Objective To evaluate the collateral circulation in patients with acute ischemic stroke(AIS)by using score and grade of prominent cortical vein(PCV)-susceptibility weighted imaging(SWI),and to analyze the relationship between these two imaging features and hemorrhagic transformation(HT).Methods A total of 68 AIS patients admitted in our hospital between Janu-ary 2018 and December 2022 were enrolled in this study.All of them received multimodal brain MRI scanning to observe and analyze the collateral circulation.Then PCV-SWI assessment was performed to obtain PCV score and grade of the collateral circulation.Within 2 weeks,brain MRI scanning was carried out again to evaluate HT,and then the patients were divided into HT group(n=39)and non-HT group(n=29).The relationship between collateral circulation and HT was analyzed.Results The HT group had significantly larger proportion of PVC grade 3 than the non-HT group(P＜0.01).Among the 68 AIS patients,32 had PCV sign with a PCV-SWI score of 0-7,and 36 were identified non-PCV sign with a score of 8-10.There were 27 patients with PCV sign experiencing HT and only 12 with non-PCV sign having HT,with the PCV patients having a higher incidence of HT than the non-PCV patients(P＜0.01).The PCV patients represented a more extensive PCV,and the incidence of HT accounted for 69.23％in them and 30.77％in the non-PCV patients.Of the 68 AIS patients,61 had a diffusion weighted imaging(DWI)-Alberta Stroke Program Early CT Score(ASPECTS)of ≤7 and 7 had a score of＞7,and the incidence of HT was higher in the patients with a DWI-ASPECTS score of ≤7 than those of a score of＞7(97.44％vs 79.31％,P＜0.05).Binary logistic regression analysis showed that PCV grade and NIHSS score at 10-14 d after admission were independent risk factors for HT(OR=2.128,95％CI:1.200-3.774,P=0.010;OR=1.308,95％CI:1.057-1.620,P=0.014),and DWI-ASPECTS score was a protective factor for HT(OR=0.646,95％CI:0.442-0.945,P=0.024).Conclusion DWI-ASPECTS score,PCV grade,and NIHSS score at 10-14 d after admission are independent predictive risk factors for the occurrence of HT in AIS patients in high-altitude areas.Further clin-ical evaluation of PCV signs and infarct size on images is helpful to predict the early occurrence of HT.

Objective:To compare the effects of pressure controlled ventilation (PCV) and volume controlled ventilation (VCV) on respiratory mechanics, hemodynamics and biochemical metabolism in patients undergoing laparoscopic colorectal cancer surgery.Methods:The clinical data of 78 patients underwent laparoscopic colorectal cancer surgery from August 2019 to June 2020 in Inner Mongolia People′s Hospital were retrospectively analyzed. Among them, 39 patients were treated with PCV (PCV group), and 39 were treated with VCV (VCV group). The respiratory mechanics, hemodynamics and biochemical metabolism indexes 10 min after anesthesia induction (T 1), 10 min after pneumoperitoneum + low head and foot height (T 2), 60 min after pneumoperitoneum + low head and foot height (T 3) and 120 min after pneumoperitoneum + low head and foot height (T 4) were recorded. The respiratory mechanical indexes included mean airway pressure (P mean), airway peak pressure (P peak), pressure of end tidal carbon dioxide (P ETCO 2) and dynamic lung compliance (C Ldyn); hemodynamic indexes included mean arterial pressure (MAP) and heart rate; and biochemical metabolic indexes included base excess, serum natrium, serum potassium, negative logarithm of the hydrogen ion concentration (pH) and blood glucose. Results:The P mean, P peak and P ETCO 2 T 1 to T 4 in PCV group were significantly lower than those in VCV group, P mean: (7.12 ± 1.37) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (8.54 ± 1.84) cmH 2O, (9.80 ± 2.26) cmH 2O vs. (11.63 ± 2.87) cmH 2O, (9.51 ± 2.17) cmH 2O vs. (11.72 ± 2.90) cmH 2O, (7.04 ± 1.34) cmH 2O vs. (8.65 ± 1.88) cmH 2O; P peak: (13.41 ± 2.68) cmH 2O vs. (15.06 ± 3.05) cmH 2O, (20.92 ± 3.11) cmH 2O vs. (23.45 ± 4.02) cmH 2O, (21.14 ± 3.50) cmH 2O vs. (23.69 ± 4.26) cmH 2O, (15.03 ± 2.74) cmH 2O vs. (16.45 ± 3.21) cmH 2O; P ETCO 2: (30.59 ± 1.57) mmHg (1 mmHg = 0.133 kPa) vs. (32.04 ± 2.11) mmHg, (35.02 ± 4.15) mmHg vs. (39.88 ± 4.76) mmHg, (35.90 ± 4.22) mmHg vs. (40.11 ± 4.87) mmHg, (34.33 ± 4.17) mmHg vs. (37.65 ± 2.69) mmHg; the C Ldyn was significantly higher than that in VCV group: (40.68 ± 3.98) ml/cmH 2O vs. (35.47 ± 2.56) ml/cmH 2O, (30.25 ± 3.21) ml/cmH 2O vs. (22.40 ± 2.75) ml/cmH 2O, (29.78 ± 3.06) ml/cmH 2O vs. (22.60 ± 2.81) ml/cmH 2O, (40.32 ± 4.25) ml/cmH 2O vs. (33.61 ± 2.81) ml/cmH 2O, and there were statistical differences ( P<0.01 or <0.05). The MAP and heart rate T 1 to T 4 in PCV group were significantly lower than those in VCV group, and there was statistical difference ( P<0.01 or <0.05). The base excess, serum natrium, serum potassium and pH T 1 to T 4 in PCV group were significantly higher than those in VCV group, while the blood glucose was significantly lower than that in VCV group, and there was statistical difference ( P<0.01 or <0.05). Conclusions:Compared with VCV, PCV can promote the recovery of respiratory mechanics index, stabilize hemodynamics and improve biochemical metabolism index in patients undergoing laparoscopic colorectal cancer surgery.

Objective:To investigate the application value of superb microvascular imagingin monitoring angiogenesis in the treatment of chronic ischemic diseases of lower limbs by tibial transverse transport.Methods:From May 2019 to December 2020, 12 patients with ischemic diseases of lower limbs who received tibial transverse transport therapy were retrospectively analyzed, including 7 male patients and 5 female patients, aged 30-86 years, with an average age of 64.0±16.6 years. Among them, there were 10 patients with diabetic foot, with a disease course of 5-30 years (mean 14.4±8.3 years), and 2 patients with arteriosclerosis obliterans. The results of lower extremity superb microvascular imaging before and after treatment were recorded and compared.Results:After treatment, 12 patients were found to have obvious new vessels around the artery of lower extremity, the number of vessels 1-8, the average number of 3.25±2.73. We found that a total of 12 patients 20 inherent lower limb artery collateral established, collateral circulation was found around 12 dorsal metatarsal artery (DMA) in 11 patients, around 3 dorsal pedis artery (DPA) in 2 patients, around 3 anterior tibial artery (ATA) in 2 patients, and around 1 posterior tibial artery (PTA) in 2 patients. The lateral branches were established in ipsilateral lower limbs in 6 patients, contralateral lower limbs in 2 patients, and bilateral lower limbs in 4 patients.Conclusion:The phenomenon of angiogenesis is obvious in the clinical application of tibial transverse transport. Superb microvascular imaging can effectively reflect the degree of promoting the establishment of collateral circulation by tibial transverse transport.

Objective:To explore the quality of life and psychological factors of patients with refractory gastroesophageal reflux disease (rGERD).Methods:From September 2016 to March 2019, 159 rGERD patients visiting the Department of Gastroenterology, Beijing Tongren Hospital Affiliated to Capital Medical University were retrospectively selected. According to the presence or absence of distal esophageal mucosal injury under gastroscopy, the patients were divided into refractory reflux esophagitis (RE) group (58 cases) and refractory non-erosive reflux disease (NERD) group (101 cases). The general data, the results of 24 h esophageal impedance pH, esophageal high-resolution manometry (HRM) and the scores of gatroesophageal reflux disease-questionnaire (GerdQ), 36-item short-form health survey (SF-36), self-rating anxiety scale(SAS) and self-rating depression scale (SDS) were recorded and compared between the two groups. Independent sample t test, rank sum test, chi-square test and multiple linear regression analysis were used for statistical analysis. Results:There were no significant differences in gender, age, abdominal circumference or body mass index between the two groups (all P>0.05). The incidence of extraesophageal symptoms of refractory NERD group was higher than that of refractory RE group (45.5%, 46/101 vs. 24.1%, 14/58), and the difference was statistically significant ( χ2=7.185, P=0.010). The episodes of gas reflux, weak-acid reflux and non-acid reflux were all more than those of refractory RE group (66.20 times, 45.20 times to 111.60 times vs. 38.40 times, 23.50 times to 59.63 times; 34.70 times, 9.05 times to 52.75 times vs. 6.35 times, 3.10 times to 24.00 times; 12.60 times, 2.15 times to 24.20 times vs. 2.15 times, 0 times to 10.30 times), GerdQ score of refractory NERD group was higher than that of refractory RE group (8.9±2.5 vs. 7.8±2.3), and DeMeester score, the symptom index and symptom association probability of refractory NERD group were all lower than those of refractory RE group (5.16, 1.75 to 14.48 vs. 15.19, 2.78 to 45.96; 33.3%, 0 to 60.0% vs. 57.5%, 40.5% to 78.0%; 87.8%, 0 to 97.8% vs. 94.0%, 82.7% to 98.2%); and the differences were statistically significant ( Z=-5.548, -5.384 and -4.338, t=3.306, Z=-2.607, -4.313 and -2.468; all P<0.05). The esophageal distal contractile integral of refractory NERD group was lower than that of refractory RE group (334.0 mmHg·s·cm, 182.5 mmHg·s·cm to 492.0 mmHg·s·cm vs. 399.0 mmHg·s·cm, 216.5 mmHg·s·cm to 756.3 mmHg·s·cm, 1 mmHg=0.133 kPa), and the difference was statistically significant ( Z=-2.204, P=0.030). There were no significant differences in lower escophageal sphincter or the length of peristaltic interruption between the two groups (both P>0.05). There were no significant differences in physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health or reported health transition of SF-36 score between refractory NERD group and refractory RE group (all P>0.05). Among 159 patients with rGERD, 98 patients (61.6%) had anxiety and 55 patients (34.6%) had depression. The SAS score of refractory NERD group was higher than that of refractory RE Group (52.6±5.8 vs. 47.0±8.8), and the difference was statistically significant ( t=4.794, P<0.05), however there was no significant difference in SDS score between the two groups ( P>0.05). The results of multiple linear regression analysis showed that GerdQ score in rGERD patients was positively correlated with DeMeester score, gas reflux, weak acid reflux, SAS score and SDS score ( r=0.201, 0.228, 0.171, 0.229 and 0.276; all P<0.05). Conclusions:Among the patients with rGERD, the reflux symptoms are more severe in refractory NERD patients, which may be related to non-acid reflux, gas reflux, esophageal motor disorders, and psychological abnormalities, especially anxiety.

Objective: To explore the clinical therapeutic method and effect of the thumb-tack needle for subcutaneous embedding therapy on treating insomnia with insufficiency of heart and spleen among breast cancer patients. Methods: Totally 80 breast cancer patients with insomnia with insufficiency of heart and spleen treated in department of oncology, the Second Affiliated Hospital of Xi′an Jiao Tong University from March 2018 till November 2018 were selected and assigned into an experiment group and a control group by random number table, 40 cases in each one. The experiment group applied thumb-tack needle for subcutaneous embedding therapy, selecting Shenmen, Sanyinjiao, Zusanli, Anmian as major acupoint and Taibai as assistant acupoint. The control group used fake needles at the same places. After four-week treatment, we evaluated the therapeutic effect using the Pittsburgh Sleep Quality Index (PSQI) and observed side effects. Results: Before treatment, no significantly statistical differences were observed between the two groups on global and each dimension′s PSQI scores (P>0.05). After treatment, the PSQI scores and PSQI global score of the experiment group on sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, and daytime dysfunction were (1.58±0.53), (1.72±0.33), (1.57±0.64), (1.61±0.68), (1.05±0.42), (1.27±0.53), (8.91±2.73) points respectively, which were (1.86±0.71), (1.90±0.41), (1.85±0.47), (1.97±0.83), (1.42±0.91), (1.56±0.45), (10.86±4.53) points respectively in the control group. There was significant difference between the two groups on PSQI global scores (t=1.998-2.637, P<0.05). The number of patients in the experiment group assessed as clinical cure, obviously effective, effective and noneffective were 8, 13, 9, 10 respectively, which were 1, 5, 12, 22 in the control group respectively. The clinical efficacy showed significant difference between the two groups (χ²=27.68, P<0.01). No side effects, such as infection, needle drop-off and etc. were observed. Conclusions The thumb-tack needle for subcutaneous embedding therapy could improve sleep quality of breast cancer patients with insomnia with insufficiency of heart and spleen, and it′s easy to operate, safe with little side effects.

Objective To analyze the relationship between body type,age,gender,esophageal motility function,lower esophageal sphincter pressure (LESP) and clinical classification and type of reflux contents of patients with gastroesophageal reflux disease (GERD).Methods From September 2015 to July 2016,at Beijing Tongren Hospital of China Capital Medical University,the results of 24-hour esophageal impedance-pH monitoring of 141 patients with GERD were retrospectively analyzed.The differences of reflux contents were compared in patients with GERD among different body type,age,gender,esophageal motility function,LESP and clinical classification.Mann-Whitney test was performed for comparison between groups.Results Acid reflux was more common in obese patients (body mass index more than 23.9 kg/m2) compared with patients with normal body type (body mass index from 18.5 to 23.9 kg/m2) (18.5,7.0 to 45.3 vs.10.0,2.0 to 32.0),and the difference was statistically significant (Z =-2.320,P =0.020).Patients under 65 years old had more numbers of weak acid reflux,non-acid reflux and gas reflux than patients over 65 years old (58.5,32.8 to95.0 vs.40.0,24.0to71.0;19.5,6.0to47.5 vs.8.0,3.0 to19.0;46.0,23.8to79.3 vs.35.0,11.0 to 56.0),and the differences were statistically significant (Z =-2.690,-3.286 and-2.091,all P＜0.05).Male patients had more gas and mixed reflux compared with female patients (53.5,24.0 to 122.8 vs.36.0,19.0 to 67.0;34.0,20.8 to 50.0 vs.27.0,14.0 to 43.0),and the differences were statistically significant (Z =-2.424 and-1.961,both P ＜ 0.05).There was no statistically significant difference in reflux contents between patients with normal esophageal motility and patients with esophageal motility disorder (weak or interrupted peristalsis) (all P ＞ 0.05).Patients with reflux esophagitis(RE) and/or Barrett's esophagus (BE) had more weak acid reflux,non-acid reflux and gas reflux compared with patients with non-erosive reflux disease (NERD) (61.0,31.3 to 102.5 vs.44.0,24.5 to 66.5;18.0,8.0 to 36.5 vs.8.0,2.0 to 22.0;49.5,27.5 to 86.5 vs.26.0,11.0 to 47.0),and the differences were statistically significant (Z =-2.585,-2.942 and-3.278,all P ＜ 0.05).Patients with lower esophageal sphincter (LES) relaxation were more likely to have weak acid reflux than patients with normal LES function (57.0,32.3 to 87.0 vs.40.0,21.0 to 73.0),the difference was statistically significant (Z =-2.065,P =0.039).Conclusion Body type,age,gender,LESP and clinical classification are related to type of reflux contents in GERD patients,while esophageal peristalsis is irrelevant.

Objective To investigate the correlation between esophageal motility abnormalities and the characteristics of gastroesophageal reflux in patients with different subtypes of refractory gastroesophageal reflux disease (rGERD).Methods From September 2015 to May 2016,a total of 100 rGERD patients were collected,all of whom received gastroendoscopy examination,high resolution manometry (HRM) and 24 h impedance-pH monitoring.According to the results of gastroendoscopy examination,the patients were divided into refractory non-erosive reflux disease (NERD) group and refractory reflux esophagitis (RE) group.Abnormal esophageal motility and pathological gastroesophageal reflux of each group were analyzed.Chi-square test,t test and sum-rank test were performed for comparison,the correlation factors were analyzed by multivariate unconditional Logistic regression.Results Among the 100 patients with rGERD,there were 83 cases in refractory NERD group and 17 in refractory RE group.The episodes of weak acid and gas-liquid mixed reflux of refractory NERD group were both significantly higher than those of refractory RE group (80.2±56.9 vs 44.8± 13.7,56.0± 25.6 vs 25.2±16.1);and the differences were statistically significant (t=3.202 and 2.229,both P＜ 0.05).The DeMeester score,acid reflux episodes and the percentage of reflux time of refractory NERD group were all significantly lower than those of refractory RE group (24.2±8.5 vs 56.8±3.0,21.4± 11.8 vs 35.9 ± 32.6,(7.1 ± 1.6) ％ vs (16.2 ± 8.8) ％),and the differences were statistically significant (t=-2.820,-2.230 and-2.604;all P＜0.05).However,the average resting pressure of lower esophageal sphincter was higher than that of refractory RE group ((7.9±5.6) mmHg (1 mmHg=0.133 kPa) vs (4.5±2.2) mmHg),and the difference was statistically significant (t=2.443,P＜0.05).Patients with esophageal motility disorders of refractory NERD group and refractory RE group were 58 cases (69.9 ％) and 12 cases (12/17),respectively,and the difference was not significant (P＞0.05).Compared with refractory RE group,the ratio of intermittent contraction was higher (1/17 vs 26.5％,22/83) and the peristaltic contraction disorder was lower in refractory NERD group (11/17 vs 43.4％,36/83);and the differences were statistically significant (x2 =3.389 and 2.587,both P ＜ 0.05).The results of multivariate non-conditional Logistic regression analysis showed that intermittent contraction and gas reflux were risk factors of the incidence of pathological weak acid reflux (odd ratio (OR) =3.139 and 1.254,both P＜0.05),while body mass index and gas-liquid mixed reflux were the risk factors of the occurrence of pathological acid reflux (OR =1.302 and 1.026,both P＜ 0.05),whereas the distal contractile integral was a protective factor (OR=0.998,P＜0.05).Conclusion Esophageal dysmotility is common in patients with rGERD,and the dysmotility disorders are different in patients with different subtypes,which may be related to the different reflux characteristics.

Objective To observe the clinical effect of aspirin on venous thrombosis in breast cancer patients after peripherally inserted central venous catheter ( PICC ) .Methods Two hundred fifty-sixty breast cancer patients with PICC were divided into the observation group and the control group according the random number table, each with 128 cases. The two groups all received the conventional PICC catheter and maintenance, the observation group received the oral administer of aspirin 100 mg for 28 day, once a day, and the control group did not take any anticoagulation drugs .The venous thrombosis was checked by the clinical observation and color Doppler flow imaging in two groups , and the adverse reactions were also observed in patients.Results The incidence rate of venous thrombosis was 3.1%in the observation group , and was lower than 9.4%in the control group, and the difference was statistically significant (χ2 =3.919, P<0.05).The adverse reactions including obvious allergy , thrombocytopenia and bleeding tendency were not found in the observation group .Conclusions Oral aspirin enteric-coated tablets can effectively prevent venous thrombosis in breast cancer patients after PICC .