22)(t=-3.04,-3.06,P<0.05) before the operation.rMTT (1.13 ±0.29) and rDT (1.29 ±0.12) were lower than rMTT (1.88 ±0.19 ) and rDT ( 3.29 ±0.47 ) before the operation ( t =4.01, 4.72, P <0.05 ).Conclusions MRA is a safe , reliable method to evaluate abnormal vessels and cerebral revascularization after the operation in moyamoya disease.PWI can detect poor cerebral perfusion , and can be used for assessment of the effect of cerebral revascularization.

Objective To photoelastically investigate the difference in load distribution of Tension More (TM) implants with different conical angle designs. Methods The following five groups of implants of different conical angles were designed: cylinder implant, upper 1/3 TM implant (taper length of 3 mm); 1/2 TM implant (taper length of 5 mm); lower 1/3 TM implant (taper length of 7 mm); and bottom TM implant (taper length of 10 mm). The implants were centrally located in individually photoelastic models consisting of a simulated trabecular bone and a 1 mm-thick layer of cortical bone. Vertical and 45° oblique static loads were applied at the center of the superstructures. The resulting stresses were monitored photoelastically and recorded photographically. Results With vertical loading, the cylinder implant showed higher stress levels in the cortical bone and trabecular bone than the upper 1/3 TM implant, 1/2 TM implant, and lower 1/3 TM implant. The four groups of TM implants showed lower stress levels in the cortical bone than the cylinder implant under oblique loads. The least favorable stress concentration in cortical bone was observed in the upper 1/3 TM implant under vertical and oblique loads. Conclusion TM implants of rational conical angle designs seem to be effective in stress distribution. For all designs and load directions, the upper 1/3 TM implant is the most favorable around the crest.