Objective:To analyze the optimal dose of urokinase (UK) for intravenous thrombolysis in Chinese patients with acute ischemic stroke within 4.5 hours of onset.Methods:Based on the intravenous thrombolysis registry for Chinese ischemic stroke within 4.5 hours of onset (INTRECIS) cohort, consecutive patients who received intravenous UK from April 1, 2017 to July 1,2019 were retrospectively collected . According to the tertile dose of UK per body weight, eligible patients were divided into low dose group [(1.00-1.67)×10 4 international unit per kilogram], moderate dose group [(1.68-2.33)×10 4 international unit per kilogram] and high dose group (2.34-3.00)×10 4 international unit per kilogram]. Furthermore, subgroups were analyzed according to age, gender, and baseline National Institutes of Health Stroke Scale (NIHSS) scores. The primary efficacy outcome was excellent functional outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0-1. The secondary efficacy outcomes included favorable functional outcome (mRS score of 0-2 at 90 days), mRS score distribution at 90 days and changes in NIHSS score at 1 day and 14 days, compared with the baseline. The primary safety outcome was symptomatic intracranial hemorrhage (sICH), and the secondary safety outcomes included recurrence of stroke within 90 days, all-cause mortality and any random bleeding events. Results:A total of 1 144 patients were included in the analysis: 549 in the low dose group, 509 in the moderate dose group and 86 in the high dose group. The proportion of excellent functional outcome was higher in the high dose group, compared with the low dose group [79.07% (68/86) vs 67.03% (368/549), OR=2.427, 95% CI 1.280-4.587, P=0.007] and the moderate dose group [79.07%(68/86) vs 70.53%(359/509), OR=1.942, 95% CI 1.023-3.690, P=0.043]. The incidence of sICH was similar among the 3 groups [high dose group vs low dose group: 1.16% (1/86) vs 2.00% (11/549), OR=0.607, 95% CI 0.071-5.153, P=0.648; high dose group vs moderate dose group: 1.16%(1/86) vs 0.79% (4/509), OR=0.330, 95% CI 0.101-1.074, P=0.596]. The subgroup analysis showed that higher proportion of excellent functional outcome was found in the high dose group patients with senior citizens (≥60 years old) [high dose group vs low dose group: 80.70% (46/57) vs 63.07% (222/352), OR=3.401, 95% CI 1.500-7.752, P=0.003; high dose group vs moderate dose group: 80.70% (46/57) vs 69.63% (227/326), OR=2.381, 95% CI 1.074-5.291, P=0.033], moderate neurologic deficit (NIHSS score 4-16) [high dose group vs low dose group:79.07% (34/43) vs 62.61% (211/337), OR=2.604, 95% CI 1.190-5.682, P=0.017; high dose group vs moderate dose group:79.07% (34/43) vs 65.02% (184/283), OR=2.315, 95% CI 1.055-5.097, P=0.036], and large artery atherosclerosis [high dose group vs low dose group: 81.40% (35/43) vs 62.32% (177/284), OR=3.584, 95% CI 1.416-9.009, P=0.007; high dose group vs moderate dose group: 81.40% (35/43) vs 66.06% (144/218), OR=2.793, 95% CI 1.090-7.143, P=0.032]. Conclusions:Intravenous UK dose calculated according to body weight may be reasonable for treating acute ischemic stroke. Intravenous UK with dose of (2.34-3.00)×10 4 international unit per kilogram may favor better benefit for acute ischemic stroke, which warrants further confirmation.

Objective:To compare the effectiveness of awake prone positioning (APP) care combined with standardized nursing and standardized nursing care in the prevention of early postoperative pulmonary complications (PPCs) in elderly patients with hip fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 84 elderly patients with hip fracture Admitted to Zhongda Hospital Affiliated to Southeast University from February 2021 to August 2021. There were 31 males and 53 females, aged 67-96 years [(82.3±6.3)years]. Fracture types were femoral neck fracture ( n=45) and intertrochanteric fracture ( n=39). Surgical procedures included closed reduction internal fixation ( n=39), hip hemiarthroplasty ( n=35), and total hip arthroplasty ( n=10). Among them, 42 patients received standardized nursing care and APP intervention (APP combined with standardized nursing care group), while the remaining 42 patients received standardized nursing care only (standardized nursing care group). The incidence rate of PPCs (including pneumonia, respiratory failure, pleural effusion, atelectasis and pulmonary edema) within 30 postoperative days, arterial oxygen pressure (PaO 2), arterial carbon dioxide pressure (PaCO 2), arterial oxygen saturation (SaO 2) on the 4th postoperative day, difference in PaO 2 between the 4th postoperative day and emergency visit, clinical pulmonary infection score (CPIS) on the 4th postoperative day, and number of adverse events related to APP were compared between the two groups. Results:All the patients were followed up for 30-90 days [(86.1±16.5)days]. The incidence rates of PPCs and type 1 postoperative respiratory failure in the APP combined with standardized nursing care group were 16.7% (7/42) and 4.8% (2/42), and were 35.7% (15/42) and 21.4% (9/42) in the standardized nursing care group (all P<0.05). The PaO 2 and SaO 2 on the 4th postoperative day, and difference in PaO 2 between the 4th postoperative day and emergency visit were (82.0±8.8)mmHg, 0.96±0.01, and 3.2 (-1.9, 8.0)mmHg in the APP combined with standardized nursing care group, and were (74.3±12.1)mmHg, 0.94±0.03, and -7.6 (-17.2, 1.1)mmHg in the standardized nursing care group (all P<0.01). The CPIS on the 4th postoperative day was 2.0 (1.0, 3.0)points in the APP combined with standardized nursing care group and 4.0 (1.0, 7.0)points in the standardized nursing care group ( P<0.05). No statistically significant differences were observed in the incidence of pneumonia, type I respiratory failure, pleural effusion, atelectasis and pulmonary edema within 30 postoperative days, as well as PaCO 2 on the 4th postoperative day between the two groups (all P>0.05). None of the patients experienced adverse events related to APP. Conclusion:For elderly patients with hip fracture, compared with standardized nursing care, application of APP combined with standardized nursing care can significantly decrease the incidence rate of early PPCs, especially type I respiratory failure, and improve postoperative oxygenation.

Objective:To explore the clinical value of cluster management in secondary hydrocephalus.Methods:Seventy-seven patients with secondary hydrocephalus admitted to Department of Neurosurgery, Shenzhen Second People's Hospital from January 2016 to June 2021 were chosen; they were divided into traditional management group ( n=30) and cluster management group ( n=47) according to different management methods. Patients in traditional management group accepted craniocerebral CT and 3 consecutive times of cerebrospinal fluid tests, and normal results were achieved and then ventriculoperitoneal shunt (VPS) was performed. In patients from the cluster management group, on the basis of management treatment, cranial plain and enhanced MRI and DNA metagenomic next generation sequencing of cerebrospinal fluid were performed before surgery, and rapid test of cerebrospinal fluid and ventriculoscope observation were performed during surgery; after exclusion of intracranial infection, VPS was performed. The differences of shunt failure rate were compared between the two groups and the positive rates of intracranial infection detected by above 4 methods were compared in the cluster management group. Results:There was significant difference in shunt failure rate between the cluster management group and traditional management group (2.1% vs. 20.0%, P<0.05). The positive rates of intracranial infection by DNA metagenomics (61.7%) and ventriculoscopy (68.1%) were significantly higher than those by preoperative cranial plain and enhanced MRI (14.9%) and rapid test of cerebrospinal fluid (6.4%, P<0.05). Conclusion:Cluster management can effectively decrease the VPS failure rate in secondary hydrocephalus; DNA metagenomics and ventriculoscopy have high efficiency in detecting intracranial infection.

Objective:To analyze the risk factors for postoperative one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment (MDT) by intramedullary nailing.Methods:The clinical data were retrospectively analyzed of the 158 elderly patients with femoral intertrochanteric fracture who had undergone MDT by proximal femoral intramedullary nailing between January 2018 and August 2020 at Department of Orthopedics, Trauma Center, Zhongda Hospital Affiliated to Southeast University. There were 41 males and 117 females with an average age of 82.5 years (from 65 to 95 years). By the modified Evans classification, there were 15 cases of type Ⅰ, 16 cases of type Ⅱ, 35 cases of type Ⅲ, 81 cases of type Ⅳ, and 11 cases of type Ⅴ. The one-year mortality was documented in the patients after surgery. To screen for risk factors, univariate analysis was conducted of gender, age, body mass index (BMI), modified Evans classification of fractures, time from injury to operation, American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI) and comorbidities, as well as preoperative hemoglobin (Hb), serum albumin (ALB) and total lymphocyte count (TLC). The factors with P<0.05 were included in the multivariate logistic regression model analysis to determine the risk factors. Results:A total of 13 patients died within one year after surgery, yielding a mortality of 8.2% (13/158). Univariate analysis showed significant differences in age, body mass index, modified Evans classification of fractures, CCI and Hb between the surviving and dead patients ( P<0.05). Multivariate logistic regression analysis showed that age >85 years ( OR=0.122, 95% CI: 0.018 to 0.834, P=0.032), BMI>23.9 kg/m 2 ( OR=0.083, 95% CI: 0.013 to 0.510, P=0.007), CCI≥3 points ( OR=0.051, 95% CI: 0.090 to 0.275, P=0.001) and preoperative Hb<90 g/L ( OR=4.733, 95% CI: 1.036 to 21.624, P=0.045) were the independent risk factors for postoperative one-year mortality in the elderly patients with intertrochanteric fracture following MDT by proximal femoral intramedullary nailing. Conclusions:After MDT by proximal femoral intramedullary nailing of femoral intertrochanteric fractures, the geriatric patients with an age >85 years, BMI>23.9 kg/m 2, CCI≥3 points and Hb<90 g/L are likely to die. Therefore, special care should be taken for them.

Objective To investigate the risk factors for post-traumatic hydrocephalus ( PTH) after traumatic brain injury ( TBI ) . Methods A retrospective case control analysis was made on the clinical data of 794 patients with acute TBI admitted to Shenzhen Second People's Hospital between January 2007 and January 2017. There were 639 males and 155 females, aged 1-90 years [(40. 5 ± 18. 6)years]. All patients were followed up for 1 years, and the patients were divided into PTH group (n=46) and non-PTH group (n=748) according to their prognosis. The following information including Glasgow coma score ( GCS ) on admission, pupil reflex, midline shift and cistern compression, subarachnoid hemorrhage ( SAH ) , operation method, decompressive craniectomy, hydrocephalus after operation, intracranial infection, timing of cranioplasty were analyzed using univariate analysis and Logistic regression. Results PTH occurred in 46 patients (5. 8％). Univariate analysis showed that GCS, midline shift, decompressive craniectomy, subdural effusion, timing of cranioplasty and SAH were significantly related to PTH (P<0. 05 or 0. 01). Logistic regression identified low GCS (OR=3. 778), decompressive craniectomy (OR=2. 508), subdural effusion (OR=2. 269), timing of cranioplasty (≥3 months)(OR=10. 478) and SAH (OR=23. 391) as the independent risk factors for PTH (P<0. 05 or 0. 01). Conclusion PTH is a common serious complication of traumatic brain injury, affected by low GCS, decompressive craniectomy, subdural effusion, delayed cranioplasty and SAH.

Objective To investigate the value of blood oxygenation level dependent(BOLD)fMRI in assessing the functional changes of the lumbar dorsal extensor muscles before and after exercise in healthy young people.Methods The changes of the R2*value of lumbar dorsal extensor group in 30 healthy young volunteers(15 males and 15 females)before and after exercise was prospectively studied.BOLD-fMRI scans were performed on healthy young volunteers before and after exercise, the exercise mode was to perform the upper body flexion and extension movement with a simple Rome stool.The scanned images were processed and analyzed, the cross-sectional area and R2* value of the lumbar dorsal extensor muscles (including the multifidus,the longissimus and the iliocostalis)were measured at the upper margin of the L3 and L4 vertebral body before and after exercise.The paired t test was used to compare CSA and R2*values of muscles before and after loading. The CSA and R2* value of different muscles in different sides were compared by independent sample t test. Pearson correlation analysis was used to analyze the relevance between CSA and R2* in muscle before and after exercise. Results After exercise, the R2* values of multifidus,longissimus and iliocostalis at the upper margin of the L4 vertebral body were[(39.2±8.6),(38.9± 7.7),(41.6±7.8)]Hz,significantly lower than before exercise[(46.1±6.9),(45.3±6.2),(46.0±6.7)]Hz(P<0.01);the changes of R2*values of the muscles between the left and right sides before and after the movements were not statistically significant(P>0.05).The R2*values of longissimus and iliocostalis at the upper margin of the L3 vertebral body were[(44.2±9.1),(46.6±9.3)]Hz,significantly lower than before exercise[(48.6±7.2),(49.7± 6.8)]Hz (P<0.01), but the R2* values of multifidus after loading was (43.9 ± 9.0)Hz, there was no statistical difference compared with before exercise (46.8 ± 6.6)Hz (P>0.05);there was a significant difference in the changes of R2*value before and after the movement between the left and right side of iliocostalis(P<0.05).A significant negative correlation between CSA and R2*value was found in the iliocostalis on the right side at the upper margin of L3 vertebral body and in the multifidus on the left side at the upper margin of L4 vertebral body,and the correlation coefficients were (-0.697,-0.616).Conclusion BOLD-fMRI can be a new way to assess the functional changes of the lumbar dorsal extensor group before and after exercise.

Objective To investigate the ex pr ession of nm23-H1 protein and proliferating cell nuclear antigen (PCNA) in huma n glioma cells. Methods Expression of nm23-H1 and PCNA in 53 br ain gliomas were detected by immunohistochemistry. Results The immunohistochemistry staini ng of nm23-H1 protein in low-grade astrocytomas (grades Ⅰ and Ⅱ) was significantly higher than that in high-grade astrocytomas (grades Ⅲ and Ⅳ). The immunohistochemistry staining of PCNA in high-grade astrocytomas was s ignificantly higher than that in low-grade astrocytomas. Conclusion The lower expression of nm23-H1 protein and the higher expression of PCNA are correlated with the pathological grade of glioma cells. The expression of nm23-H1 may be used as a hopeful marker for predicting the metastastic potential of gliomas.